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Gastric Carcinoma with Rapid Deterioration: Autopsy cases clinically considered as non-neoplastic disorders I. Kino 1 1Department of Pathology, Tokyo University and Tokyo University Branch Hospital pp.467-474
Published Date 1974/4/25
DOI https://doi.org/10.11477/mf.1403111794
  • Abstract
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 Eleven autopsy cases of gastric carcinoma, clinically diagnosed as non-neoplastic disorders, as representative cases demonstrating rapid generalized deterioration, were selected from the files of Department of Pathology, Tokyo University and Section of Pathology, Central Laboratry, Tokyo University Branch Hospital during the years 1958~1973. This comprised 0.13% of the total 8,395 autopsy cases and 2.1% of the total 529 autopsy cases for gastric cancer.

 According to clinical manifestations the following classification was made.

1. Cardiopulmonary insufficiency

2. Meningeal irritation with increased intracranial pressure 2 cases

3. Symptoms of peritonitis 3 cases

4. Hematoporetic disorders 2 cases

5. Generalized infection 2 cases

 Consequently 7 cases were considered as infection diseases (mostly tbc.) and 4 as non-infection disorders. Nine cases demonstrated clinical symptoms caused by cancer metastasis per se. One patient died of purulent peritonitis due to perforation of ulcerative gastric cancer, and the other succumbed to sepsis secondary to gastric cancer. The youngest age was 18 and the oldest 73 with the mean years of 37.4. The shortest clinical course was 3 days, in which case the diagnosis was acute cardiac failure, and the longest was 7 months with a mean value of approximately 2 1/2 months. There has been no case of gastric cancer clinically diagnosed as infections or hematopoietic diseases since 1969, suggesting great improvement of X-ray diagnosis and endoscopic techniques.

 Pathologically all cases but one revealed cancer reaching the serosa. The exceptional case was early cancer, 2×2 cm in size, involving only the mucosa and submucosa, with extensive meningeal metastasis. Histologically 9 cases showed adenocarcinoma mucocellulare (undifferentiated or poorly differentiated adenocarcinoma). In the remaining two cases one showed tubular pattern, the other varied structures ranging from mucocellular to papillotubular adenocarcinoma. The latter was 18-year-old female with clinical diagnosis of miliary tuberculosis.

 Clinical manifestations exactly corresponded to the main cancer metastasis, that is, cardiopulmonary insufficiency to diffuse lung carcinomatosis, meningeal irritation to diffuse meningeal metastasis; hematcpoietic disorders to extensive bone marrow metastasis. Nine patients, all having distant metastasis with or without peritoneal dissemination, demonstrated retroperitoneal lymph node involvement, most of which also revealed Virchow's meatastasis. In 6 of llcases there was diffuse pulmonary meatastasis in the form of vascular and/or lymphatic tumor embodism. In 3 and 5 cases there were diffuse meningeal and bone marrow meatstases, respectively. Of 5 cases with bone metastasis 4 had metastatic lung carcinomatosis at the same time. Because bone marrow metastasis was hematogenous and in metastatic pulmonary carcinomatosis both vascular and lymphatic involvements were present the author maintains the theory of the hematogenous nature of pulmonary lymphangitis carcinomatosa. In addition other recent investigations also support this theory.

 As for the meningeal metastasis most past studies favoured lymphatic spread through the vertebral foramen transversarium partly because in most cases retroperitoneal lymph-nodes were extensively involved by cancer. However, since some reported cases had no retroperitoneal involvement and Virchow's nodes were mostly invaded by cancer, meningeal carcinomatosis might also be due to hematogeneous spread. The fact that histology in most cases with lung and bone metastasis showed similar features to that of cases with diffuse meningeal carcinomatosis also supports the theory of hematogenous metastasis.


Copyright © 1974, 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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