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PubMed1997

[Primary signet-ring-cell carcinoma of the bladder. Description of a case and review of the literature].

The authors describe a case of infiltrating signet-ring cell carcinoma of the bladder, a rare and extremely aggressive form of adenocarcinoma. This neoplasia in only rarely found in a histologically pure form. In the majority of cases the atypical elements which characterise it are mixed with the gland-like and papillary structures of the adenocarcinoma and with foci of transitional or pavimentous carcinoma. The origin is probably metaplastic. These carcinoma are generally invasive, scarcely differentiated and often cause linitis plastica of the bladder. The histological picture is characterized by atypical epithelial elements with abundant, vacuolised cytoplasma. The nuclei are hyperchromic and eccentric, thus representing the typical appearance of signet-ring cells. The histological picture cannot be distinguished from that of a secondary gastrointestinal or prostatic form, therefore the primary diagnosis requires a full clinical and pathological examination of the sectors describes. The prognosis is severe. Elective therapy consists in radical cystectomy with pelvic lymphadenectomy.

Carcinoma, Signet Ring Cell↗
PubMed1992

Immunohistochemical study of epidermal growth factor and transforming growth factor-beta in the penetrating type of early gastric cancer.

We report that the penetrating type of early gastric cancer (PEN) is a specific type of early gastric cancer and that the poorly differentiated PEN type could be considered an initial lesion of linitis plastica-type cancer. We performed an immunohistochemical study to clarify the role of growth factors (epidermal growth factor [EGF] and transforming growth factor-beta [TGF-beta]) in the PEN type of early gastric cancer. The results indicated that the PEN type of early gastric cancer has a high growth capacity. Moreover, it was suggested that EGF was involved in its specific infiltrative growth and that both EGF and TGF-beta were involved in its specific scirrhous growth. From these findings, it was assumed that the immunohistochemical staining of EGF and TGF-beta in endoscopic biopsy specimens was useful for the diagnosis of the PEN type of gastric cancer and also for the diagnosis of the initial lesion of linitis plastica-type gastric cancer.

Epidermal Growth Factor↗
PubMed1986

Breast cancer metastases masquerading as primary gastric carcinoma.

Three patients are described in whom primary gastric carcinoma of the limits plastica type was initially diagnosed. All three patients had been treated for breast carcinoma; in two the disease had been bilateral, and in two the gastric tumour was the first manifestation of relapse of that patient's breast carcinoma. The three cases are examples of a pattern of spread particularly likely to occur in infiltrating lobular carcinoma of the breast. The importance of recognizing this is paramount if appropriate therapy is to be given. One of the patients has had an excellent remission on Tamoxifen, another may be showing some response, and the third has commenced treatment with Medroxyprogesterone acetate.

Aged↗
PubMed1994

Shifting proportions of gastric adenocarcinomas.

OBJECTIVES: To substantiate reports of increasing proportions of gastric adenocarcinoma of diffuse histologic type and in the proximal portion of the stomach, to better understand the prognostic features that govern survival, and to determine whether alterations of operative strategy might improve the surgical results. DESIGN: Retrospective analysis of 289 consecutive patients with gastric adenocarcinoma operated on by general surgeons over a 26-year period. Records were reviewed for location, histologic type, resection, operative mortality, lymph node status, and outcome. SETTING: The Section of Surgical Oncology, the New England Deaconess Hospital, Boston, Mass. MAIN OUTCOME MEASURES: Survival rate, length of life of the patients who died, and operative mortality. RESULTS: A marked and significant shift of gastric adenocarcinoma to a proximal location (54% between 1985 and 1990) occurred over 26 years (P = .0075) with a significant stage improvement at presentation (P = .0235). Percentages of cancers that were of the diffuse, poorly differentiated histologic type increased to 48%. More curative operations were performed in the last period (61%), and this upward trend from 37% was significant. Proximal gastric cancers had a poorer prognosis with more operative deaths, more lymph node metastases, and worse survival rates than distal cancers. Poor survival rates occurred even when comparing patients with negative lymph nodes or favorable histologic features with patients with similar distal cancers. CONCLUSIONS: Despite significant increases in the proportion of proximal cancers, survival rates have improved only slightly. Nodal status plays a less prognostic role than does location or histologic type but does provide prognostic information for individual locations. Survival rates for diffuse histologic cancer were consistently worse than those for intestinal histologic cancer, which emphasizes the underlying disease biology controlling outcome. Radical lymphadenectomy for gastric adenocarcinoma would not improve surgical outcome in the United States.

