A clinicopathologic variant of intramucosal early gastric cancer with widespread dissemination: Report of three cases

We describe the clinicopathological characteristics and post-mortem findings of three cases of intramucosal early gastric cancer (EGC) selected from nine cases of our series to characterize its unusual clinical behavior. All patients were treated at the Instituto Nacional de la Nutricion in Mexico City between January 1986 and December 1995. The following features were the most salient of the three cases: (1) The tumors were constituted by only few nests of intramucosal cells; two of them were signet-ring cell carcinomas and the other one was of the intestinal type. (2) Grossly. all tumors were inconspicuous. (3) All the patients had a short clinical course and in none of them the clinical diagnosis was suspected. (4) A wide dissemination was found at autopsy; additionally, in two of the cases, extensive lymphatic and venous thrombi and multiple secondary hemorrhages were found. (5) In all patients, the symptoms and deaths were caused by the metastases. No cases as early as those reported here were found either in the Japanese or in Western literature. Although larger series of EGC should be studied in our country, these findings suggest that at least in Mexico there is a group of EGC with unusual aggressive behavior.