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PubMedDate not supplied

Delay in diagnosis of gastric cancer: a prospective study evaluating doctors'- and patients' delay and its influence on five year survival.

Despite new diagnostic techniques, gastric cancer in its less aggressive stages is not diagnosed more frequently and the prognosis still remains poor. Thus, a possibility exists that there is still a delay in diagnosis. This study was therefore designed to investigate whether a delay in diagnosis of gastric cancer exists, to identify factors leading to diagnostic delay, and to settle whether the prognosis is dependent on a delay. Fifty consecutive patients with gastric carcinoma were interviewed and the diagnostic attempts prior to diagnosis were checked. It was found that thirteen patients (26%) had patients' delay (more than three months of symptoms before consulting a doctor) whereas twelve (24%) had doctors' delay (more than three months of investigations before correct diagnosis was made). Doctors' delay was more common in female (7/13) than in male patients (5/37) (p less than 0.05) and in linitis plastica (5/8) than in other types of gastric cancers (7/42), (p less than 0.05). Seven of the twelve patients with doctors' delay had been on regular check ups before diagnosis. A negative barium meal was the most common reason for doctors' delay. Survival was influenced only by tumour stage (r = -0.71, p less than 0.05). Our conclusion is that both patients' and doctors' delay are considerable in the diagnosis of gastric cancer; it is therefore suggested that improvement in five-year survival requires improved presymptomatic diagnostic methods and screening programmes.

Actuarial Analysis↗

PubMed1990

[Lymph node involvement: the only prognostic factor after curative resection of cancer of the stomach. Results of a multivariate analysis].

The aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric adenocarcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5-year survival rate was 25 +/- 4%. After curative resection, the 5-year survival rate was 44 +/- 6%. Univariate analysis applied to these patients showed that poor survival was related (p less than 0.01) to: age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5-year survival rate was 75.5 +/- 8% without LNI, 28 +/- 10% with proximal LNI and 7 +/- 6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.

Adenocarcinoma↗

PubMed1990

Gastric polyps: the case for polypectomy and endoscopic surveillance.

Thirty-two patients with gastric polyps and a mean follow-up period of 18 months were analysed. The principal presentation was epigastric pain accompanied at times by haematemesis or melaena. As in other series, the hyperplastic polyps (21 cases) predominated, followed by the adenomatous type (six patients). Endoscopy was an effective first-line investigative method for 21 patients and for a further five who had initial false negative barium studies. Gastric polypectomy was performed for 60% of patients without any complications. There was discrepancy between the biopsy material and polypectomy specimen in five of seven patients who were recalled for snaring. Although no polyp in this series turned malignant, one diffuse polyposis patient developed linitis plastica after 4.5 years of follow-up. Hence, for reasons of recurrence, new polypoid growths and development of gastric cancer, long-term surveillance is indicated.

Adult↗

PubMed1989

[Primary adenocarcinoma of the bladder. Apropos of 10 cases. Retrospective study].

We report ten clinicopathological cases of primary adenocarcinoma of the urinary bladder. Histologic features were often reminiscent of those seen in digestive tumors: Lieberkühnian adenocarcinoma (4 cases), mucinous adenocarcinoma (3 cases) and signet ring cell adenocarcinoma with linitis plastica (1 case). Prognosis was poor in these tumors that were all invasive and had spread beyond the muscular layer: four patients died and six were critically ill when they were lost to follow-up. We emphasize the role played by glandular metaplasia of the vesical urothelium in the histogenesis of these tumors.

Adenocarcinoma↗

PubMed1989

[Total gastrectomy versus partial gastrectomy of adenocarcinoma of the antrum. A French prospective controlled study].

In a prospective multicentric trial we compared the post-operative mortality and the 5-year survival of elective total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study: thirty two were excluded after pathological examination (linitis plastica, superficial cancer, lymphoma). One hundred and sixty nine patients remained for analysis with 93 TG and 76 SG. Elective TG did not increase post-operative mortality (1.3%) in comparison with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both operations TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗

PubMed1986

[Present diagnostic status of scirrhous type gastric cancer--with special reference to the endoscopic diagnosis].

