Abstract
The author studied autopsy cases of gastric cancer at Department of Pathology of Showa Medical School and Kanto Teishin Hospital during 5 year period ranging from April, 1956 to March, 1961. Those cases were devided into two groups, that is, A and B group. A group consists of 50 gastrectomied cases and B group 50 non-gastrectomied ones. The gastrectomied cases were studied from the various points as compared with the nongastrectomied cases. In 32 cases of A group, the gastrectomy was performed at the Surgical Clinic of Showa Medical School, and the primary foci of those cases were fully studied macroscopically and microscopically and were compared with those of nongastrectomied. As to the distribution of metastasis, comparative study were made in consideration of the age, the sex, the gross appearance and the histologic findings.
The results and conclusions are as follows.
1) In the relationship between the age of cases of gastric carcinoma and the histologic pattern, the younger patients are, the more numerous are cases of anaplastic carcinoma (scirrhous carcinoma or medullary carcinoma), whereas in older age group, cases of adenocarcinoma supervene. The mean age is 53.6 years in males and 48.6 years in females, so female cases are younger than male ones. As compared with B group, in A group cases are few in the second and the seventh decades of life and cases in the fifth decade are overwhelmingly numerous.
2) In B group the most common type of primary foci is the IV type (54 per cent) according to Borrmann's classification. The second type is III type (32 per cent), followed by II type (14 per cent) and I type (4 per cent) .
In A group the most common type is III type (40.6 per cent) . The following types are II type (28.1 per cent), IV type (25 per cent) and I type (6.2 per cent) . In the relationship between the gross appearance of primary foci and histologic findings, among 26 cases of IV type in B group the most common histologic type is scirrhous carcinoma (13 cases) and adenocarcinoma (8 cases), medullary carcinoma (4 cases), gelatinous carcinoma (2 cases) follow. In A group, however, cases of IV type are all scirrhous carcinoma histologically.
3) In cases of medullary carcinoma the distribution of metastasis is quite widespread and is in high degree in all modes of metastasis. There is no wide difference in metastasis between A and B group.
In cases of scirrhous carcinoma, diffuse infiltrative growth is especially prominant. In these cases lymphogenous and hematogenous spreads are checked to some extent by surgical intervention. On the other hand, the infiltrative growth will not be checked by surgical operation.
5) In cases of adenocarcinoma showing low grade differentiation, the distribution of metastasis is more spread than those showing high grade differentiation. In both cases, however, the lymphogenous and hematogenous metastases can be checked by surgical interventation.
6) In females metastases to the ovaries (including Krukenberg's tumors) are met in higher incidence in younger cases.
7) In A group (gastrectomied cases), many cases survive over a year, whereas in B group almost all die within a year. From this evidence it may be said that the survival effect is expected to some extent by surgical intervention.
