Changes in Gross Appearanee of Gastric Cancer with Development

Abstract

A study was made of 669 foci in 628 cases of gastric cancer surgically resected and 23 foci of gastric cancer in 23 autopsies on the basis of Japan Gastroenterological Endoscopic Society classification and Borrmann's classification at the Center for Adult Diseases, Osaka, during the past 7 years.
The obtaned results were as follows:
(1) Non-superficial cancer cases did not show a lesion resembling a flat type (IIb type)superficial cancer in gross appearance. A flat type (IIb type) superficial cancer was likely to develop into other cancerous types.
(2) In non-superficial cancer, there were many lesions macroscopically resembling a depressed type with co-existing ulcer (IIc with converging folds, IIc+III and III type) of superficial cancer, suggesting that IIc converg, (+), IIc+III and III types might maintain their appearance throughout malignant progression.
(3) By the gross appearance of lesion and findings of histologic malignant distribution in the gastric wall, gastric cancer was classified into 4 groups: A-group which mainly showsa protruded lesion without converging folds; B-group which shows a depressed lesion surrounded by marginal elevation without converging folds; C-group which mainly shows a depressed lesion with converging folds; D-group which is flat in appearance.
A-group consisted of a protruded type (I type) and an elevated type (IIa type) in superficial cancer, and mainly Borrmann I and Borrmann II types in non-superficial cancer. B-group consisted of a protruded type with defect of the top (I defect (+) type) and a depressed type without converging folds (IIc converg. (-) type), and mainly Borrman II type, C-group consisted of depressed and concaved types with co-existing ulcer (IIc converg. (+), IIc+III and III type), and mainly Borrmann III type, D-group consisted of flat type (IIb type), and mainly Borrmann IV type, respectively.
(4) Types in the same group resembled to each other on clinicopathological findings. But these findings were extremely different between superficial cancer and non-superficialcancer in D-group only. Such resemblance leads to a probability that there is a shift or interchange among the types in the same group, except for D-group.
D-group of non-superficial cancer clinicopathologically resembled C-group of superficial cancer, suggesting that a certain depressed type (IIc type) might develop into Borrmann IV type.
(5) C-group showed a very high incidence of advanced cancer. The incidence of A- and B-groups in advanced cancer was lower than that in superficial cancer, suggesting that A- and B-groups in superficial cancer transformed into C-group in advanced cancer, and all gastric cancer finally transformed into Borrmann III type.