A comparative analysis of available classifications of gastric neuroendocrine tumors was performed. It was showed that there were many contradictions regarding the issues of termi- nology and, in particular, criteria for determining the degree of differentiation of these tumors that significantly influenced on the choice of methods of treatment. There were unclearly marked symptoms of benign tumors, treatment of which could be conducted by endoscopy removal. There was absent the category of high- and moderately differentiated neuroendocrine tumors that metastasized by lymph and blood. Malignant tumors were represented by just low-differentiated malignancies although now many researchers noted the heterogeneity of this group and a different response to therapeutic agents. Up to now there were no standard methods for determining the pro- liferative level because any discrepancies between a number of mitoses and Ki67 index might be. Proliferative activity in tumor itself was often heterogeneous and it was necessary to select a specific point in tumor to determine its grade. Despite a proof of endodermal origin and the presence of combined tumors with epithelial component (mucocarcinoid, adenoneuroendocrine, amphicrine carcinoma) gastric neuroendocrine tumors were considered as a separate group in contrast to such standard symbols in pathology as adenomas and carcinomas. Thus it is necessary to accumulate further material for the standardization of nomenclature and more accurate determina- tion of malignant potential of tumors with the aim of studying the effect of various methods of treatment.
The authors studied endocrine apparatus of the mucous membrane of 53 stomachs in various forms of carcinoma. Silver impregnation and electron microscopy were used as well as routine histology and histochemistry. All the tumors were divided into endocrine-cell and non-endocrine-cell tumors (ET and NET). Cells of the diffuse endocrine system take an important part in the development of the background and pretumorous processes in the stomach mucous membrane. Endocrinocyte hyperplasia, degree I and II, of the mucous membrane of the antrum and enterolysation foci was the background for all NET. Endocrinocyte hyperplasia was more pronounced (degree II and III) in ET and spread to the fundal glands being combined with endocrinocyte dysplasia and metaplasia. These changes are assessed as precancerous for tumors with high content of endocrinocytes.
Screening of the endocrine cell participation in the stomach carcinoma has been performed. Endocrine cells are found in all stomach tumors and those in which these cells occupy more than 75% of the surface are distinguished as endocrine cell carcinomas (ECC). They are subdivided into well (WD), moderately (MD) and poorly differentiated (PD). ECC are more frequently observed in males, their predominant location is cardia and fundus. The growth in the deep parts of mucosa and submucosa (this determines late clinical symptoms) is characteristic for these tumors. Alveolar, trabecular and glandular structural variants are observed in WD ECC and MD ECC, while PD ECC corresponded to small cell carcinoma (iat cell and intermediate types). Prognosis is unfavorable in MD ECC and PD ECC. Apart from this amacrine and combined tumors with an endocrine component are described. The authors emphasize the necessity to single out ECC from whole group of stomach carcinoma.
38 of 50 patients with hemorrhagic apoplexy were operated on. The most frequent causes of the death were progression of the hemorrhagic syndrome, intraventricular hematomas, thromboembolism of the pulmonary artery and its branches. Frequent complications were diencephalo-catabolic syndrome, polybacterial pneumonia, acute renal failure.
The histological features and morphogenesis of acute peptic mucosal lesions in gastroesophageal reflux disease (GERD) were studied using 2220 biopsy specimens obtained from 669 patients. The stages of their development and two variants of their healing, which affected the duration and outcome of the disease, were identified. Acute erosions and ulcers in the laminated squamous and cylindrical epithelial areas were shown to be a natural stage of changes that preceded the development of Barrett esophagus and promoted its progression. All the described changes must be embodied in the histological reports on esophageal mucosal biopsy specimens and taken into consideration when using local and systemic treatments.
One case is reported of amphicrin thyroid carcinoma with signs of A- and C-cell differentiation. This tumor at its early stage had a follicular structure with massive deposits of amyloid in the stroma. In the course of progression the tumor transformed into C-cell anaplastic carcinoma with stromal amyloid deposits in the form of thin fibrils and production of polypeptide hormones and their precursors by tumor cells. The distinctive feature of the tumor metastases was the presence of many giant cells which, as was shown, were amyloid-clasts.
Histological variants of colon carcinoma depending upon the quantity of endocrine cells are distinguished on the basis of 66 malignant epithelial colon tumours morphological investigation. Special emphasis was made on the characteristics of the endocrine cell carcinoma, combined tumours with a combination of glandular and endocrine components, and amphicrin neoplasms. A trabecular-glandular variant of endocrine cell carcinoma is found to be predominant in the colon. The criteria are suggested for the identification of endocrine-cell tumours.