Chemotherapy of unresectable Borrmann's type IV stomach cancer

In the inoperable Borrmann type 4 Gastric cancer, which is to be used as a synonym of gastric scirrhus clinically, it is regrettable but effect is hardly expected from radiotherapy or immunotherapy, and the treatment relies entirely on chemotherapy. We have reported the results of our questionnaires collected from 108 hospitals (internal medicine-40 and surgical-68) all over Japan to investigate the prevailing circumstances of inoperable Borrmann type 4 gastric cancer. Therapies performed by singular medication were: 1). oral and intravenous 5-FU-33.3%, 2). oral, intravenous and suppository tegafur-27.4% and intravenous MMC-27.4%, of the total 84 methods reported in the field of internal medicine; and 1). administration of 5-FU-29.1%, 2). intravenous MMC-26.8% and 3). tegafur-22%, of the total 127 therapies reported in the surgical field. The therapies performed by combined medications were: 1). 5-FU+MMC-22.6%, 2). MFC-12.1%, 3). tegafur+MMC, and FAM-8.3% (further 29 examples of combination medications consisting of 2-4 preparations), of the total 124 therapies reported in the field of internal medicine; and 1). 5-FU+MMC-22.6%, 2). MFC-12.1% and tegafur+MMC-7.3% (further 37 examples consisting of 2-4 preparations), of the total 124 therapies reported in the surgical field. The total cases judged as 'effective' in all the hospitals were 71. The breakdown is as follows: 1). 'effective for the primary focus'-47 cases/66.7%, expansion of affected site proved by gastric radiogram and endoscopic image-33 cases/46.5%, expansion of affected site proved only by endoscopy-4 cases/5.6%; shrinkage of malignant ulcer and flattening of randwall, disappearance of extra-gastric compression by endoscopic image-2 cases. 2). ineffective for the primary focus'-24 cases/33.8%, of which disappearance of or decrease in ascites-11 cases/15.5%; improvement of anorexia, nausea, vomiting, abdominal fullness, strange epigastric sensation, abnormal evacuation, disappearance of diarrhea etc. and increase in body weight-13 cases. In 50% survival period, the cases in which chemotherapy was judged as entirely ineffective were 283 and the period was 2.9 months. The 50i% survival period for the above-mentioned total effective cases was 8.5 months, of which the 50%r survival period for the effective cases by radiographic and endoscopic findings in the primary focus was 10.65 months showing the prolongation effect of life span. One year survival rate was also 36%. Draft of the Critria of Cancer Chemotherapy for Gastric Cancer proposed by Japanese Research Society for Gastric Cancer, which including the evaluation of Borrmann type 4 cancer, was introduced.     

The histological type and lymphatic permeation of diffuse infiltrative carcinoma of the stomach

Although diffuse infiltrative carcinomas of the stomach are mostly composed of anaplastic/mucocellular type, some cases show tubular/trabeculoacinar carcinoma in a large or small part of the tumor. We have subdivided diffuse infiltrative carcinoma into two subtypes, mixed type and pure type, from the viewpoint of the carcinoma's histological structure and lymphatic permeation (LP). The former, or mixed type, includes a tubular/trabeculoacinar element in at least 10% of the tumor tissue, and shows a high tendency for LP. On the other hand, the latter, or pure type, consists almost exclusively of anaplastic/mucocellular carcinoma with a low tendency for LP. No difference in the frequency of LP between males and females was found in the pure type carcinomas, but a significantly higher frequency and grade of LP was observed in males in the mixed type carcinomas. Further, even in the pure type, the LP was rather frequent in people 60 or more years old. Thus, lymphatic permeation seems to be influenced not only by the histological type of the carcinoma but also by sex and age.     

Sex hormone dependency and endocrine therapy in diffuse carcinoma of the stomach

In order to investigate the hormone dependency of gastric cancer, the presence of estrogen receptor (E.R.) in surgically resected carcinomatous tissues was studied. E.R. assay was performed by dextran coated charcoal method. We have found 10% E.R. positive cases in gastric cancer (4/40). These 4 patients were all female, and showed Borrmann 3 or 4 type macroscopically. The histological types of these cases were signet-ring cell carcinoma or poorly differentiated adenocarcinoma. Furthermore, experimental studies suggest that the growth of signet-ring cell carcinoma transplanted on nude mice depends on sex hormone. Based on these observations, the clinical trial of chemo-endocrine therapy after gastrectomy for female patients with diffuse carcinoma of the stomach has been performed in our hospital since 1980. The therapy consists of Mitomycin-C plus subsequent Tegafur, with or without Tamoxifen 20 mg/day given orally, twice a day starting 2 weeks after surgery. The results are as follows: The cumulative 3-year survival rate in 21 cases receiving chemo-endocrine therapy (TAM+) after gastrectomy revealed higher (43.3%) than that (5.6%) in 23 cases receiving chemotherapy alone (TAM-). Furthermore, 2 and 3 years survival rates of TAM + in curatively resected cases (8 cases) were both 100% including 2 recurrent cases. In TAM- 10 cases, 2 and 3 years survival rate showed 68.4% and 16.3% respectively with statistically significance (p less than 0.01). Chemo-endocrine therapy for non-curatively resected and recurrent cases were also effective. This result suggests that the chemo-endocrine therapy after gastrectomy may be a new hopeful adjuvant in female patients with diffuse carcinoma of the stomach.     

