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PubMed2003

Autoimmune gastropathy in type 1 diabetic patients with parietal cell antibodies: histological and clinical findings.

OBJECTIVE: Approximately 15-20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs) targeting gastric H+/K+ATPase. We examined whether iron deficiency anemia, pernicious anemia, and autoimmune gastritis, which may predispose to gastric tumors, were more frequent in PCA+ than in PCA- patients. RESEARCH DESIGN AND METHODS: Gastric biopsies from 88 consecutively recruited type 1 diabetic patients (51 men and 37 women, 47 PCA+ and 41 PCA-, aged 42 +/- 13 years) were evaluated using the updated Sydney system. Immunostaining was done for parietal cells, B- and T-cells, enterochromaffin-like (ECL) cells, and Helicobacter pylori (HP). PCAs were assayed by indirect immunofluorescence, H+/K+ATPase antibodies by enzyme immunoassay, and HP by serology, urea breath test, and histology. Pentagastrin tests were performed in 42 subjects. RESULTS: Autoimmune gastritis (AG) was present in 57% of PCA+ and 10% of PCA- cases (OR 12.5, P < 0.0001). PCA positivity (beta = 1.44; P = 0.04) and hypergastrinemia (beta = 0.01; P = 0.026), but not HP, age, diabetes duration, sex, and HLA-DQ type were risk factors for AG. Iron deficiency anemia (OR 3.9, P = 0.015), pernicious anemia (OR = 4.6, P = 0.022), and hypochlorhydria (OR = 20.0, P = 0.0002) were more frequent in AG+ individuals. HP infection was present in 47 patients but did not influence corpus histology or gastrinemia. (Pre)malignant lesions were found in 26% of PCA+ subjects: ECL cell hyperplasia in 7 AG+ patients, comprising 1 with a gastric carcinoid tumor, and corpus intestinal metaplasia in 11 AG+ patients, including 1 with linitis plastica. CONCLUSIONS: PCA+ type 1 diabetic patients should be screened for autoimmune gastritis, iron deficiency, and pernicious anemia. Particularly hypergastrinemic PCA+ patients with autoimmune gastritis are at increased risk for (pre)malignant gastric lesions.

Adult↗
PubMed1986

Endoscopic ultrasonography of normal and pathologic upper gastrointestinal wall structure. Comparison of studies in vivo and in vitro with histology.

Endoscopic ultrasonographic analysis of the upper gastrointestinal wall was performed in vivo (preoperatively) and in vitro (resection specimen or postmortem material). The images obtained were correlated with histology. The normal intestinal wall was visualized as a five layer structure. The wall structure was interpreted as abnormal when partial or total destruction of the wall architecture was visualized. A diffuse submucosal hypoechoic structure without penetration into the muscularis propria was indicative of a benign lesion. Diffuse irregular hypoechoic echo pattern penetrating into the muscularis propria, with or without alteration of the mucosal layer, was usually found in linitis plastica. As a rule, early gastric cancer could readily be differentiated from advanced gastric cancer when penetration of the lesion into the muscularis propria appeared to be absent. Follow-up EUS was helpful in the differentiation between a benign and malignant ulcer. Remaining sonographic abnormalities after successful treatment of an ulcer was compatible with malignancy. Further in vivo and vitro studies must be performed to determine the accuracy and limitations with which the ultrasonographic findings are interpreted.

Digestive System↗
PubMedDate not supplied

[Primary non-Hodgkin's lymphoma of the stomach (a rare case of extensive spread to the entire organ)].

