J.Jpn. Surg. Soc.. 55(7): 760-765, 1954
Others
On Ulcer-Carcinoma
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Muto's Surgical Clinic, Tohoku University Susumu MAJIMA, Nobuhide KURAKAKE, Nobuo HOSHI, Tadahisa USUBA, Junya SATO, Rokuro ISHIKAWA |
1) Ulcer-carcinoma seems to originate from the regenerative epithelium of atypical proliferation.
2) Cancer foci, which have developed multicentrically at the ulcer margin extend independently through the submucous layer and the free ends of the musular layer to the subserous layer, and invade the callous tissue making up the ulcer base. There takes place also sideward infiltration of the superficial part of the base and the free omentum tissue. Therefore, when a carcinomatous proliferation is seen at the ulcer base, the case may be taken to be of incipient peritoneal carcinomatosis. This is the reason why an unfavorable prognosis is to be given to a case of ulcer-carcinoma for its size.
3) An investigation was made on the late results of gastrectomy with 60 cases where operation had been performed before more than one year, with the following results : In cases of relatively early ulcer-carcinoma, in which the cancer localized at the ulcer margin or at the small part of the base, the 5-year-survival-rate was comparatively higher (66.7%), while the 2-year-survival-rate was 24 in those cases of ulcer carcinoma where cancer infiltrated a great part of the ulcer base and groups of cancer cells were found beyond the serous membrane as well as in the normal omentum adjoining the callous omentum composing the base.
4) When a callous ulcer becomes malignant, there takes place rapid carcinomatous infiltration at the ulcer base, thus leading to peritoneal carcinomatosis ; and, moreover, early diagnosis of malignant changes is clinically difficult. Cases of callous ulcer should, therefore, be operated on.
(author's abstract)
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