Abstract
To elucidate the relationship between the biological features of cancer, the mode of submucosal invasion and the pathologic characteristics of submucosal heterotopic glands in the proximal third of the stomach, a clinicopathological study was performed on 73 cases of early cancer in the proximal third of the stomach (including 26 cases in the cardia and 47 cases in the so called “C portion”). From the results of this study, the characteristics of early cancer in the cardia were clarified. 1) The cardiac cases usually showed a smaller lesion measuring less than 20mm, and were differentiated adenocarcinoma histologically. 2) The ratio of cardiac cases showing submucosal invasion was 80.8%, and the crevice mode of submucosal invasion accounted for 52.4 % of these. 3) Heterotopic glands existed in 73.1% of the cardiac cases. 4) Heterotopic glands were more frequently under the cancerous lesion in the cardiac cases. 5) The distribution of heterotopic glands was mainly around the cardiac region. 6) Many cases had marked intestinal metaplasia in the surrounding mucosa, and 91.7% of the cases with marked intestinal metaplasia were accompanied by heterotopic glands. 7) All of the cardiac cases showing the crevice mode of submucosal invasion were accompanied by the heterotopic glands.
More submucosal heterotopic glands existed in the cardiac region. This fact indicated that the lamina muscularis mucosa of the cardiac region may exist in some crevices. Therefore, when differentiated adenocarcinoma occurs in the cardiac mucosa, the cancerous tissue can more easily invade the submucosal layer through these crevices.