Primary gastric lymphoma is the most frequent extra nodal primary site for non-Hodgkin's lymphoma (NHL) and is itself uncommon. Moreover, a massive infiltration of all stomach (from cardias to antrum) simulating a linitis plastica, it's rare. We present a case report of this atypical presentation of primary gastric NHL in a 73 year old females. The patient came to our observation complaining of dyspepsia, epigastric pain and vomiting from 7 months associated with weight loss and asthenia. Physical examination revealed an epigastric palpable mass. Computed tomographic findings has been necessary to confirm that the massive infiltration of gastric wall (from cardias to pylorus) was ascribed to lymphoma. Dawson's criteria was respected to define primary gastric NHL and was performed a total gastrectomy with systematic lymphadenectomy. The histopathological evidences have confirmed clinical diagnosis of primary gastric NHL. Preoperative diagnosis to clarify the nature of lesions (primary or not) and accurate staging of neoplasm before the operation are indispensable for a correct therapeutic approach; in according to the Ann Arbor classification modified by Musshoff our cases was stage IIE and radical gastrectomy with systematic lymphadenectomy was performed. Surgical resection is generally considered to have a definitive role in the treatment of primary gastric lymphoma specially for the stage IE and IIE.

Aged↗
PubMed2000

[Mesogastrectomy in the surgical treatment of gastric carcinoma. Experience with 61 cases].

BACKGROUND: In gastric cancer surgery, to search for a technique to remove the entire posterior mesogastric region using a standardised operation using well defined methods and anatomic-embryological planes. METHODS: A concise description of the embryological evolution of the posterior mesogastrium allow the formation of the mesogastric fascia (and the supramesocolic fascia of the omentum--which is a continuation) to be documented. It is also clear that the mesogastric fascia is the embryological--anatomical equivalent of Treitz's fascia, pancreatic retro-head, and Toldt's retrocolic fascia, of which it is a structural continuation. Like Treitz's and Toldt's fascias, the mesogastric fascia also represents the surgical plane for the detachment of the region in question and allows maximum safety and radicality. By carrying out primary ligature of the arteries at the origin and the veins at the outlet, the entire posterior mesogastric region, with the relative lymph node stations, can be removed en bloc with maximum radicality and safety, and also in line with the principle of "no touch isolation". We used this technique to operate 61 cases, 17% of all cases of gastric carcinomas between 1973 and 1994. RESULTS: Mesogastrectomy was required in 87% of cases with carcinoma in a high localisation or widespread nature of the linitis plastica type. Only 23 cases (37%) were at pTNM II and III A stages. Thirty-eight cases (63%) were at stages III B and IV. In non-selected cases and those with severe associated pathologies and undergoing emergency surgery, and those cases that were extended beyond mesogastrectomy, morbidity was above all linked to pleural effusion. There were only 2 cases (3%) of operating mortality owing to two technical errors: an esophago-jejunal anastomotic dehiscence (the only case in the series, 1.6%) caused by esophageal cancer nests in the suture and a case of necrosis in the left hepatic region following the section of the left gastric artery at the origin despite the existence of a large hepatic collateral vessel. The results for stages II and III A were excellent: stage II, 100% survival at 5, 10 and 15 years; stage III A 88% survival at 5 years, 70% at 10 years, 55% at 15 years, but only two deaths from neoplasia at 2.7 and 4.6 years. The results for stages III B and IV are comparable to large series undergoing traditional forms of surgery. Postoperative conditions of nutrition and quality of life were good and patients resumed activities with the aid of constant chlorhydric-peptic replacement treatment and the total extraction of gastric mucosa. CONCLUSIONS: We believe that mesogastrectomy represents a real advance in both technical terms and results for stages II and III A; it is debatable for stages III B and IV, although individual cases who survived for more than 10 years were also reported. The case of a stage pT3N0M1 = IV pathology, with a single hepatic metastasis that increased until one year and then spontaneously resolved leaving the patient alive and in good health 20 years and 6 months after the operation is truly amazing.

Adult↗
PubMed2001

A case of alpha-fetoprotein-producing gastric cancer.