胃微囊型及粘液型印戒细胞癌

应用电镜、光镜及免疫组化法对９例胃印戒细胞癌进行研究，发现大部分印戒细胞癌是由胞质内大量粘液颗粒积聚所致少数则由胞质内微囊形成所致。由此，我们把胃印戒细胞癌分为粘液型和微囊型两型。根据癌细胞质中有无粘液分泌颗粒，粘液印戒细胞癌又可分为颗粒型，粘液池型和中间型３种亚型。     

Different expression of Bcl-2 in diffuse and intestinal type stomach carcinomas

The aim of the present study was to examine immunohistochemically the expression of Bcl-2 in stomach carcinomas in relation to the clinical staging of the patients. Staining with a monoclonal antibody against Bcl-2 was positive in 60% of the 40 investigated carcinomas. A significant difference in staining patterns could be demonstrated, as 87% of the intestinal type tumors and only 44% of tumors of the diffuse type showed positive staining. No specific relation was observed concerning pTNM staging or tumor grading. Four investigated stomach carcinoma cell lines showed strong positive staining. We conclude from our results that the expression of Bcl-2 is a common phenomenon in stomach carcinomas, where it is related to more differentiated tumors, but its detection seems of no direct value for clinical staging of the patients.     

Intestinal and diffuse carcinoma of the stomach among the ethnic and dialect groups in Singapore

This study attempts to determine the relative prevalence of intestinal-type and diffuse-type carcinomas (using a modified Lauren classification of gastric carcinomas) and to evaluate its significance in relation to the difference in stomach cancer risks among the different ethnic and Chinese dialect groups in Singapore. Of the 648 cases of primary adenocarcinoma of the stomach studied, 405 (62.5%) were of the intestinal type, 206 (31.8%) of the diffuse type, and 37 (5.7%) of the mixed type. Men had higher proportions of intestinal-type carcinoma than women. The intestinal-diffuse carcinoma ratio increased progressively with age. Although the relative intestinal-diffuse carcinoma ratios in women appeared to reflect the relative incidence rates of stomach cancer of the different ethnic and dialect groups, the ratios in men were inconsistent. Indian men had a higher intestinal-diffuse carcinoma ratio than Chinese men despite a lower incidence of stomach cancer. Hokkien men had the highest incidence of stomach cancer and the lowest intestinal-diffuse carcinoma ratio among the Chinese dialect groups. The use of the ratio as an indicator of relative risks for gastric cancer between populations of different genetic makeup is inconsistent and unreliable.     

A case of primary lymphoma of the stomach, diffuse lymphoplasmacytic type, with massive hematemesis

A case of primary lymphoma of the stomach with massive hematemesis and melena who underwent emergency gastrectomy is reported. The patient was a 72-year-old woman. The tumor was 3.5 X 3.0 cm in size and occupied the posterior wall of the upper part of the gastric body. The surface of the tumor was covered with hematoma, and was there was a lack of gastric mucosa. Histological diagnosis of the tumor was primary gastric lymphoma, diffuse lymphoplasmacytic B-cell type, and monoclonal kappa-light chain was demonstrated by the immunohistochemical method. The bleeding source of the tumor tissues was a ruptured artery invading the tumor tissue in the submucosal layer of the stomach.     

Chemotherapy of malignant diffuse mesothelioma.

The clinicopathologic features of six pleural and one peritoneal mesothelioma were analyzed. Six patients were treated with either adriamycin or a multiple drug regimen consisting of cyclophosphamide, vincristine, methotrexate, and 5-fluorouracil (COMF). Of those who received COMF, one obtained a complete response lasting 19 months and two had partial responses lasting 3 and 7 months. Adriamycin was administered to five patients. Two obtained a complete response lasting 19 and 7 months. Three had partial responses lasting 2, 6, and 9 months. Grading of response was often difficult requiring serial review of chest x-rays. Survival from diagnosis ranged from 2 to 39 months, with a median of 9 months. We conclude that adriamycin or COMF treatment may offer worthwhile remissions in mesothelioma and that malignant diffuse mesothelioma is more responsive to chemotherapy than previously realized.     

