In order to elucidate the relationship between stomach cancer and gastritis the histopathologic changes of the mucosa of stomach cancer were studied with special reference to cellular infiltration, intestinal metaplasia, mitotic rate of gastric mucosa, thickness of mucosal and glandular layer and the ratio of glandular layer to mucosal layer. The tissue specimens from 16 cases of gastric cancer (3 cases of them being early gastric cancer), 3 cases of gastric ulcer, 4 cases of gastritis and one case of normal subject, to the total of 24 cases were selected for the present study. The stomachs surgically removed were opened along the greater curvature for macroscopic observations and fixed in 10% formol solution. A number of specimens from 11 to 33 with average of 22 were prepared to cover the entire area of the resected stomach. The specimens were stained with the hematoxylin-eosin solution. Practically, the entire area of stomach was divided into 6 areas, namely, anterior, posterior wall and lesser curvature of fundus and pyloric area. The vicinity of the lesion was added to above 6 areas in case of gastric cancer and ulcer. The specimeus were taken from the areas as evenly as possible. According to the extent of cellular infiltration and intestinal metaplasia the changes were classified into 0 Point 3 Points. The mitotic rate was determined by Teir's method. The measurements were carried out with the mitotic areas of the glandular tubules cut continuously from gastric pit to base of the gland and arranged perpendicular to muscularis mucosae. The rate was measured in the areas of gastric, pyloric and intestinal type gland in separate. The mitotic rate was expressed by the percentage of mitotic cells to the total cell count. As for the thickness of the mucosal and the glandular layers, serial sections were cut from gastric pit to base of the gland. The measurements were made with the gastric and the pyloric gland arranged perpendicular to muscularis mucosae. The thickness between the surface of muscularis mucosae and the mucosal surface was taken as the thickness of the mucosal layer, and that of lamina propria excepting the gastric pit was taken as the thickness of the glandular layer. The ratio of the glandular layer to the mucosal layer was calculated by measuring the thickness from corresponding glandular layer to mucosal layer. The results of the measurment were as follows. 1. The cellular infiltration in gastric cancer was more intense than other stomach diseases. The entire resected specimens of the stomach cancer were given about 2 Points of the cellular infiltration in average. The specimens of stomach cancer having carcinoma focus in the area of the gastric gland revealed more intense cellular infiltration than the ones having the foci in the area of pyloric gland. Furthermore, the change was related to the stage of the disease, namely more intense cell infiltration was observed in the advanced cases of gastric canccr. 2. The incidence and the extent of intestinal metaplasia of gastric mucosa were highest in gastric cancer, notably in the area of pyloric gland. The intestinal metaplasia was not related to the depth of the gastric wall involved by carcinoma and the site of carcinoma foci. 3. The mitotic rate of both gastric gland and pyloric gland was proved to be equal between gastric cancer and other stomach diseases. However, in the resected specimens of stomach carcinoma the rate was higher in the area of pyloric gland than the area of gastric gland and it was least in the vicinity of the lesion. 4. The mitotic rate of intestinal type gland showed no difference between gastric cancer and other stomach diseases. In the resected specimens of stomach carcinoma having the carcinoma foci in the area of gastric gland showed a higher mitotic rate than those having the lesion in the area of pyloric gland.