INTRODUCTION: A case of alpha-fetoprotein (AFP)-producing gastric cancer is described in a 57-year-old Chinese woman. CLINICAL PICTURE: She presented with bleeding tendency and bone pain, and was found to have haematological evidence of disseminated intravascular coagulation and spinal metastasis. Her tumour markers, including AFP, Ca 19-9 and carcinoembryonic antigen (CEA) were elevated. In view of the elevated tumour markers, there was an exhaustive search for a primary lesion in the gastrointestinal tract, liver and ovaries. There was no radiological evidence to suggest any lesion in the chest, liver or pelvis. Lectin affinity electrophoresis of the AFP showed AFP-L2 and AFP-L3 bands, which are suggestive of a non-hepatoma malignancy. MANAGEMENT: Gastroscopy showed a gastric ulcer and she developed bleeding after the gastric biopsy which required urgent surgery. Intraoperatively she was found to have carcinomatous peritone and a malignant ulcer in the greater curve of the stomach. Histology confirmed a linitis plastica like adenocarcinoma which stains for AFP. OUTCOME: She died from multi-organ failure 3 days after surgery. CONCLUSION: AFP-producing adenocarcinoma of the stomach is not uncommon. Lectin affinity electrophoresis of AFP is helpful in the differentiation between hepatoma and non-hepatoma malignancies.

Adenocarcinoma↗
PubMed1975

Endoscopic diagnosis of advanced gastric cancer. Factors influencing yield.

Factors influencing diagnostic yield by directed endoscopic biopsy and cytology were studied in 50 patients with advanced gastric cancer using a forward-viewing panendoscope. The diagnostic yield was higher for exophytic lesions than for infiltrative tumor, and directed brush cytology alone was more productive than directed biopsy alone. The lesions that provided non-diagnostic tissue were mostly recurrent or infiltrative cancers, and were most often in the cardia, antrum, or were of the linitis plastica type. The combination of infiltrative character and location in antrum or cardia, especially if recurrent, often resulted in non-diagnostic biopsy and cytology specimens.

Biopsy↗
PubMed2003

[A gastric signet ring cell carcinoma as the first expression of a breast carcinoma].

A 73-year-old woman presented with dull pain in the epigastric region, a rapid feeling of fullness upon eating and a weight loss of 10 kg in 6 months. Further examination showed linitis plastica due to a signet ring cell carcinoma in the stomach, multiple bone metastases, and an occult, small breast tumour. Immunohistochemical comparison of the tumours strongly suggested that all cases involved a metastasised breast carcinoma. At check-up after one year of tamoxifen treatment, the complaints had disappeared and the activity of the tumour marker had dropped. Gastric metastases from breast carcinoma are rare. Nevertheless, this possibility should be kept in mind in women presenting with malignancies of the stomach and mastopathy. Hormonal treatment and chemotherapy may result in reasonable palliation.

Aged↗
PubMed1992

[Cancer of the cardia. Prognostic factors and treatment].

Pronostic of carcinoma of the esogastric junction is worsened by the potential two-way route of spread in case of lymph node metastasis: mediastinum and abdomen. During the last 10 years the authors observed 71 cases of adenocarcinoma of the gastric cardia, including 7 cases of linitis plastica. Histopathologic and clinical follow-up data are presented. The aims of the study were to evaluate prognostic factors and to define the best surgical treatment. There were mainly elderly patients with a poor physical status. Ten patients did not undergo surgery (14%). Among 57 patients undergoing radial resection (80.3%), total gastrectomy and upper polar esogastrectomy were performed in respectively 29 and 28 cases. The carcinomas were truly located to the gastric cardia in only 37 cases (65%). Operative mortality was 12.3%, not depending of the surgical technique. All patients five-year survival rate was 10.2%, improving to 15% in case of curative resection. The value of lymph node metastasis (80.7% of the patients) as a prognostic factor depended of the proximal or distal localization of the nodes. A positive surgical margin (15.7% of the patients) was a poor prognostic factor with a 6.9 months mean survival. The authors conclude that an aggressive surgical approach is worthwhile, because of the carcinoma invasion (nodes, margin), but not always possible (poor physical status).

Adenocarcinoma↗
PubMed1992

Syphilitic gastritis in an HIV-infected individual.

