T Toda

In a retrospective study of 503 cases of early gastric cancer, 17 of the patients had died of a recurrence of the gastric cancer and 72 had died of unrelated causes. The cumulative recurrence mortality rates were 2.2% at 9 years for mucosal cancer and 8.4% at 8 years for submucosal cancer. The recurrence patterns of early gastric cancer were hematogenic metastasis to the liver, lung, or bone (nine cases), recurrence from lymph nodes (three cases), and recurrence in the residual stomach (five cases). Submucosal cancers with a macroscopically elevated appearance, lymph node metastasis, and evidence of vessel invasion were the high-risk cancers for hematogenic recurrence, and adjuvant chemotherapy should be prescribed. Two cases of lymph node recurrence were attributed to inadequacy of lymph node dissection. Because metastasis to the group 2 lymph nodes was noted in 1.5% of cases of early gastric cancer and a macroscopic diagnosis of nodal status was inaccurate, complete dissection should be performed regardless of identification of metastasis. Five cases of recurrence in the residual stomach were attributed to overlooked lesions of multiple carcinoma and were detected at an advanced stage. Careful and regular postoperative follow-up is required to detect these recurrences at an early stage.

A 39-year old woman, with a pancreatic arteriovenous malformation (AVM) which ruptured into the pancreatic duct, was treated successfully with distal pancreatectomy and splenectomy. Histological examinations revealed an AVM with extravasation into the pancreatic ducts. A review of the cases reported to date emphasizes the importance of physical signs, individual histories and angiographic studies for early diagnosis and surgery.

Six hundred and two consecutive cases of gastric cancer and 204 of colorectal cancer in recent decades were investigated for recurrence. Recurrence occurred in 103 cases of gastric cancer and 31 cases of colorectal cancer. We classified three categories of recurrent patterns; A: local, B: peritoneal dissemination, and C: distant metastasis. In gastric cancer, 11 cases (11%) were grouped A, 50 (48%) were B, and 42 (41%) were C. Similarly, 12 (39%) were grouped A, 5 (16%) were B, and 14 (45%) were C in colorectal cancer. The incidence of local recurrence was more increased in colorectal cancer than in gastric cancer (p < 0.01). On the contrary, that of peritoneal dissemination was more increased in gastric cancer than in colorectal cancer (p < 0.01). In gastric cancer, 8 cases of 103 survived more than 5 years after operation, furthermore 7 cases obtained more than 5 years of tumor-free interval. At the time of diagnosis of recurrence, data of serum CEA was available in 77 for gastric cancer and 29 for colon cancer. CEA positive cases were revealed 32 (42%) for gastric cancer and 24 (83%) for colorectal cancer (p < 0.01). Our data clarified the different recurrence patterns between gastric cancer and colorectal cancer. And suggest that more than 5 years follow-up should be needed in patients with gastric cancer.

OBJECTIVE: Lymph follicles are frequently found on histological examination of a surgically removed gallbladder. The significance of these lymph follicles is not clearly understood. The aim of this study was to examine the clinicopathological correlation between the lymph follicles in the gallbladder morphologically and the mucosa-associated lymphoid tissue (MALT) in the gut. METHODS: The gallbladders were fixed and cut serially. The tissue slices were processed in the routine manner for a histological examination. The histological criteria for MALT in this study was defined as the presence of lymph follicles with germinal centers in the lamina propria mucosae in approximately equal numbers in all portions of the gallbladders from the neck to the fundus. Biliary bile obtained at surgery was cultured for a bacteriological examination in the hospital laboratory. The types of gallstones were classified according to the Classification of Gallstones by the Japanese Society of Gastroenterology. RESULTS: Of the 1341 patients, 158 (11.8%) patients fulfilled the histological criteria, including 64 men and 94 women with an average age of 64.2 years. Gallstones were present in 89.2% of the patients, and 74.5% of these were calcium bilirubinate gallstones. Cultures of the bile were positive in 95.4% of the patients. A variety of bacterial species were thus found, most commonly Escherichia coli and Klebsiella spp. Grossly, the gallbladders usually showed a granular appearance of the mucosa. CONCLUSION: The MALT in the gallbladder is not a rare condition and is frequently encountered in clinical practice. This lymphoid tissue may represent a mucosal and morphological immune phenomenon for infection rather than a substrate for the development of low-grade B-cell lymphoma.