Adenosquamous carcinoma of the stomach

The appearance of adenosquamous structures in cancer of the stomach was studied in 385 resected specimens. Such structures were observed in 9.1% of the specimens. However, they were not found in cases in which the invasion was limited to the mucosa. The frequency of the appearance increased in correlation with the extent of the cancerous invasion. The type of adenocarcinoma that coexisted with the squamous changes was the intestinal type of Lauren in 68% of the specimens. This indicates that the squamous structures, seen in gastric cancer result from secondary metaplasia of the intestinal type in this condition.     

Mucoepidermoid carcinoma of the stomach

A rare case of mucoepidermoid carcinoma of the stomach in a 70-year-old man is reported. The protruded mass with central depression resembled a submucosal tumor, located on the posterior wall of a part of the cardia, fornix, and upper corpus. Histologically, submucosal ectopic glands composed of columnar cells, mucus-producing cells that closely resemble gastric epithelium, and ciliated epithelium were observed. The tumor consisted of an admixture of cuboidal, columnar cells, mucus-producing cells, singled or pseudostratified ciliated epithelium, and squamous metaplastic cells. The tumor cells were intimately continuous with the submucosal ectopic glands. Gradual transition between tumor cells and epithelium of submucosal ectopic glands was recognized. It is supposed that mucoepidermoid carcinoma of the stomach in this case derived from preexisting submucosal ectopic mucous glands of the stomach.     

Efficacy of intraperitoneal chemotherapy for advanced Borrmann type IV gastric carcinoma

We report four patients with advanced Borrmann type IV gastric carcinoma, in whom intraperitoneal chemotherapy with low-dose CDDP and 5-FU plus MMC via a peritoneal port was effective against peritoneal metastasis. However, none of the four patients survived for a long period. During treatment, they were followed on an outpatient basis and received intraperitoneal chemotherapy biweekly with good control of peritoneal metastasis. The ratio of the outpatient follow-up period was more than 50% in all these patients. Intraperitoneal chemotherapy may be effective for controlling peritoneal metastasis of advanced Borrmann type IV gastric carcinoma, and contribute to maintaining the patient's quality of life.     

Epidemiology of breast carcinoma IV: Age and histologic tumor type

The purpose of this study was to correlate major chronologic events known to have a bearing on the risk for developing breast carcinoma with histologic tumor type. Data were obtained for 1024 consecutively treated patients with the seven most common forms of mammary carcinoma. The age of occurrence of the following events was determined: menarche; first marriage; first pregnancy and first childbirth; last pregnancy and last childhood; diagnosis. The interval between each of these events and diagnosis of breast cancer was also calculated. Patients with medullary carcinoma had a significantly lower mean age at diagnosis than those with any of the other tumor types. Because of the lower mean age at diagnosis, medullary carcinoma patients were found to have significantly shorter intervals between age at diagnosis and the following: menarche, first pregnancy or first childbirth, and last pregnancy or last childbirth, Intervals between age at diagnosis and these other events were not significantly different among patients with other types of carcinoma. The ages of menarche, marriage, or pregnancy were not related independently to any tumor type. These data indicate that except for current age. the age of occurrence of major risk factors for developing breast cancer is unrelated to the histological type of tumor a patient develops.     

癌胚抗原、上皮细胞膜抗原及Ⅳ型胶原与胃癌分化、浸润和转移的关系

 本文应用免疫组化方法对66例胃癌组织内CEA、EMA及ColⅣ的含量及分布进行了观察，用以探讨CEA、EMA及ColⅣ的表达与胃癌分化、浸润及转移的关系。结果表明：正常胃粘膜上皮细胞CEA及EMA阴性，ColⅣ见于胃腺管基底膜内，呈连续线状。分化型癌具有较强合成EMA及ColⅣ的能力（EMAP<0.05；ColⅣP<0.01）。随胃癌侵袭能力的增加，CEA含量明显增加（P<0.05；P<0.01），ColⅣ含量明显减少（P<0.05）。术后呈恶性经过的胃癌，ColⅣ含量有降低的趋势，但差异无显著意义（P>0.05）.作者认为正常胃粘膜与胃癌组织CEA、EMA及ColⅣ含量及分布上的差异，使之可能成为临床诊断胃癌，判断其分化程度的有用指标。CEA含量增加和/或ColⅣ含量减少的胃癌，恶性度较高，侵袭力较强，预后较差。