Actuarial Analysis↗
PubMed1984

A comparison of the metastatic pattern of infiltrating lobular carcinoma and infiltrating duct carcinoma of the breast.

The metastatic sites of infiltrating duct (IDC) and infiltrating lobular carcinoma (ILC) have been compared using both clinical and autopsy data. The following statistically significant differences were found: Lung parenchymal metastases were more common in IDC. Bone trephine biopsies were more likely to be positive in ILC. Carcinomatous meningitis was associated almost exclusively with ILC. Peritoneal/retroperitoneal metastases of distinctive pattern occurred in ILC. There was often associated linitis plastica-like involvement of the stomach wall and diffuse infiltration of the uterus. Hydronephrosis was a common secondary phenomenon.

Adult↗
PubMed2002

[Acute cor pulmonale, a rare manifestation of carcinomatous lymphangiosis and hemangiosis].

HISTORY AND CLINICAL DATA: A 33-year-old previously healthy woman developed acute cor pulmonale after nonspecific prodromal symptoms. Findings on echocardiography and computed tomography, elevated levels of d-dimers and progressively increased lactate dehydrogenase suggested recurrent small pulmonary emboli. DIAGNOSIS, TREATMENT AND COURSE: She was given i.v. heparin, but her condition abruptly deteriorated and, despite high-dosage fibrinolysis, she died in cardiopulmonary shock. Autopsy revealed chronic cor pulmonale and widely metastasized gastric carcinoma. Pulmonary embolism was excluded as the cause of death. CONCLUSION: Even currently available diagnostic means may fail to reveal advanced malignant disease, and the early diagnosis of gastric cancer remains a challenge. This case is also a reminder that autopsy may disprove a supposedly definite clinical diagnosis.

Acute Disease↗
PubMed1983

[Involvement of the colon in gastric and pancreatic processes].

Using representative case studies the diagnostic problems of colonic infiltration in cases of gastric and pancreatic neoplastic or inflammatory lesions are discussed. Typical signs in both barium enema and ultrasonography lead to the detection of secondary bowel wall lesions. Characteristic intraperitoneal pathways of spread and roentgen-morphologic features are important in the attempt to differentiate inflammatory from malignant infiltrations. In these cases ultrasonography, showing a diffuse thickening of gastric or bowel wall, is a useful additional diagnostic tool, which gives further information about topographical relations in the abdomen.

Adenocarcinoma, Scirrhous↗
PubMed1983

Fibronectin and type III collagen in epithelial neoplasms of gastrointestinal tract and salivary gland.

The distribution of fibronectin (FN) and collagen type III (IIIC) have been compared in a series of epithelial neoplasms from the gastrointestinal tract and salivary gland. The difficulty of distinguishing between FN of epithelial and fibroblastic origin is emphasised and evidence is presented for the validity of this distinction. In carcinomas FN was sometimes, but not invariably, lost from epithelial cell surfaces. Both FN and IIIC were increased in reactive connective tissue stroma. It is concluded that loss of cell surface FN is unlikely to be a useful diagnostic marker for malignancy, but that the occurrence of this phenomenon in vivo as in vitro indicates that it is biologically significant.

Adenocarcinoma↗
PubMed2001

Identification of the prelinitis condition in gastric cancer and analysis of TGF-beta, TGF-beta RII and pS2 expression.

