Clinicopathologic features and prognostic significance of duodenal invasion were studied in a retrospective study on 593 patients who underwent gastrectomy for adenocarcinoma in the antrum. The patients were grouped into three, according to the histologic extent of duodenal invasion: Group A (80 patients), obvious invasion beyond the pyloric ring; Group B (61 patients), invasion up to the pyloric ring; and Group C (452 patients), no evidence of duodenal invasion. Five-year survival rates in Groups A, B, and C were 7.9'10, 31.6%, and 57.6'10, respectively (P < 0.001). Cox's regression analysis showed that duodenal invasion is an independent prognostic factor in cases of a gastric antrum carcinoma. Gastric cancer with duodenal invasion (Groups A and B) most often was infiltrative and the incidence of serosal invasion, lymphatic and vascular invasion, and lymph node metastasis was high. Duodenal invasion was direct through submucosal or subserosal layers or through submucosal lymphatics. Cancer 68:380-384,1991. HE INCIDENCE of carcinoma in the gastric antrumT invading the duodenum ranges from 9% to 69%.'-4Koehler et a/.' noticed that duodenal invasion was detectable radiographically in 5% of all patients with a gastric carcinoma, but that histologically the incidence was 18%. Zinninger and Collins' reported that even in macroscopically well-localized gastric lesions, microscopic extension into the duodenum occurred as far as 35 mm from the apparent edge of the tumor. Thus, duodenal invasion by gastric cancer seems to be more frequent than expected, based on gross appearance of the tumor. The prognosis of patients with a gastric carcinoma invading the duodenum has only infrequently been documented. We describe here the relationship between the extent of duodenal invasion by tumor and the prognosis in 593 patients with adenocarcinoma in the gastric antrum. We also examine From the Department of Surgery 11. Faculty of Medicine, KyushuThe authors thank M. Ohara for helpful comments.

Cell nuclear DNA content was microspectrophotometrically measured in 60 cases of early and six of advanced gastric carcinoma. DNA distribution pattern was classified into Types I, II and III, according to the degree of dispersion on the DNA histogram. Five of 6 cases of the advanced carcinomas were Type III. In early carcinoma, the majority of Super (superfically spreading) type were Type II, while all of Pen A (expansively penetrating growth) type were Type III. In Pen B (infiltratively penetrating growth)type, six of ten cases were Type II and the other four were Type III. Thus, there was a distinct difference in the DNA pattern between Super and Pen Types, i.e., the DNA analysis reflected these growth types. Since about 20% of those with small mucosal carcinomas, not classifiable into the Super or the Pen types presented Type III, the cytophotometric DNA analysis should be useful in the detection of Pen A like carcinoma, in its early stage. The development from early stage. The development from early to advanced carcinoma was discussed in terms of the similarity of the DNA histogram patterns.

The pathological changes of regional lymph nodes in cases of gastric carcinomas with lymphoid stroma (LS group) and the prognostic significance of the findings were studied in comparison with those in cases of ordinary stroma (OS group). The purpose of this study was to elucidate the immune responses of regional lymph nodes, histologically, in patients with gastric carcinoma and lymphoid stroma. In the LS group, the incidence of paracortical hyperplasia (PH) was high, irrespective of lymph node metastasis, while that of germinal center hyperplasia (GH) was high in the absence of lymph node metastasis but tended to be low in the presence of metastasis. In the OS group, the incidences of PH and GH were low, particularly in the presence of lymph node metastasis. The five year survival rate in those with no lymph node metastasis was as favorable as that of patients with lymph node metastasis in the LS group, the latter being significantly higher than the rate in the OS group. These results indicate that gastric carcinomas with lymphoid stroma are closely related to reactive hyperplasias of the regional lymph nodes, particularly paracortical hyperplasia, and in such cases, there is a favorable prognosis, regardless of the lymph node metastasis.

Two hundred and sixty-seven cases of gastric carcinoma detected by mass survey included 196 discovered at the first examination (Group A) and 71 noted at the annual sequential examination (Group B) were analyzed in terms of growth pattern and prognosis. The incidence of early carcinoma was 54.9 per cent in Group B higher than 35.7 per cent in Group A. In early carcinoma, the superficially spreading (SUPER) type of carcinoma was more common in Group A than in Group B. On the contrary, the penetrating growth (PEN) type of carcinoma was more frequently found in Group B than in Group A. About eighty per cent of those with an advanced carcinoma, in both groups, was the advanced PEN type. The outcome of the patients in Group B was more favorable. These results support the hypothesis that the majority of advanced carcinoma is derived from the PEN type of early carcinoma. Early detection of the PEN type of carcinoma is mandatory.

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