Gastric carcinoma: A multicentric lesion

Collins, William T.; Gall, Edward A.

doi:10.1002/1097-0142(195201)5:1<62::aid-cncr2820050109>3.0.co;2-h

Cited by 62 publications

(10 citation statements)

References 5 publications

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“…One can only guess at the time taken for a surface carcinoma to become actively invasive but the age differential suggests that it is several years. RELATIONSHIP TO CHRONIC SIMPLE ULCERS The present study fully confirms the conclusions of others that gastric carcinomas are commonly multifocal in origin (Collins and Gall, 1952;Moertel, Bargen, and Soule, 1957;Friesen et al, 1962). Stewart (1955) and Beasley (1960), in studies of more advanced cases, considered that a considerable proportion of cancers originate in simple chronic ulcers, but in this series of early cases separate foci of carcinoma were found away from the ulcer in all but one.…”

Section: Discussionsupporting

confidence: 93%

Surface carcinoma of the stomach

Mason¹

1965

Gut

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EDITORIAL SYNOPSIS Surface carcinomata confined to the mucosa have been found in 10% of stomachs operated on for apparently benign conditions. A multifocal origin is not uncommon. The prognosis is good. In this series the diagnosis was established by pathological studies on resected specimens but an increased awareness of this possibility may alert clinicians to make the diagnosis before operation.The majority of patients who present with a gastric carcinoma have a large growth which can be diagnosed with comparative ease, both by clinical procedures and by naked-eye inspection of the excised stomach. There is, however, a group of cases in which the growth is confined to the mucosa and, in the absence of an obvious tumour, the diagnosis can only be made by microscopic examination. The lesions have been studied by several authors (Ewing, 1936;Gutmann, Bertrand, and Peristiany, 1939;Mallory, 1940;Stout, 1942;Bamforth, 1955;Friesen, Dockerty, and ReMine, 1962) who have applied a variety of names but the most satisfactory term is probably 'superficial' or 'surface' carcinoma. Their particular importance lies both in the good prognosis and also in the information they provide on the pathogenesis of gastric cancer. The following series of cases is presented to show the incidence and pathological features of the condition. MATERIALS AND METHODSA total of 158 stomachs surgically removed by partial gastrectomy for apparently benign conditions were obtained fresh, opened along the greater curvature and pinned out flat on a cork board. Cytological studies were undertaken on the unfixed mucosa by scraping it in various areas with a toothbrush and spreading the material obtained onto a slide. Care was always taken to obtain a smear from the vicinity of any ulcer. The smears were fixed while still wet in Schaudinn's solution and stained with haemalum and eosin. The stomachs were then fixed on the cork board for 24 hours in formol saline. The entire lesser curvature was then sectioned using the 'swiss roll' technique of Magnus (1937), and stained with haematoxylin and eosin. Sections were also taken from any ulcers situated away from the lesser 'Present address: Department of Pathology, St. James's Hospital, Leeds. curve and from representative areas of the pyloric and body mucosa. Eight surface carcinomas were discovered by this means. When one of these lesions was found, it was mapped out and its size determined by taking further sections in a plane at right angles to the lesser curve as shown in Fig. 1, which illustrates the findings in case 1. A search was also made along the greater and lesser curvatures in all specimens for lymph nodes and sections taken of all those found.An additional four stomachs with surface carcinomas became available later and were examined in a similar way. Finally, a search through earlier gastrectomy specimens revealed three more stomachs in which surface carcinomas were present but these were not available for further sectioning.

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Section: Discussionsupporting

confidence: 93%

Surface carcinoma of the stomach

Mason¹

1965

Gut

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“…The fact that specific alterations at the analyzed loci can be drastically different in individual IM glands from the same patient suggests that these tissues could remodel their genome independently, regardless of whether or not they were derived from the same progenitor. Such a finding would support the suggestion of multi‐centric initiation for GA . Such a conclusion is further supported by the analysis of closely apposed IM glands, where changes in the MS markers are often unrelated, even though these glands have a high probability of being formed through a fission like process .…”

Section: Discussionsupporting

confidence: 67%

Spatially defined microsatellite analysis reveals extensive genetic mosaicism and clonal complexity in intestinal metaplastic glands

Guo

Zhou

Huang

et al. 2014

Intl Journal of Cancer

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Intestinal metaplasia (IM) has been recognized as the first irreversible precancerous stage of intestinal-type gastric cancer at which genetic instabilities, such as microsatellite (MS) instability and loss of heterozygosity, can already be detected. However, the extent and clonal relationship of these genetic lesions in the precancerous tissues are not fully appreciated. In this work, we have used well established MS markers to analyze the relatedness of spatially separated individual metaplastic glands as well as subsegments within single glands from the same patients. We found that individual IM glands frequently show different marker lengths even for closely apposed IM glands, suggesting that these tissues have already gained the ability to independently evolve their genome regardless of whether or not they share a common origin. Furthermore, within individual IM glands, there is also significant intra-gland diversity in the MS markers. Since most of these cells are not dividing and only have a limited lifespan, this result indicates that in each IM gland, a single dominant clone is rare and new clones are constantly created by either progenitor cells or stem cells. This greatly enhanced ability to create de novo genetic alterations may underlie the importance of this stage in the eventual progression toward cancer. Given the widely observed phenotype switch in the early stages of many solid tumors, whether this associated genetic stability is also an intrinsic property of metaplastic transformation should be extensively characterized to further our understanding of cancer initiation.

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“…With regard to the clonality of multiple gastric cancers, a theory proposing a multicentric or independent origin rather than the local or distant spread of 1 cancer (multifocality) has been favored 4, 31, 32. In our results, 6 patients showed concordant results of the MSI + phenotype and mutations of the TGF‐βRII gene in individual cancers, while only 3 cases showed discordant MSI + phenotype.…”

Section: Discussionmentioning

confidence: 99%