In the present study, we performed an immunohistochemical examination of the expression of transforming growth factor-beta (TGF-beta), TGF-beta type II receptor (TGF-beta RII) and a trefoil peptide, pS2, in the several types of gastric cancer. The TGF-beta:TGF-beta RII ratios of IIc-like type and Ménétrier type closely resembled that of linitis type. pS2 was intensely expressed in cytoplasm of the superficial and foveolar epithelium, as well as in scirrhous type gastric cancers which retained the gastric or intestinal phenotype. However, pS2 expression was significantly (p < 0.05) reduced in linitis type gastric cancers (1 of 6; 17%) when compared with other scirrhous types of gastric cancers (13 of 22; 59%). A decrease in the TGF-beta:TGF-beta RII ratios in linitis type, IIc-like type and Ménétrier type gastric cancers may be associated with the fibrosis seen in these types of cancer. Furthermore, reduction of pS2 expression in linitis type gastric cancer may represent a dedifferentiation of the cancer from gastric or intestinal phenotype. Judging by the expression patterns of TGF-beta, TGF-beta RII and pS2, it is possible that IIc-like type and Ménétrier type gastric cancers are precursor lesions of linitis type gastric cancer.

Humans↗
PubMed2006

Different regression equations relate age to the incidence of Lauren types 1 and 2 stomach cancer in the SEER database: these equations are unaffected by sex or race.

BACKGROUND: Although impacts upon gastric cancer incidence of race, age, sex, and Lauren type have been individually explored, neither their importance when evaluated together nor the presence or absence of interactions among them have not been fully described. METHODS: This study, derived from SEER (Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute) data, analyzed the incidences of gastric cancer between the years 1992-2001. There were 7882 patients who had developed gastric cancer. The total denominator population was 145,155, 669 persons (68,395,787 for 1992-1996, 78,759,882 for 1997-2001). Patients with multiple tumors were evaluated as per the default of the SEER*Stat program. 160 age-, five year period (1992-1996 vs 1997-2001)-, sex-, race (Asian vs non-Asian)-, Lauren type- specific incidences were derived to form the stratified sample evaluated by linear regression. (160 groups = 2 five year periods x 2 race groups x 2 sexes x 2 Lauren types x 10 age groups.) Linear regression was used to analyze the importance of each of these explanatory variables and to see if there were interactions among the explanatory variables. RESULTS: Race, sex, age group, and Lauren type were found to be important explanatory variables, as were interactions between Lauren type and each of the other important explanatory variables. In the final model, the contribution of each explanatory variable was highly statistically significant (t > 5, d.f. 151, P < 0.00001). The regression equation for Lauren type 1 had different coefficients for the explanatory variables Race, Sex, and Age, than did the regression equation for Lauren type 2. CONCLUSION: The change of the incidence of stomach cancer with respect to age for Lauren type 1 stomach cancer differs from that for Lauren type 2 stomach cancers. The relationships between age and Lauren type do not differ across gender or race. The results support the notion that Lauren type 1 and Lauren type 2 gastric cancers have different etiologies and different patterns of progression from pre-cancer to cancer. The results should be validated by evaluation of other databases.

Adult↗
PubMed2006

Metastatic breast cancer to the gastrointestinal tract: a case series and review of the literature.

Metastatic breast cancer involving the hepatobiliary tract or ascites secondary to peritoneal carcinomatosis has been well described. Luminal gastrointestinal tract involvement is less common and recognition of the range of possible presentations is important for early and accurate diagnosis and treatment. We report 6 patients with a variety of presentations of metastatic breast cancer of the luminal gastrointestinal tract. These include oropharyngeal and esophageal involvement presenting as dysphagia with one case of pseudoachalasia, a linitis plastica-like picture with gastric narrowing and thickened folds, small bowel obstruction and multiple strictures mimicking Crohn's disease, and a colonic neoplasm presenting with obstruction. Lobular carcinoma, representing only 10% of breast cancers is more likely to metastasize to the gastrointestinal tract. These patients presented with gastrointestinal manifestations after an average of 9.5 years and as long as 20 years from initial diagnosis of breast cancer. Given the increased survival of breast cancer patients with current therapeutic regimes, more unusual presentations of metastatic disease, including involvement of the gastrointestinal tract can be anticipated.