First, we presented an actual diagnostic situation in nowadays for gastric cancer of Borrmann 4, which is virtually the same as scirrhous gastric cancer. Among 12 patients treated by the author, all of whom were discovered late, only 3 underwent surgery. In fact, with inoperable cases in Borrmann 4, even those endoscopically found to show insufficient stretching of the gastric wall, thickening and tortuosity of folds, uneven gastric mucosa, redness and white coating, there may be negative in gastric biopsy. However, the significance of an endoscopic examination for diagnosis of scirrhous cancer is in obtaining proof of the carcinoma (especially when still operable) by gastric biopsy. Thus, one must strive not to overlook slight redness, white coating which means small erosions, but to go over gastric biopsy again and again. Next, with carcinoma presenting a leather bottle (linitis plastica type) of the stomach itself, the II c portion of the stomach consisted of fundic glands (undifferentiated carcinoma) shall become the primary focus supporting Nakamura's theory. One case of diffuse invasive cancer, mistakenly diagnosed as a II c case, and two cases of regional type, one similar to II c and the other a Borrmann 2 carcinoma of advanced carcinoma showing strongly fibrous scirrhous tendency toward infiltration, were jointly monitored.

Adenocarcinoma, Scirrhous↗

PubMed1988

[A case of gastric metastases from carcinoma of the breast].

Reported is a case of a gastric metastases from a cancer of the breast in a 54-year-old woman who had received a standard radical mastectomy for a cancer of the right breast (T2N1bM0). Microscopic examination had revealed a lobular carcinoma, partially showing a signet ring appearance, and metastases in 4 axillary lymph nodes. Two years and 6 months later as a result of an upper GI series and a gastroscopy, linitis plastica was observed. Because there were no other metastatic lesions, a laparotomy was performed. The stomach, however, was unresectable. Further, a nodal biopsy revealed a metastatic breast cancer. Because of the probe laparotomy, however, the patient's symptoms were aggravated for several months. Death occurred three years and five months after the mastectomy. An autopsy revealed systemic metastases which included the stomach that had originated from her breast.

Breast Neoplasms↗

PubMed1986

[Malignant tumors of the stomach: apropos of 583 anatomo-clinical cases].

A retrospective study interesting 582 anatomoclinical cases of gastric malignant tumors was realised in two anatomo-pathological services of Tunis from 1970 to 1985. The average age of patients is 55 years old, with extensive ranges from 17 to 85 years old. The authors point out significative male predominance 64.6% of cases. The ulcered form is the most frequent, about 3.8% of macroscopic aspect cases. Among these last, the authors find 26.7% of ulcerating and polypoid form with invasive characteristics, and 18.83% of linitis plastica. The pyloric area localisation is the most frequent, 68% of cases. Diffuse tumors are observed in 8.47% of cases and numerous stomach localisation in 0.82% of cases. 84% of histological aspect are represented by adenocarcinoma, the most frequent of them (35%) is well differentiated type, then the poorly differentiated (20%) and atypic form (19.75%). Frequency of lymphosarcoma reaches 14.7%, the first is the centroblastic form, then lymphoblastic and lymphoplasmocytic forms. Concerning evolution, gastric cancer is an infiltrative tumor: serosal surface is attempted in 69.5% of cases, and during the first chirurgical act half cases show lymph nodes metastasis.

Adenocarcinoma↗

PubMed1979

Effects of acute and chronic pancreatitis on the stomach patterns of radiographic involvement.

The radiographic gastric changes associated with acute and chronic pancreatitis are described. The pertinent literature is reviewed and forms of involvement previously not reported are illustrated and discussed. Intramural and perigastric permeation of extravasated pancreatic enzymes and the secondary inflammatory reaction that follows are responsible for the radiographic changes observed. Generalized rugal thickening and particularly a localized spiculated appearance to the posterior wall of the stomach are transitory findings seen in acute pancreatitis. Radiographic abnormalities associated with chronic pancreatitis include patterns mimicking linitis plastica, indurated and nondistensible rugae involving the proximal stomach and a severely distorted gastric configuration induced by perigastric adhesions. The recognition of these patterns of involvement helps in the radiographic diagnosis and avoids confusing or evasive interpretations.

