A series of 1,630 patients with gastric cancer was reviewed with special reference to their ages. The overall resectability rate was 84.6%. With increasing age, there was also an increase in: the male-to-female ratio, the frequency of tumors located in the distal third of the stomach, and the degree of differentiation of the carcinoma (p less than 0.01). There was no age-related association to: tumor size, early gastric cancer of 30-40%, macroscopic classification, histological staging, or symptomatology. The 5-year survival rates did not differ significantly among the various age groups. From 1980 to 1984, clinical characteristics were evaluated in 58 patients under 40 years of age and in 39 patients 80 years of age and older. Preexisting medical illnesses and postoperative complications were more frequent in the aged group; however, there were no operative deaths in either group. In conclusion, although there are several distinct properties depending on the age of the patients, very elderly as well as young patients can be successfully treated.

Adenomyoepithelioma is thought to be a low-grade malignancy, and cases showing malignant behavior are rare. A massive breast tumor with skin invasion in a 60-year-old woman was diagnosed as malignant adenomyoepithelioma. Despite the tumor size and skin invasion, noaxillary lymph node metastases were detected. Light microscopy showed proliferation of tubular structures composed of atypical epithelial and myoepithelial cells and occasional anaplastic cells with mitotic figures extending to the epidermis of the skin. Twenty-four months after the surgery the patient complained of dull pain in the right thigh, and was found to have bone, lung and mediastinal lymph node metastases. There was neither local recurrence nor axillary lymph node metastasis. Subsequent femur fracture was treated by osteotomy. Despite additional chemoradiotherapy, the patient died 43 months after the first operation. Our case and literature review indicated that this tumor tends to show hematogenous metastasis.

Five hundred ninety-two patients with early gastric cancer underwent surgical resection from 1970 to 1986 in our hospital, and 13 died from a recurrence of their disease. A careful analysis of these 13 patients suggests that carcinomas which invaded to the submucosa tend to recur more often than those confined to the mucosa. Well differentiated and papillary adenocarcinomas characterized by protruded or elevated lesions tend to recur earlier than poorly differentiated or signet-ring cell carcinomas characterized by depressed or excavated lesions. However, both types recurred from hematogenous metastases, with the liver being the most common site. Therefore, the macroscopic and histological features presently used to characterize early gastric cancer do not provide sufficient information to accurately predict which patients are at most risk for recurrence.