Gastric cancer in the elderly--relationship between macroscopic appearance and histological type in autopsy specimens

Abstract

We sought to clarify the characteristics of gastric cancer in the elderly. We examined 349 specimens of gastric cancers. All specimens were obtained at autopsy from patients who were over 65 years old. We analyzed the relations among five factors: age of the patient, histological type, macroscopic appearance, grade of invasion and location. Older patients were more likely to have papillary adenocarcinoma, tubular adenocarcinoma, and Borrmann-2 and 3 lesions. Papillary and tubular adenocarcinoma together accounted for 14 of 84 Borrmann-4 lesions (16.3%). Borrmann-1 signet-ring-cell carcinomas were observed in two cases. Tubular adenocarcinomas made up 31 in 38 depressed-type early carcinomas (81.6%). Over half of the papillary and tubular adenocarcinomas were confined to the mucosal or submucosal layers, but over 60% of the poorly differentiated adenocarcinomas or signet-ring-cell carcinomas had invaded the extraserosal layer. Papillary and tubular adenocarcinomas were commonly found in the lower part of the stomach, but poorly differentiated adenocarcinomas and signet-ring-cell carcinomas were found in all parts of the stomach. Unlike specimens obtained during surgery, many of those obtained at autopsy were from older patients, and the gastric cancers were advanced. Compared to many reports about specimens obtained during surgery, tubular or papillary adenocarcinomas are not a few histological type in Borrmann-4 lesions in this study. Surgical specimens of depressed-type early cancer in younger patients are most commonly found to be signet-ring-cell carcinoma, but tubular adenocarcinoma was common in this study. We found many differences between specimens obtained at autopsy and during surgery. These findings indicate that autopsy studies can reveal some otherwise-obscure characteristics of gastric cancer in the elderly.