The present study was conducted with the purpose to clarify endoscopic findings of early stomach cancer and the relationship between endoscopic findings and the histopathological findings with special reference to the depth of the gastric wall involved by carcinoma. Out of the 1, 492 cases who were examined by endoscopy 65 cases were diagnosed as gastric cancer, one case was gastric ulcer and another one case was gastric polyposis. The total of 67 cases were send to the surgery clinic for gastrectomy. With the resected stomach specimens of these cases macroscopic as well as histopathologic observations were carried out. As a control study, similar observations were made with the tissue specimens obtained from gastric polyp and polypoid carcinoma. Those cases diagnosed as stomach cancer with simply radiological examination were excluded in the present study. For the endoscopic examinations, gastrocameras of type III, IV and V were employed, and the gastrocamera findings were studied. For histopathologic observations sections of 5mm in width were prepared with the area involved by carcinoma and these tissue sections were stained with the hematoxylin-eosin solution. Early stomach cancer was defined as the cases involved only the mucosa and the submucosa with carcinomatous tissue. Those cases involved the muscle layer were excluded from the designation. According to the classification established by the Japan Endoscopic Society, these samples were classified into three types, I, II and III. The Type II was further subdivided into three types, IIa, IIb and IIc (Fig. 1). The results of these examinations were as follows. 1. Of the 67 cases examined, 51 cases were stomach cancer by histopathologic examination. Among them 14 cases were proved to be the cases of early stomach cancer. The incidence of early stomach cancer was 27.4% in those cases performed gastrectomy. As for type of early stomach cancer, a predominant incidence was observed in Type IIc, which amounted to one half of the total cases. 2. The principal endoscopic findings of Type I were unevenness of the surface of the elevated mucosa, hyperemia and discoloration of the mucosa. 3. As for Type IIc, irregularity of margin of the depressed mucosa, bleeding cr hyperemia of the edge, irregular shaped coat or adherent mucus were main endoscopic findings. 4. In Type III, converging folds, discoloration, unevenness and irregularity of the floor of the depressed mucosa were observed by endoscopy, however, none of these findings were thought to be pathognomonic for early stomach cancer. 5. As for the endoscopic findings that enable to decide the depth of the gastric wall involved by carcinoma, cessation of the fold, stiffness of the angle, unevenness and irregularity of the edge may be pointed out. The cessation of the fold paralleled with the depth of the gastric wall involved by carcinoma. The findings of unevenness and irregularity of the edge were also in accordance with the depth of the gastric wall involved by carcinoma, though the relation was not observed in Type III.
In order to elucidate the relationship between stomach cancer and gastritis the histopathologic changes of the mucosa of stomach cancer were studied with special reference to cellular infiltration, intestinal metaplasia, mitotic rate of gastric mucosa, thickness of mucosal and glandular layer and the ratio of glandular layer to mucosal layer.
The tissue specimens from 16 cases of gastric cancer (3 cases of them being early gastric cancer), 3 cases of gastric ulcer, 4 cases of gastritis and one case of normal subject, to the total of 24 cases were selected for the present study.
The stomachs surgically removed were opened along the greater curvature for macroscopic observations and fixed in 10% formol solution. A number of specimens from 11 to 33 with average of 22 were prepared to cover the entire area of the resected stomach. The specimens were stained with the hematoxylin-eosin solution. Practically, the entire area of stomach was divided into 6 areas, namely, anterior, posterior wall and lesser curvature of fundus and pyloric area. The vicinity of the lesion was added to above 6 areas in case of gastric cancer and ulcer. The specimeus were taken from the areas as evenly as possible.
According to the extent of cellular infiltration and intestinal metaplasia the changes were classified into 0 Point 3 Points. The mitotic rate was determined by Teir's method. The measurements were carried out with the mitotic areas of the glandular tubules cut continuously from gastric pit to base of the gland and arranged perpendicular to muscularis mucosae. The rate was measured in the areas of gastric, pyloric and intestinal type gland in separate. The mitotic rate was expressed by the percentage of mitotic cells to the total cell count.
As for the thickness of the mucosal and the glandular layers, serial sections were cut from gastric pit to base of the gland. The measurements were made with the gastric and the pyloric gland arranged perpendicular to muscularis mucosae. The thickness between the surface of muscularis mucosae and the mucosal surface was taken as the thickness of the mucosal layer, and that of lamina propria excepting the gastric pit was taken as the thickness of the glandular layer. The ratio of the glandular layer to the mucosal layer was calculated by measuring the thickness from corresponding glandular layer to mucosal layer. The results of the measurment were as follows.
1. The cellular infiltration in gastric cancer was more intense than other stomach diseases. The entire resected specimens of the stomach cancer were given about 2 Points of the cellular infiltration in average. The specimens of stomach cancer having carcinoma focus in the area of the gastric gland revealed more intense cellular infiltration than the ones having the foci in the area of pyloric gland. Furthermore, the change was related to the stage of the disease, namely more intense cell infiltration was observed in the advanced cases of gastric canccr.
