Geographical pathology of gastric carcinoma

Strain differences in the induction of intestinal metaplasia by X-irradiation in rats

Strain differences in the susceptibility of rats to induction of intestinal metaplasia by X-irradiation were examined. The gastric regions of 5-week-old males of five inbred strains of rats (F344/NSlc, Copenhagen, Buffalo/NacJcl, and ACI/NHos) and three strains of randomly bred rats (HOS:Donryu, Slc:Wistar, Slc:SD) were irradiated with a total dose of 20 Gy X-ray given in two equal fractions at 3-day interrals. When examined after the rats were killed, 6 months after the last irradiation, the number of intestinal metaplastic crypts positive for alkaline phosphatase (ALP) was highest in the Donryu and lowest in the Copenhagen rats. Morphologically, the number of crypts with intestinal metaplasia in the glandular stomachs of Donryu, Wistar, SD, and Buffalo rats was higher than the number in ACI, F344, and Copenhagen rats. Intestinal metaplasia was more frequently observed in the pyloric than in the fundic glands. These results demonstrate that the induction of intestinal metaplasia by X-irradiation in rats is greatly influenced by the rat strain.

Cancer of the stomach: a review of two hospitals in Korea and Japan

The records of 525 patients with primary adenocarcinoma of the stomach treated at Korea University Hospital (K.U.H.), Seoul, Korea, and 1,932 patients treated at National Cancer Center Hospital (N.C.C.), Tokyo, Japan, over a 7-year period were reviewed to study biologic characteristics and treatment results in the two hospitals. More than 70% of the patients were 41 to 70 years old in both hospitals, though K.U.H. had more younger patients and N.C.C. had more older patients. Comparison in regard to clinicopathologic features showed significant differences in type of cancer, tumor size, depth of invasion, lymph node metastasis, stage, and histologic type. Such a difference mostly was due to a greater frequency of early gastric cancer in N.C.C. patients (51.2%) than in K.U.H. patients (19.0%). Patients of K.U.H. were more likely to have advanced cancer, large invasive tumors, a higher percentage of lymph node metastasis, a higher stage, and more undifferentiated tumors. The 5-year survival rate of all resected cases was 69.5% in N.C.C. and 54.2% in K.U.H. (p > 0.05). Those factors which showed a significant difference in clinicopathologic features did not affect the survival difference between the two hospitals except in stage IIIb and signet-ring-cell cancer. The 5-year survival rate for stage IIIb was 18.0% in K.U.H. and 36.8% in N.C.C. It would seem that survival difference in stage IIIb related to extensive lymph node dissection in N.C.C. Survival difference in signet-ring-cell gastric cancer (31.2% in K.U.H. and 91.0% in N.C.C.) was related to the fact that 79.1% of signet-ring-cell gastric cancer patients in N.C.C. had early gastric cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal and diffuse types of gastric cancer: secular trends in Sweden since 1951

In order to test the hypothesis that the general decline in gastric cancer observed in many countries is due to a selective decline in Laurén's intestinal type, we re-examined all 427 histologic sections obtained from gastric carcinomas diagnosed at the Department of Pathology, University Hospital, Uppsala, Sweden, in 1951, 1961, 1971-72 and 1981. The relative proportions of intestinal and diffuse type cancers were compared. The intestinal type was significantly (P less than 0.001) more common among elderly people than in the younger age groups. The relative proportions of intestinal type carcinoma in the four periods under study were 65%, 55%, 42% and 60%, respectively. The absence of any clearly discernible trend over time contradicts the hypothesis of diverse secular trends for intestinal and diffuse types of gastric carcinoma.

Tritiated thymidine autoradiographic study on histogenesis and spreading of intestinal metaplasia in human stomach

The non-diseased portions of the antral mucosa of patients suffering from gastric cancer or ulcer were biopsied. The biopsy specimens were then labelled with 3H-thymidine in vitro, and distribution of the labelled epithelial cells in the normal pyloric and in the intestinalized mucosa was studied with autoradiography, and modes of histogenesis and spreading of the intestinal metaplasia were studied, and kinetic characteristics of the intestinalized mucosa were discussed. In the normal pyloric mucosa, the labelled cells were confined to the isthmus region (the middle one-third level of the mucosa), indicating that the surface epithelial and the pyloric glandular cells are normally replaced from the isthmus region. On the other hand, a zone of the labelled cells was found at the lower one-third level in the intestinalized mucosa. The absorptive and the goblet cells in the intestinalized mucosa appear to be renewed by about 70 hours in a fashion similar to that of the small intestine. Microscopic and autoradiographic analysis of the antral mucosa in the course of intestinalization indicates that the intestinal metaplasia begins in the isthmus region of the pyloric glandular tubules of an intact mucosa unaffected by gross injury through transformation of the generative cells from a pyloric to an intestinal pattern. This permits the pyloric lining cells to be replaced with intestinal villous cells and also permits the generative cell zone of the intestinal tubules to shift from the isthmus to the base of the gland until the process is complete. The downward shift of the intestinal tubules occurs in a framework of one of the branched pyloric glands and other glands disappear, resulting in a change of mucosal architectures of the antrum from a branched to a simple tubular gland. The intestinal metaplasia spreads in the mucosa through multi-focal (and sporadical) transformation of the neck generative cells in individual glandular tubules.