Abdominal Pain↗
PubMed2004

Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973-2000: increase in the signet ring cell type.

CONTEXT: During the last 50 years, the incidence and mortality of gastric cancer has declined in many countries. This decline has primarily included the intestinal type (Lauren classification). However, there is an impression among pathologists that the diffuse type, especially the signet ring cell subtype, has become more prevalent. OBJECTIVES: Using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, we analyzed the trends of the 2 primary types (intestinal and diffuse) of gastric carcinomas from 1973 through 2000. DESIGN: Trends in age-adjusted rates were determined for gastric carcinomas through the SEER statistical program (SEER*Stat), which is available on the Internet to the public. RESULTS: During the period studied, the intestinal type continued to decline in males, females, African Americans, and whites. The intestinal type was more common in males than in females and more common in African Americans than in whites. In contrast, a consistent increase in the rate of the diffuse type of gastric carcinoma was seen during this period. The rate increased from 0.3 cases per 100 000 persons in 1973 to 1.8 cases per 100 000 persons in 2000. This increase was seen in males, females, African Americans, and whites. The predominant increase occurred in the signet ring type. CONCLUSIONS: The results indicate a progressive decrease in the incidence of the intestinal type of gastric cancer and an increase in the diffuse type of gastric carcinoma, especially the signet ring cell type. The clinical implications of the increase are considered.

Adenocarcinoma↗
PubMed2000

Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma.

BACKGROUND: Breast carcinoma is the most common malignancy in women. Metastatic involvement of the stomach is not well known. METHODS: Endoscopic features and treatment options were evaluated retrospectively for 51 patients with gastric metastases of breast carcinoma. RESULTS: The presenting sites of metastases were skeleton (43%), stomach (27%), lung (8%), and liver (4%). Diagnosis of gastric involvement was histologically confirmed in 41 patients and based on endoscopic features, despite negative biopsies in 10 patients. Six patients (12%) presented with nonfatal hemorrhage; in the others, symptoms were nonspecific: anorexia (71%), epigastric pain (53%), and vomiting (41%). Endoscopy showed 3 patterns: 18% localized lesions, 57% diffuse infiltration, and 25% external compression at the cardia or pylorus. Histology showed mainly lobular breast carcinoma (n = 36) compared with ductal carcinoma (n = 10) and other types (n = 5), contrary to the usual distribution. The overall response to systemic therapy was 46% (17 of 37 treated patients). Median survival from detection of gastric metastases was 10 months, with a 2-year survival rate of 23%. CONCLUSIONS: Gastric metastases usually derive from lobular rather than ductal breast carcinoma. Endoscopy revealed mainly a diffuse linitis plastica-like infiltration. Chemotherapy or hormonal treatment may result in fair palliation in selected patients, although many patients are heavily pretreated.

Adult↗
PubMed2001

[Cutaneous metastases revealing gastric linitis].

BACKGROUND: Cutaneous metastases from gastric carcinoma are uncommon and are exceptionally the first sign of disease. CASE REPORT: A 33-year-old man presented with nodular lesions that had developed three months earlier on the trunk, scalp and limbs. A skin biopsy suggested a metastatic origin. The upper digestive fibroscopy with biopsy demonstrated gastric linitis. Due to the presence of bone metastasis, treatment was not initiated, the patient died four months later. DISCUSSION: Metastatic dissemination of gastric carcinoma to the skin usually occurs in advanced stage disease. Generally, the skin lesions are painless hard nodules on the anterior abdominal wall. Our patient developed unusual inaugural skin metastases with an exceptional localization.

Adult↗