We report the first known case of syphilitic gastritis in an HIV-infected person. The presentation of nonspecific abdominal pain and weight loss in a 48-yr-old former intravenous drug user previously treated for asymptomatic syphilis led to a barium swallow which demonstrated linitis plastica. Upper endoscopy reinforced a suspicion of carcinoma, but biopsy made the diagnosis of syphilis by silver staining. Further testing revealed a positive serology for syphilis as well as HIV infection with a depressed CD-4 lymphocyte count. Treatment with parenteral penicillin led to a rapid resolution of symptoms. This case represents a rare complication of late syphilis, and is another example of the unusual manifestations of syphilis seen in the HIV-infected population.

Gastritis↗
PubMedDate not supplied

[Role of endoscopic gastric biopsies in the management of gastritis. A study of 250 consecutive cases].

BACKGROUND: The practical role of gastric biopsy in the management of gastritis is controversial. AIM: To estimate the yield of endoscopic biopsies in the clinical, endoscopic and pathologic approach of gastritis. MATERIAL AND METHODS: Prospective study of 250 consecutive patients who underwent an upper G.I. endoscopy between July 1996 and January 1997, for upper G.I. symptoms, miscellaneous manifestations requiring an upper G.I. endoscopy or presenting a gastritis on EGD performed for other indications. Every patient had 6 biopsies: 2 in the antrum, 2 in the corpus, and 2 in an intermediate zone. RESULTS: After defining the abnormal elemental endoscopic and pathologic patterns, gastric mucosa was endoscopically normal in 57 cases (22.8%) and abnormal in the remaining of the 250 cases (77.2%). The pathologic findings were normal in 69 cases (27.6%) and abnormal in the remaining 181 cases of 250. H. pylori was found in 126 cases (50.4%), 10 cases of which (7.9%) had normal pathology. There was no significant correlation between clinical symptoms, endoscopy and pathology. There was a correlation between endoscopic abnormalities and tobacco use (P = 0.0073), NSAIDs use (P = 0.0001) and the presence of H. pylori (P < 0.0001). There was also a correlation between pathologic findings, tobacco use (P = 0.0015), NSAIDs use (P = 0.0022) and the presence of HP (P < 0.0001). On the other hand, there was a correlation between the presence of an inflammatory infiltrate in H. pylori gastritis (P = 0.0007) and its absence in NSAIDs use (P = 0.0003). The correlation between endoscopy and pathology existed only for certains patterns: erosion and ulcerations (P = 0.0002), purpuric (P = 0.033), congestion (P < 0.0001) and mosaic (0.0095). CONCLUSION: Gastric biopsy brings no important practical supplement to endoscopic examination except in revealing the presence of H. pylori. It adds nothing to endoscopy in helping explain the clinical symptoms. But it is obvious that it may reveal some serious pre-malignant dysplasia or malignant gastric lesions (maltoma, linitis plastica). This did not occur during our study.

Adolescent↗
PubMedDate not supplied

Total gastrectomy for gastric carcinoma.