2. The incidence and the extent of intestinal metaplasia of gastric mucosa were highest in gastric cancer, notably in the area of pyloric gland. The intestinal metaplasia was not related to the depth of the gastric wall involved by carcinoma and the site of carcinoma foci.
3. The mitotic rate of both gastric gland and pyloric gland was proved to be equal between gastric cancer and other stomach diseases. However, in the resected specimens of stomach carcinoma the rate was higher in the area of pyloric gland than the area of gastric gland and it was least in the vicinity of the lesion.
4. The mitotic rate of intestinal type gland showed no difference between gastric cancer and other stomach diseases. In the resected specimens of stomach carcinoma having the carcinoma foci in the area of gastric gland showed a higher mitotic rate than those having the lesion in the area of pyloric gland.
The authors reported two cases of aberrant pancreas in the stomach. Out of 2, 430 cases who were examined with gastrocamera, two cases of aberrant pancreas in the stomach were found. Case 1 was a 31 year-old male. Case 2 was 41 year-old female. They were diagnosed radiologically and endoscopically as submucosal tumor of the stomach and were gastrectomyzed. The resected specimens were diagnosed histologically as aberrant pancreas. The importance of the radiologic and endoscopic findings of aberrant pancreas in the stomach was discussed.
The present study was conducted with the purpose to clarify endoscopic findings of early stomach cancer and the relationship between endoscopic findings and the histopathological findings with special reference to the depth of the gastric wall involved by carcinoma.
Out of the 1, 492 cases who were examined by endoscopy 65 cases were diagnosed as gastric cancer, one case was gastric ulcer and another one case was gastric polyposis. The total of 67 cases were send to the surgery clinic for gastrectomy. With the resected stomach specimens of these cases macroscopic as well as histopathologic observations were carried out. As a control study, similar observations were made with the tissue specimens obtained from gastric polyp and polypoid carcinoma. Those cases diagnosed as stomach cancer with simply radiological examination were excluded in the present study.
For the endoscopic examinations, gastrocameras of type III, IV and V were employed, and the gastrocamera findings were studied. For histopathologic observations sections of 5mm in width were prepared with the area involved by carcinoma and these tissue sections were stained with the hematoxylin-eosin solution. Early stomach cancer was defined as the cases involved only the mucosa and the submucosa with carcinomatous tissue. Those cases involved the muscle layer were excluded from the designation.
According to the classification established by the Japan Endoscopic Society, these samples were classified into three types, I, II and III. The Type II was further subdivided into three types, IIa, IIb and IIc (Fig. 1). The results of these examinations were as follows.
1. Of the 67 cases examined, 51 cases were stomach cancer by histopathologic examination. Among them 14 cases were proved to be the cases of early stomach cancer. The incidence of early stomach cancer was 27.4% in those cases performed gastrectomy. As for type of early stomach cancer, a predominant incidence was observed in Type IIc, which amounted to one half of the total cases.
2. The principal endoscopic findings of Type I were unevenness of the surface of the elevated mucosa, hyperemia and discoloration of the mucosa.
3. As for Type IIc, irregularity of margin of the depressed mucosa, bleeding cr hyperemia of the edge, irregular shaped coat or adherent mucus were main endoscopic findings.
4. In Type III, converging folds, discoloration, unevenness and irregularity of the floor of the depressed mucosa were observed by endoscopy, however, none of these findings were thought to be pathognomonic for early stomach cancer.
5. As for the endoscopic findings that enable to decide the depth of the gastric wall involved by carcinoma, cessation of the fold, stiffness of the angle, unevenness and irregularity of the edge may be pointed out. The cessation of the fold paralleled with the depth of the gastric wall involved by carcinoma. The findings of unevenness and irregularity of the edge were also in accordance with the depth of the gastric wall involved by carcinoma, though the relation was not observed in Type III.