Acute Disease↗

PubMed1984

[Pathology and histogenesis of gastric scirrhous carcinoma].

Gastric scirrhous carcinoma can be tentatively defined as the following. Histologically, poorly differentiated adenocarcinoma, scirrhous type, according to histological classification by Japanese Research Society for Gastric Cancer. Grossly, Borrmann IV type (diffusely infiltrating without ulceration or mass formation). Extensive infiltration of the stomach. Gastric scirrhous cancers were classified as follows. Pyloric stenotic type (6 cases). Cancers were located at the distal pyloric portion, causing stenosis, and considered to originate from the pyloric gland. IIc-erosive type (6 cases). Cancers were located about at the border between pyloric and fundic areas, and considered to arise from the intermediate (or transitional) zone. Rugal type (or Linitis plastica type) (9 cases). Cancers were located at the gastric corpus, causing giant rugae in the fundic region, and considered to originate from the fundic gland. Gastric scirrhous cancers must start at the gastric mucosa as intramucosal cancers, whose histology shows adenocarcinoma mucocellular (signet-ring cell carcinoma). Signet-ring shaped cells in adenocarcinoma mucocellulare disclosed at least three types as follows.

Adenocarcinoma, Scirrhous↗

PubMedDate not supplied

Metastatic carcinoma of breast simulating Crohn's disease.

A 52-year-old female had radical surgery on both breasts in 1971 and 1973 for infiltrating lobular carcinoma of the breast. One year later, multiple metastases simulating Crohn's disease were found radiologically and intraoperatively in the colon and small bowel. The pathological examination revealed multiple areas of linitis plastica type carcinoma in the colon and small bowel. Review of the breast slides showed that the original breast carcinoma was morphologically identical to the metastatic lesions. The literature is reviewed and arguments are presented to attest that signet-ring-cell carcinoma of the breast is a distinct entity, which not too infrequently metastasizes to the gastrointestinal tract.

Adenocarcinoma↗

PubMed1982

Gastric hyalinization associated with peptic ulceration.

Gastric hyalinization, the severe hyaline thickening of the stomach wall that predominantly involves the submucosa, seems to have been described only in autopsy cases. Although initially thought to be a consequence of radiation or chemotherapy, subsequent studies suggested that it results from an artifactual postmortem chemical denaturation of the protein of the gastric submucosa, possibly related to an agonal tear in the gastric submucosa. We studied the clinicopathologic and ultrastructural findings in a case that had morphologic features of gastric hyalinization but that, in contrast with previous reports, was present in a surgically removed stomach and was associated with a small, chronic, peptic ulcer, with clinical manifestations of gastromegaly and borderline gastric retention. Ultrastructurally, the severe submucosal hyaline thickening that focally involved the muscularis and serosa largely consisted of proteinaceous material, ground substance, and collagen fibers, with occasional interspersed fibroblasts and myofibroblasts. This case indicated that gastric hyalinization can be a nonartifactual and clinically significant entity that may be associated with peptic ulcer disease and that should be distinguished from neoplastic (linitis plastica) and other processes.

Adult↗

PubMed1980

Carcinoma of the stomach in the young adult.

Of 1,383 patients with carcinoma of the stomach seen at this institution during a 30 year interval, 37 were 35 years of age or younger. Fourteen of the patients were less than 30 years of age and the females predominated. While all young adults underwent roentgenologic examination of the upper gastrointestinal tract, only 12 had findings considered diagnostic for a malignant lesion of the stomach at the time of the initial study. Endoscopy with biopsy was done in 16 patients and confirmed the diagnosis of carcinoma in 13 patients. Carcinoma of the stomach was first diagnosed at laparotomy in 13 patients. Only 30 of 37 patients were considered operative candidates. Of the gastric resections done, 19 were curative and two, palliative. Seventy-six per cent of the lesions were either linitis plastica or poorly differentiated adenocarcinomas, and lymph node metastases were present in 31 patients. Prognosis was dismal. Thirty-one patients were dead within two years of diagnosis and only two patients have survived five years. In this series, carcinoma of the stomach in young people was particularly lethal. A high index of suggestive symptoms should prompt an early, aggressive roentgenologic and endoscopic evaluation of the upper gastrointestinal tract if any chance for an increase in cure rates is to be realized.

