1982年 · 第02卷第02期

Of 1881 patients with gastric cancer admitted to the surgical ward of the Ruijin Hospital from January, 1958 through December, 1981, 621 cases underwent various types of operations with an overall 5-yr survival rate of 17.86%. Of these, 685 were submitted to the so-called extended radical operation which yielded an overall 5-yr survival rate of 30.04%, the corresponding figures for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ patients being 71.34%, 48.31%, 29.41% and 8.92% respectively. Basing on the analysis of data, it is proposed that for the early lesions, subtotal gastrectomy accompanied by curage of regional lymph nodes is an adequate operation; the extended radical operation is indicated for Stages Ⅱ and Ⅲ; while Stage Ⅳ cases should be treated by appropriate simpler procedures. Except for cases with suspicious para-cardial nodes or those which are located primarily at the cardia or at the body of the stomach, near-total gastrectomy is deemed a better choice than the total gastrectomy.

Two hundred surgically resected gastric specimens with malignant or non-malignant primary lesions were examined. Among them 65 minute cancer foci less than 5 mm in diameter were detected from 25 cases. The pathological features of the micro-gastric carcinoma were represented as: (1) Macroscopically, they were of flat type (type II) in absolute majority. (2) Histologically, they were relatively simpler in type, mainly, the tubular and signet ring cell carcinoma. (3) The tumor cells were seen to be relatively more undifferentiated in general. (4) Stroma in tumor tissue was scanty and lymphocytic reaction in the extending border was minimal. (5) The lesions were generally intramucosal except in a few cases there were submucosal invasions. The minute cancer foci usually budded out multicentrically in a "field of generation", and all of them were derived from the stem cell of the mucosa. The malignant changes of the gastric mucosa proper were generally known to form diffuse carcinoma of the "gastric type", but in this paper goblet cell carcinoma was formed directly and so was some tubular type. The tumors derived from the intestinal metaplastic epithelium were generally recognized as to form tubular carcinoma of the "intestinal type", but we found that they also gave rise to diffuse carcinoma of the stem cell type.

This article presents the endoscopic observation of 14 cases of small gastric carcinoma (10-6 mm in diameter) and 8 of microgastric carcinoma (less than 5 mm), and the description of their different patterns. Under endoscopic examination the diagnoses of 8 cases (6 of micro-gastric carcinoma) were missed by naked eyes, since the micro-gastric carcinoma and superficial ulcer or superficial erosion were similar in appearance and thus difficult to differentiate from each other. Hence, the authors recommend the histologic and cytologic studies as routine procedures in differentiating the small carcinoma and erosion. This is considered to be an indispensable means to enhance the rate of detection of microgastric carcinoma and reduce the missed diagnosis. Furthermore, the authors introduce the experiences and technics in performing the gastric biopsy.

Four cases of pernicious anemia and one case of latent pernicious anemia were discovered in a study of chronic atrophic gastritis in Shanghai. All showed marked mucosal atrophy of the stomach body with minimal changes in gastric antrum, marked hypochlorhydria or achlorhydria, and a positive PCA test in two of three cases tested. Four of them showed morphological characteristics of megaloblastic anemia and were rapidly reverted to normal after the treatment of vitamin B₁₂. All showed abnormal dual isotope test suggesting the lack of intrinsic factor and/or the presence of anti-intrinsic factor antibodies. One of the four cases had low serum vitaming B₁₂ level (65 pg/ml), but the other three had normal level probably due to determination done after the treatment of vitamin B₁₂. The fifth case had no anemia but had an abnormal dual isotope test, and was in agreement with the diagnosis of latent pernicious anemia. This report is considered to be the first one documenting the presence of genuine pernicious anemia in China.

The kinetics of cell division in PHA-stimulated lymphocytes from 14 patients with esophagus cancer was studied by using the method of 5-BrdUrd incorporation into cell DNA. The results were: (1) After 3 days of culture with PHA, the percentages of the patients' lymphocytes metaphases in 1st-, 2nd- and 3rd-cycle were 52.4, 31.0, and 16.6 respectively, whereas in normal individuals were 32.2, 39.4 and 28.4 respectively (P<0.001). (2) The mitotic rate of lymphocytes in the patients was 5.09%, lower than that of the normal individuals, 6.93% (P<0.01). (3) Lymphocytes of the patients gave the same frequencies of SCE's as in the healthy persons. The authors consider that the decreased kinetics of cell division of lymphocytes in these cancer patients may be an important indicator in decreased cellular immunity.

Four cases of idiopathic intestinal pseudoobstruction are reported. Among them two were siblings. The main clinical manifestations were recurrent episodes of abdominal pain and bloating, nausea and vomiting, and diarrhea. Roentgenologic studies of GI tract demonstrated small bowel dilatation with gas-fluid levels, but no parenchymatous changes. The barium emptying was delayed. Only one case was remitted after palliative treatment and discharged, the other three died after operation. Autopies performed in two cases showed extreme dilatation of small bowel and degenerative changes of mesenteric and myenteric plexuses. The pathogenesis, clinical manifestation, differential diagnosis and treatment of this disease were briefly discussed.

This report presents our experiences in the use of ERCP for the diagnosis of 82 cases of pancreatic carcinoma and 37 cases of chronic pancreatitis. The findings indicating pancreatic carcinoma were: stenosis and obstruction in 61 cases, "double duct sign" in 6, mixed changes in 6, abnormalities of side branches in tumor area in 5, abnormalities of common bile duct in 19, but normal findings in 4. In correlation with the pathology, the X-ray findings were classified into four types: obstructed type, stenosed type, mixed type and filling defect type. The findings of chronic pancreatitis were: minimal in 11 cases, moderate in 6 and advanced in 20. These appearances indicated three different stages of pathologic changes in chronic pancreatitis. The differential diagnosis of pancreatic carcinoma and chronic pancreatitis as well as the technics of the examination were discussed.

Among the biopsies from 800 cases of gastric mucosa taken during the year of 1974~1980, 251 cases (31.38%) were found to have gastric carcinoma. The majority of the specimens were found to be of differentiated type histologically and of intestinal type histogenetically. By using Alcian blue-PAS mucin histochemical staining, both intestinal and gastral types showed various degrees of differentiation which was related to age and sex of the patients. The differential diagnosis of atypical epithelial proliferation fro n well-differentiated adenocarcinoma, and some problems in diagnosing the undifferentiated cancer, signet ring cell carcinoma and malignant lymphoma, as well as the histopathological features of the early gastric carcinoma were discussed.