BACKGROUND/AIMS: Gastric cancer is one of the most common organ cancers all around the world and surgical resection is essential for treatment. Total gastrectomy is the procedure of choice for treatment of proximal gastric cancer. Mortality and morbidity risks of this procedure are high, especially among the elderly. METHODOLOGY: Thirty-eight gastric cancer patients underwent total gastrectomy in the Third Surgical Clinic of Izmir Ataturk Training and Research Hospital between 1996 and 2001. Age, gender, location of the tumor, histopathological findings, TNM stage, type of anastomosis, operation time, blood transfusions, oral food intake, postoperative hospital stay, morbidity, mortality both early and late, and survival rate were evaluated. RESULTS: Mean age of the patients was 59.5 years (22-85 years). Sites of the tumors were: cardia 28.9%, cardia and corpus 15.8%, corpus 34.3%, corpus and antrum 18.4%, linitis plastica 2.6%. Histological types were adenocarcinoma (97.4%), and squamous cell carcinoma (2.6%). TNM stages were: stage la 2.6%, stage II 7.9%, stage IIIa 39.5%, stage IIIb 42.1%, and stage IV 7.9%. Esophagojejunostomies were performed manually (34.3%) or by circular staplers (65.7%). Operation time ranged between 3 and 6.5 hours. Gastric tubes were removed on the fourth postoperative day. Average postoperative hospital stay was 12.9 days. Postoperative morbidity was 21%. Wound infection occurred in three patients (7.9%), pulmonary infection occurred in two patients (5.2%) and anastomotic stricture developed in three patients (7.9%). Hospital mortality was 20%. Anastomotic leak occurred in five cases (13.2%) and all died on days 8, 13, 14, 26, and 30. Three patients (7.9%) died of cardiac complications on days 1, 5, and 29. Twelve patients survived for less than one year and eight patients survived for one to two years. Average survival was 10.5 months for 20 out of 30 patients (median 8 months). Ten patients are still alive after 14.3 months. Four patients have been living for less than one year, another four patients for one to two years, and two patients for more than two years. CONCLUSIONS: Total gastrectomy, either performed with a curative or palliative aim, is a safe procedure with acceptable mortality rates. 89.5% of our cases were stage III or IV resulting in a low survival rate. Longer survival rates can be achieved in patients with comparatively earlier stages.

Adenocarcinoma↗
PubMed2005

[Stomach cancer].

Despite its decline in incidence in developed countries, gastric cancer is the second digestive cancer in France and remains the second most cause of cancer-related deaths in the world. Gastritis induced by H. pylori infection and food regimen are the most frequent precancerous gastric factors. However there is no definite clinical evidence of the benefit of eradication on cancer risk. By waiting for effective anti-H. pylorivaccine, H. pylori should be only eradicated in selected patients at the highest risk of cancer. The stake is to develop inexpensive tests for identification of individuals at high risk, depending on genotypic polymorphisms of both the bacterium and the host. The endoscopic diagnosis is currently made at an advanced stage, related to non-specific and late symptoms. The prognosis remains poor with 5 years overall survival rate less than 20%. Surgical resection with D1 lymphadenectomy is the gold standard curative treatment. An adjuvant therapy with chemoradiotherapy should be considered for patients at high risk for recurrence. Gastric cancer is considered to be a chemotherapy sensitive disease, but polychemotherapy regimens (fluorouraci +/- cisplatin +/- epirubicin) result in modest increased survival (median 9 months); yet, the promising effectiveness of new drugs (irinotecan, docetaxel, oxaliplatin, capecitabin, targeted biotherapies) makes us hope an improvement of results. A number of entities, linitis plastica, gastric MALT lymphoma and stromal tumors should be recognised, because must have a different treatment.

France↗
PubMed1991

Effects of transforming growth factor-beta released from gastric carcinoma cells on the contraction of collagen-matrix gels containing fibroblasts.

To investigate the mechanisms underlying contraction of the stomach wall in cases of gastric scirrhous carcinoma, we have developed an in vitro model for gastric cancer, in which both fibroblasts and gastric carcinoma cells are embedded within a collagen matrix. Gastric carcinoma cells of the scirrhous type (KATO-III) but not the nonscirrhous type (MKN-28) markedly enhanced the ability of human intestine, human lip, and mouse kidney fibroblasts to contract collagen gels. KATO-III cells released transforming growth factor-beta (TGF-beta) into culture media in an activated form, whereas the MKN-28 cells produced a latent form. The role of TGF-beta produced by gastric cancer cells from the scirrhous type was clarified by adding TGF-beta (receptor grade) into collagen gels embedded with fibroblasts, contraction being enhanced. Other growth factors tested, including transforming growth factor-alpha and epidermal growth factor, did not enhance the contraction of collagen gels containing embedded human and rodent fibroblasts. These results suggest that the activated form of TGF-beta released from gastric scirrhous carcinoma cells stimulates fibroblasts to contract the collagenous stroma of the stomach wall, which leads to the so-called "linitis plastica" stomach condition.

