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Clinical and Histopathological Features of Scirrhous Carcinoma of the Stomach K. Nakamura 1,2 , K. Sugano 2 , N. Sugiyama 3 , M. Maruyama 3 , Y. Baba 3 , K. Takagi 4 1Department of Pathology, Institute of Basic Medicine, Tsukuba University 2Department of Pathology, Cancer Institute 3Department of Internal Medicine, Cancer Institute Hospital 4Department of Surgery, Cancer Institute Hospital pp.1275-1284
Published Date 1976/10/25
DOI https://doi.org/10.11477/mf.1403107447
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 The purpose of the present paper is to summarize clinical and histopathological features of scirrhous carcinoma of the stomach which is synonymous with carcinoma fibrosum (Borrmann, R.; Konjetzny, G. E.), diffuse carcinoma (Järvi, O. H., Lauren, P.), diffusely infiltrative carcinoma (Ming, Si-Ch.), and undifferentiated adenocarcinoma (Nakamura, K.), and furthermore to deduce a period of time from cancer development to the leather bottle stomach.

 Histologically, cells of scirrhous carcinoma are small and scatteringly present in dense fibrous tissue (Fig. 1), and are rare to form glandular pattern. This typical pattern of scirrhous carcinoma is recognized in the gastric layers except the mucosa. In the mucosa involved by scirrhous carcinoma cells, there is no proliferation of connective tissue. In the mucosa, cells of scirrhous carcinoma diffusely infiltrate without formation of gland, or show signet ring cell type, or show trabecular arrangement (Fig. 6). There is nearly one-to-one correspondence between these histological patterns in the mucosa and scirrhous carcinoma. Consequently, it is evident that intramucosal carcinoma showing these three patterns is early phase of scirrhous carcinoma. Carcinoma showing these three patterns in the mucosa and scirrhous carcinoma belong histogenetically to the same category classified as undifferentiated adenocarcinoma. The undifferentiated adenocarcinoma has been named from the view-point of structure atypism, and is a general term for these three histological patterns in the mucosa and scirrhous carcinoma in the gastric layers except the mucosa. The undifferentiated adenocarcinoma arises from the ordinary mucosa of the stomach consisting of the pyloric, fundic and cardiac gland mucosae, and is characteristic of diffuse infiltration in the gastric wall.

 Macroscopically, the majority of undifferentiated adenocarcinoma shows depressed type (IIc, IIc+III, III+IIc) in early phase, and shows diffusely infiltrative type (Borrmann 4, diffuse carcinoma, diffusely infiltrative carcinoma) in advanced phase (Fig. 3).

 The undifferentiated adenocarcinoma becomes infrequently a state called linitis plastica type. As to primary location of carcinoma of linitis plastica type, the undifferentiated carcinoma having arisen from the fundic gland mucosa (the corpus) becomes more frequently linitis plastica than the one from the pyloric gland mucosa (the antrum) (Fig. 4). This reason may be that it is clinically difficult to disclose a small lesion in the corpus of the stomach lined with the fundic gland mucosa except the lesser curvature site. Therefore, the undifferentiated adenocarcinoma arising from the fundic gland mucosa is shown to be linitis plastica in many instances.

 It has been deduced that a period of time from cancer development to linitis plastica (leather bottle stomach) is several years (about 6 years) (Table 4).

 The prognosis of patients having the undifferentiated adenocarcinoma has been generally interpreted as worse than that of patients having differentiated carcinoma, such as tubular or papillary adenocarcinoma. However, the prognosis of patients having the undifferentiated adenocarcinoma measuring less than 4 cm in the largest diameter is better than that of patients having the differentiated adenocarcinoma (Fig. 10). In carcinoma measuring more than 4 cm in the largest diameter and infiltrating up to the proper muscle, the prognosis of patients having the undifferentiated is also better than that of patients having the differentiated (Fig. 11). Meanwhile, in patients operated on for carcinoma penetrating the proper muscle and measuring more than 4 cm in the largest diameter, the prognosis is worse in the undifferentiated than in the differentiated (Fig. 11).


Copyright © 1976, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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