Gastric Sarcoma Research Articles

Peritoneale Splenose 26 Jahre nach traumatischer Milzruptur - seltene Differenzialdiagnose eines submukösen Magentumors - Fallbericht und Literaturübersicht

Differential diagnoses of subepithelial gastric masses include benign (leiomyoma, lipoma, haemangioma, lymphangioma, neurogenic tumours, glomus tumour) and malignant (leiomyosarcoma, gastric Kaposi's sarcoma, metastases) neoplastic lesions, gastrointestinal stromal tumours (GIST) and lesions of non-neoplastic origin (heterotopic pancreatic tissue, intramural pseudocysts, intramural haematoma). Occasionally, however, suspected gastric wall tumours are caused by extragastral lesions that are not always easily distinguished from genuine gastric wall lesions by endoscopy or radiological imaging. We report the case of a 77-year-old patient undergoing laparoscopy for suspected gastric GIST in our institution in whom splenectomy had been performed 26 years prior to presentation due to traumatic splenic rupture. The tumour revealed to be ectopic splenic tissue located at the parietal peritoneum of the ventral abdominal wall, thereby fulfilling the definition of splenosis. Epidemiology, pathogenesis, diagnostics and therapy of splenosis are discussed in the context of a review of the relevant literature.

Gastric Mucosal Lymphoid Follicles: Histology, Distribution, Frequency, and Etiologic Features

Mucosal lymphoid follicles reportedly do not occur in normal gastric mucosa or are rare. Detection of many primary and occasional secondary lymphoid follicles in the otherwise normal mucosa of a patient with multiple gastric sarcomas prompted study of the lesions of 84 patients--30 males and 54 females--and 2 fetuses. The conditions in the group were intramural tumors (27 cases), intramucosal lesions (16 cases), and putatively normal mucosa (43 cases). Overall, 229 sections totaling 567 cm of mucosa were examined and the lymphoid follicles counted. Follicles were found in 174 sections of 76 patients (88%) and in all categories examined except the fetuses. There were 773 follicles in fundal mucosa and 43 in antral mucosa (average, 1 follicle/7 mm of fundal mucosa and 1 follicle/21 mm of antral mucosa). The follicles were most frequent in the patients with multiple stromal sarcomas (1 follicle/8 mm of mucosa) and least frequent in pediatric patients.

F-18 FDG PET-CT Imaging in Gastric Sarcoma

We report the F-18 fluorodeozyglucose positron emission tomography computed tomography appearance of a biopsy-proven primary gastric sarcoma in a 24-year-old man who presented with early satiety, dyspepsia, and weight loss. Gastric sarcoma is a rare form of malignancy constituting approximately 0.3% to 8% of malignant soft tissue tumors of the stomach. The tumor appears as an ill-defined heterogeneous mass protruding off the lesser curvature of the stomach on computed tomography with central photopenia and peripheral intense uptake on positron emission tomography images.

Evolution of Human Herpesvirus Type 8-associated Gastric Kaposi's Sarcoma Following Corticosteroid Treatment for Asthma

The association of gastric Kaposi's sarcoma (KS) with human herpesvirus type 8 (HHV-8) may be found in immunosuppressed patients such as those with AIDS or transplant recipients. A 64-year-old man with a 2-year history of corticosteroid treatment was admitted due to the impression of chronic obstructive pulmonary disease with secondary infection. Abdominal fullness and tarry stool led to the performance of panendoscopy, which revealed two hypertrophic gastric mucosal lesions. These lesions had transformed into a large polyp 2 months later. KS was not diagnosed until a third endoscopic biopsy was performed. The polyp further transformed into a flattened, elongated tumor within a month. The patient died from acute cardiopulmonary insufficiency 4 days after radical gastrectomy. Polymerase chain reaction study identified HHV-8 in all biopsied specimens and resected tumor lesions. Immunostaining further demonstrated the virus in the tumor cells. Both of these methods seemed more sensitive in diagnosing KS than histologic examination of small biopsied specimens. This case suggests the existence of a relationship between gastric KS and HHV-8 infection.

