Carcinoma of the stomach; a report of an epidermoid carcinoma of the pyloric antrum.

Abstract

C ANCER of the stomach is a timely topic at any time, particularly when considering such a clinical rarity as an epidermoid carcinoma of the pyloric antrum. Carcinoma of the stomach is the most lethal, if not the most frequent, visceral cancer in human beings, with a yearly toll of about 50,000 deaths in the United States. This exaggerated death rate results from the lack of preventive measures, the tardiness in establishing the proper diagnosis, and the failure to encompass the disease process in an ample and radical operation in the greatest majority of cases; it is largely due to the insidious nature of the disease, its rapid growth with a widespread infiltration of the organ, its diffuse metastasis, as well as to the relative difficulty in examining this viscus, the utter neglect of the patient in submitting himself to the proper clinical studies in due time, and to the most regrettable underestimation or unrecognition of the disease by the physician who first sees the case. Carcinoma of the stomach is by all odds adenomatous in type (78 per cent). Only 2 per cent of the cases are scirrhous and 20 per cent mixed type. The epidermoid carcinomas are indeed rare. In the most recent review of the literature on this subject, O’Brien and Meehan? reported 13 adenocanthomas and only 9 pure epitheliomas of the stomach. To these I want to add another epidermoid carcinoma of the pyloric antrum. The reason for the development, of these epidermoid cancers in the stomach is not at all clear, and the hypotheses that have been advanced in their support are not generally accepted. Most authors reporting cases of this type have not dealt at any length with this fundamental consideration. Those who have given any regard at all to this topic have dismissed it by considering thesetumors merely as heterotopic or metaplastic in nature. When the tumors occur in the upper segment of the stomach, this assumption may be valid, for the growth may develop from an ectopic islet of esophagic mucosa or even by continuity of an epidermoid carcinoma of the lower end of the esophagus. However, this is not acceptable when considering a squamous-cell carcinoma in the pyloric antrum. It is true, nevertheless, that epidermoid carcinomas have occurred even “in the gall bladder, which is one of the last places to expect squamous epithelium in the human body,” according to Walters, Gray, and Priestley.4 In a review of the literature at hand on this particular subject, the only author I have found trying “to crack the nut” of the etiology of these epidermoid carcinomas in the stomach and intestinal mucosae is Duran-Jorda, now in Manchester, England. In a personal communication, dated April 13,