Surface carcinoma of the stomach

Abstract

EDITORIAL SYNOPSIS Surface carcinomata confined to the mucosa have been found in 10% of stomachs operated on for apparently benign conditions. A multifocal origin is not uncommon. The prognosis is good. In this series the diagnosis was established by pathological studies on resected specimens but an increased awareness of this possibility may alert clinicians to make the diagnosis before operation.The majority of patients who present with a gastric carcinoma have a large growth which can be diagnosed with comparative ease, both by clinical procedures and by naked-eye inspection of the excised stomach. There is, however, a group of cases in which the growth is confined to the mucosa and, in the absence of an obvious tumour, the diagnosis can only be made by microscopic examination. The lesions have been studied by several authors (Ewing, 1936;Gutmann, Bertrand, and Peristiany, 1939;Mallory, 1940;Stout, 1942;Bamforth, 1955;Friesen, Dockerty, and ReMine, 1962) who have applied a variety of names but the most satisfactory term is probably 'superficial' or 'surface' carcinoma. Their particular importance lies both in the good prognosis and also in the information they provide on the pathogenesis of gastric cancer. The following series of cases is presented to show the incidence and pathological features of the condition. MATERIALS AND METHODSA total of 158 stomachs surgically removed by partial gastrectomy for apparently benign conditions were obtained fresh, opened along the greater curvature and pinned out flat on a cork board. Cytological studies were undertaken on the unfixed mucosa by scraping it in various areas with a toothbrush and spreading the material obtained onto a slide. Care was always taken to obtain a smear from the vicinity of any ulcer. The smears were fixed while still wet in Schaudinn's solution and stained with haemalum and eosin. The stomachs were then fixed on the cork board for 24 hours in formol saline. The entire lesser curvature was then sectioned using the 'swiss roll' technique of Magnus (1937), and stained with haematoxylin and eosin. Sections were also taken from any ulcers situated away from the lesser 'Present address: Department of Pathology, St. James's Hospital, Leeds. curve and from representative areas of the pyloric and body mucosa. Eight surface carcinomas were discovered by this means. When one of these lesions was found, it was mapped out and its size determined by taking further sections in a plane at right angles to the lesser curve as shown in Fig. 1, which illustrates the findings in case 1. A search was also made along the greater and lesser curvatures in all specimens for lymph nodes and sections taken of all those found.An additional four stomachs with surface carcinomas became available later and were examined in a similar way. Finally, a search through earlier gastrectomy specimens revealed three more stomachs in which surface carcinomas were present but these were not available for further sectioning.

Early Gastric Carcinoma

“…Temporary healing of early gastric carcinomas is well documented (Sakita et alii, I971 ;Morrissey, 1972). Early carcinomas are often multifocal (Mason, 1965), but this feature was not demonstrated in any patient in our series. I n one patient (Case 4) the tumour could be seen involving only part of the thickness of the mucosa, and the affected zone centred on the neck region of the gastric pits.…”

Clonal analysis of superficial depressed-type gastric carcinoma in humans

“…Gastric carcinoma is characterized by various growth patterns. In particular, a superficially spreading intramucosal growth1‐3 is peculiar to gastric carcinoma and is scarcely seen in colorectal carcinoma. This type of growth can be regarded as an extreme of superficial‐type growth that corresponds in large part to what has been referred to as early stage gastric carcinoma.…”