Adenocarcinoma, Scirrhous↗
PubMed1991

Exophytic signet-ring cell carcinoma of the colorectum.

Previous studies have assessed colorectal signet-ring cell carcinomas of the linitis plastica variant but not of the exophytic subtype. We retrospectively reviewed 20 cases of colorectal signet-ring cell carcinoma of the exophytic subtype (greater than 50% signet-ring cells). The patients ranged in age from 14 to 79 years (mean, 51.8 years); 10 were male; 17 were white; and three were black. Ten tumors were colonic (eight, right sided; two, left sided) and 10 were rectal; seven were stage B and 12 were stage C. One patient presented with distant metastases. Eleven of 16 tumors assessed by flow cytometry were diploid. Parenchymal hepatic metastases developed in only two patients. The overall 5-year survival rate was 36%, and matched cases did not vary significantly in survival from typical nonmucinous adenocarcinomas. There was a trend toward poorer survival for patients with advanced-stage tumor. Survival was not affected by primary site, ploidy, presence of vascular/lymphatic invasion or residual adenoma, or percentage of extracellular mucin or signet-ring cells. Our cases were somewhat lower stage than literature cases of signet-ring cell carcinoma of the lintis plastica variant.

Adenocarcinoma, Mucinous↗
PubMed1990

[Apparently bladder origin signet ring cell carcinoma: a case report].

A 72-year-old woman with signet-ring cell carcinoma of the urinary bladder treated with total cystectomy is described. The bladder yielded linitis plastica pattern of infiltration similar to that seen in the gastric cancer, i.e., cancer tissue extended almost whole bladder deeply to the serosa, whilst the mucosal surface was only minimally invaded. She received no adjuvant therapy and she is alive without recurrence 8 months after the operation. We review the reported cases and shortly discuss the prognosis and treatment of primary signet-ring cell carcinoma of the urinary bladder.

Adenocarcinoma, Mucinous↗
PubMed1990

Signet-ring cell carcinoma of urachus: a case report and review of literature.

Signet-ring cell carcinoma of the urachus and bladder is a rare lesion. Its histological picture is unique and similar to linitis plastica of stomach. The tumor arises through metaplasia of the totipotent transitional epithelium lining the urachus. It is a highly malignant tumor with propensity for local invasion and distant metastasis, and carries a uniformly poor prognosis. Herein we report one such rare case of urachal carcinoma who is free of disease for 2 years after surgical treatment.

Adenocarcinoma, Mucinous↗
PubMed1977

Gastric carcinoma 2. An analysis of morphological and prognostic parameters correlated to the classification proposed by Masson, Rember and Mulligan.

One-hundred and fifteen gastric adenocarcinomas were classified according to Mulligan and Rember into one of the following types: Intestinal cell carcinoma (IC), pyloro-cardiac gland carcinoma (PC), mucous cell carcinoma (MC) and unclassified. The tumour type was correlated to the growth pattern and inflammatory reaction at the margin of the tumour, invasion of the veins and nerve sheaths, Dukes' stage, intra- and extracellular mucous production, and occurrence of intestinal metaplasia in the non-tumour bearing parts of the gastric mucosa. MC was the only type of tumour producing the macroscopic picture "linitis plastica". PC was the type of tumour that dominated in the cardiac region. The following parameters showed no relation to tumour type: Sex and age, size of tumour, invasion of lymphatic vessels. This study suggests that the three types of tumour are different entities, MC being the most aggressive and IC the least aggressive of the types of tumour.

Adenocarcinoma↗
PubMed1990

[Signet ring cell carcinoma of the bladder. Apropos of a case].

Signet ring cell adenocarcinoma of the bladder is a very rare tumor. It presents similar to the linitis plastica type of gastric adenocarcinoma. The authors report a new case and analyze the medical literature in order to specify the diagnostic problems and the histogenesis of this tumor.

Adenocarcinoma↗