We studied the phenotypic expression, DNA ploidy patterns and other clinico-pathological features of early gastric cancers accompanied by lymph node metastasis. Of 241 cases studied, 18 (7.5%) were lymph node-positive. Histologically, 4 were tub1, 7 tub2, 4 sig and 3 por. Seven of the 18 were differentiated type cancers with accompanying undifferentiated type cancer cells in a part of the cancer tissue. Mucin histochemistry showed that 15 of the 18 cancers were composed exclusively of gastric type cells, while the other 3 were composed of intestinal type cells. The incidence of gastric type cells in node-positive cancers was significantly higher (p<0.05) than that in node-negative cancers. All node-positive mucosal cancers were composed mainly of gastric type cells. These findings indicate that there are many cancers which are originally gastric in type, and that gastric type cancers readily develop lymph node metastasis. On the other hand, a cytofluorometric study showed that 10 tumors were diploid and 8 were aneuploid. There was no statistically significant association between DNA ploidy patterns and the occurrence of lymph node metastasis.
The phenotypic expressions of AFP producing gastric carcinomas were investigated by histological, immunohistochemical, mucinhistochemical and biochemical studies. Intramucosal histology was well differentiated adenocarcinoma in fifteen out of seventeen cases. In the invasive area, papillary or papillary and solid structure of the cancer cells with clear cytoplasms were in fourteen cases, but there were only three cases that showed hepatoid structure. In the mucinhistochemistry, thirteen cases (76%) showed intestinal type mucin. And in the lectin binding property of serum AFP, five of seven cases showed yolk sac tumor like pattern and the other two cases showed hepatic pattern. These results suggests that most of the AFP producing gastric carcinomas derive from intramucosal intestinal type well differentiated adenocarcinoma, that retrodifferentiated to fetal intestine in the invasive area and produce fetal intestinal type AFP.
To clarify characteristics and development of stump cancers of the stomach, we studied 10 cases (12 lesions) of them with mucin-histochemical and immunohistochemical techniques and gene analysis using polymerase chain reaction. Sixty-seven % of the cancers were mostly composed of gastric-type cells and 67% also showed abnormal accumulation of p53 protein in their nuclei. There were scattered cells with abnormal accumulation of p53 protein in cystically dilatated glands that were often found to be surrounding cancers. Immunohistochemistry of proliferating cell nuclear antigen also demonstrated proliferating activity of these cystic glands. It is suggested that the cystically dilatated gland is precancerous lesion of stump cancers of the stomach. The gene analysis showed less occurrence of K-ras abnormality, and the mutation of APC gene is suggested to be infrequent.
Predictable factors in healing of 48 patients with gastric ulcer by PPI or H2-RA on 4 and 8 weeks of treatment were investigated. We evaluated the following factors such as patient's profile, local morphologic factors of gastric ulcer and suppression rate of 24hr intragastric pH between healed and unhealed patients using single and multiple variable analysis. Results obtained from multiple variable analysis, the significant and independent factors of intractable gastric ulcers on the 4th week of treatment were ulcer size in over 20mm and solitary ulcer. On the contrary, those of 8th week of treatment were shortage of holding time of intragastric pH over pH4 (less than 16.7hrs) during treatment, the site of ulcer at lesser curvature of gastric angle and the shape of ulceration which showed mucosal overhanging. Considering with single and multiple variable analysis, we concluded that, in early phase, local shapes of the ulceration were important predictors in the healing of gastric ulcer, and the after that, the inhibition of intragastric acidity were significant factors in healing process of gastric ulcer.