Metastatic Tumor of the Gastrointestinal Tract Seiji Haraoka 1 1Department of Pathology, Chikushi Hospital, Fukuoka University Keyword: 消化管転移性腫瘍 , 剖検 , 消化管 , desmoplastic reaction pp.1755-1771
Published Date 2003/12/25
DOI https://doi.org/10.11477/mf.1403100705
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 In order to grasp the characteristic features of metastatic tumor of the gastrointestinal tract,73,134 autopsy cases registered with a nationwide pathologic autopsy database in Japan and 50 surgical specimens encountered at our institute in the past 13 years were studied from the standpoint of clinicopathology. The autopsy series revealed that metastasis to the small intestine occurred most frequently in the gastrointestinal tract. The incidence of metastasis to the small intestine, colon/rectum/vermiform appendix, stomach, oesophagus, anal canal was 8.53 %,6.56 %,5.86 %,3.90 %,0.07 %, respectively. The primary site of malignant tumor that has a high incidence of metastasis to the gastrointestinal tract was mostly a neighboring organ or an intraabdominal organ. Therefore, most metastatic tumors of the gastrointestinal tract in autopsy case seems to be attributable to direct invasion or disseminated metastasis from a neighboring organ, reflecting the end stage of a malignant tumor of an intra-abdominal organ. Among the malignant tumors of the extra-abdominal organ, the incidence of metastasis of lung cancer to the stomach, small intestine and large intestine was high. On the other hand, examination of the 50 surgical cases(54 lesions)revealed that metastatic tumors of the gastrointestinal tract had developed in 2 cases of the oesophagus,4 cases of the stomach,19 cases of the small intestine,4 cases of the vermiform appendix,21 cases of the colon, and in 4 cases of the rectum. The most common primary lesions were in the stomach and colon, with 14 cases each. The primary tumors of extra-abdominal organs were lung cancer in 7 cases and breast cancer in 1 case. The most common histological cell type of a primary tumor was adenocarcinoma(42/54,77.8 %). The histological type of the primary tumor of lung cancer was anaplastic carcinoma(large cell carcinoma)in 5 cases and adenocarcinoma in 2 cases. According to the classification of pathways of spread and metastasis of tumors, the cases were classified as disseminated metastasis(22 cases), direct invasion(17 cases), intramural metastasis(8 cases), and distant metastasis(7 cases). The most common microscopic features of the metastatic tumors resulting from direct invasion from a neighboring organ or intraperitoneal seeding were the proliferation of carcinoma cells mainly in the deeper portion from the muscularis propria accompanied with stromal fibrosis(desmoplastic reaction)in the submucosa and subserosal layer. On the other hand, the solid proliferation of carcinoma cells arranged in medullary pattern with scant fibrous stroma in the mucosa and submucosal layer was the microscopic feature observed in many cases classified as intramural metastasis and distant metastasis via lymphatic or blood vessel permeation. It was especially noted that the solid growth pattern in the mucosa was presented only in cases of distant metastasis. In conclusion, to grasp the characteristic clinicopathological features of tumors of the gastrointestinal tract is necessary for detecting whether or not they are metastatic tumors, and also for locating the primary site of the metastasis. To discover this in the early stages of disease helps in the choice of a precise and effective therapy.

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