Adenocarcinoma↗

PubMed1995

Signet-ring carcinoma in Crohn's disease presenting as a neck mass.

We report a case of signet cell carcinoma of the colon in a patient with Crohn's disease. Signet cell carcinoma, also termed linitis plastica, is an unusual malignancy of the colon and is rarely associated with Crohn's disease. In general, metastatic disease is evident at the time of diagnosis, and the prognosis is uniformly poor. The radiographic, endoscopic, and histological features are discussed.

Carcinoma, Signet Ring Cell↗

PubMed1994

[Neoadjuvant chemotherapy for far-advanced gastric carcinoma].

Far-advanced gastric carcinoma of the stomach remains a lethal disease, showing a particularly poor prognosis in the patients with linitis plastica type. Considering the high potential for biological malignancies, we attempted preoperative induction (neoadjuvant) chemotherapy against far-advanced cancer associated with distant metastases. Anticancer drugs used in this study were FAM or sequential MTX/5-FU. Neoadjuvant chemotherapy was carried out on 24 patients prior to surgery. The response to chemotherapy showed shrinking of massive nodal involvement in 50% (5/10) and complete disappearance of malignant ascites in 87.5% (7/8). The morphological improvement of primary gastric lesions was obtained in 9 out of 24 cases (37.5%). In 15 cases (68.2%) total gastrectomy was done with extended lymph node dissection. In one of 9 cases showing marked improvement, no viable cancer cells were seen in whole stomach associated with multiple foci of granulomatous lesions of regional nodes after 3 cycles of MTX/5-FU. Disease-free survival of neoadjuvant group showed a significant prolongation of its median survival of 14 months, compared to that of 4-6 months in the surgery alone group. Our result leads to the conclusion that the patients whose tumor was effectively destroyed by neoadjuvant chemotherapy had a good prognosis.

Adult↗

PubMedDate not supplied

[Primary bladder signet ring cell adenocarcinoma. Apropos of 1 case. Review of the literature].

The authors report a new case of signet ring cell carcinoma of bladder whose characteristic findings are the parietal infiltration and the rapidly fatal course. Based on a review of the literature, they define the histological features of this very rare tumour (less than 20 documented cases have been reported). The pluripotent behaviour of urothelial cells appears to be the essential element in the histogenesis of this tumour type, which is very similar to gastric linitis plastica.

Carcinoma, Signet Ring Cell↗

PubMedDate not supplied

[Uterine metastasis revealing gastric adenocarcinoma].

We report a case of metastasis to the uterine corpus revealing a primary gastric adenocarcinoma. A 26-year-old woman suffered from weight loss, vaginal bleeding, abdominal pain. An endometrial curettage showed apparently metastatic adenocarcinoma. The primary site of the tumour was gastric. The upper gastrointestinal endoscopy revealed an ulcus and aspect of linitis plastica in the fundus. Biopsies showed diffuse type adenocarcinoma. Because of extensive disease, laparotomy was not performed and exclusive palliative chemotherapy was started. The patient died 10 months after the diagnosis. Metastasis from primary gastric cancer to the female genital tract are rare and are usually observed in young premenopausal women with diffuse type gastric adenocarcinoma. This case report underlines the interest, for those patients of careful gynaecologic examination at the initial staging and after treatment.

Adenocarcinoma↗

PubMed1997

[Diagnosis of gastric tumors].

Gastric adenocarcinomas are currently diagnosed at an advanced stage, related to non specific and late symptoms. Gastroscopy is the first examination to perform in case of recurrent epigastric pain, nausea, loss of weight, anorexia. Endoscopic diagnosis is usually easy in case of polypoid and ulcerative mass, sometimes more difficult in case of linitis plastica or tiny mucosa lesion. Biopsies are mandatory and allow to type cancer in intestinal and diffuse forms. Imaging techniques by X-ray series, sonography, scanner or echo endoscopy are useful to select patients for surgical procedure.

Adenocarcinoma↗