Author reply

We thank Dr. Yalçin and Dr. Kars for their comments on our recently published article and for their additional data.1, 2 The interval between the onset of one component of Carney syndrome and another is very long in some cases. Carney et al. reported that the mean interval between detection of the first and second tumors was 8.4 years (median, 6 years); the 5 longest intervals were 21, 21, 24, 24, and 26 years in a follow-up study of 79 patients with Carney syndrome.3 Moreover, we also showed that the duration between the onset of multiple chondromatous hamartomas of the lung and time of recurrence is very long; the average was 12.7 years, and the shortest and longest were 5 and 30 years, respectively.1 There is the possibility that the triad might consist of familial and inherited disorders. Carney et al. reported that a sibling of each of two patients with gastric sarcoma and paraganglioma had bilateral carotid body paragangliomas.3 Furthermore, it is noteworthy that gene abnormalities have been reported in some cases of pulmonary hamartoma. Johansson et al. documented that cytogenetic analysis of short term cultures from seven pulmonary hamartomas revealed an abnormal karyotype in six of them, especially recombinations of chromosomal bands 6p21 and 14q24.5 The risk of lung carcinoma has been estimated to be 6.3 times higher in patients with pulmonary hamartoma than in the general population by Van Den Bosch et al. They showed that 11 of 154 patients (7%) also had bronchial carcinoma, which was synchronous in 6 patients and metachronous in 5 patients.6 Again, we must emphasize the necessity of careful and elaborate follow-up for any patients with one or more components of Carney syndrome, keeping in mind that neoplastic lesions may appear in any anatomic site except in the stomach, lung, extraparaganglion, adrenal gland, and esophagus after a remarkably long period. Takuji Kiryu M.D.*, Shimpei Kawaguchi M.D.*, Eisuke Matsui M.D.*, Hiroaki Hoshi M.D.*, Mitsuharu Kokubo M.D. , Kuniyasu Shimokawa M.D. , * Department of Radiology, Gifu University School of Medicine, Gifu, Japan, First Department of Surgery, Gifu University School of Medicine, Gifu, Japan, Department of Laboratory Medicine, Gifu University School of Medicine, Gifu, Japan

The Carney Eponym

To the Editor: The recent article on the Carney triad1Carney JA Gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal paraganglioma (Carney triad): natural history, adrenocortical component, and possible familial occurrence.Mayo Clin Proc. 1999; 74: 543-552Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar and, particularly, the editorial by Dr Appelman2Appelman HD The Carney triad: a lesson in observation, creativity, and perseverance [editorial].Mayo Clin Proc. 1999; 74: 638-640Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar prompted me to remind readers that there are 2 separate syndromes with the eponym Carney. The association of gastric sarcoma, pulmonary chondroma, and paraganglioma is distinct from the constellation of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas. The former is usually referred to as the “Carney triad,” the latter as the “Carney complex”3Carney JA Carney complex: the complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas.Semin Dermatol. 1995; 14: 90-98Crossref PubMed Google Scholar; however, the triad often includes other components, and often2Appelman HD The Carney triad: a lesson in observation, creativity, and perseverance [editorial].Mayo Clin Proc. 1999; 74: 638-640Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar 2 of the factors that make up the triad are absent. The terms triad, complex, and syndrome are often interchanged, even in Appelman's editorial: “This complex has subsequently been designated the ‘Carney triad.’ … The Carney triad has 3 anatomic components, but from the beginning, it was obvious that this was more than a triad because it had 2 unusual clinical features, female sex and young age, thus making it a syndrome.”2Appelman HD The Carney triad: a lesson in observation, creativity, and perseverance [editorial].Mayo Clin Proc. 1999; 74: 638-640Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar In the literature, Carney does not seem to have attempted to publicize the existence of these 2 separate entities. In their Dictionary of Medical Syndromes, Magalini and Magalini4Magalini SI Magalini SC Dictionary of Medical Syndromes. 4th ed. Lippincott-Raven, Philadelphia, Pa1997Google Scholar have recognized them as Carney I and Carney II. It would be helpful if Carney would acknowledge his 2 eponymic syndromes and suggest ways in which the medical literature could keep them distinct. Perhaps Carney would be willing to share his appellation with others, as other prolific physicians such as Osier and Weber have done. The Carney Eponym: In ResponseMayo Clinic ProceedingsVol. 74Issue 10PreviewDr Tashima raises the issue of nomenclature of 2 multi-organ tumorous conditions that I have described. Full-Text PDF

Gastric Stromal Sarcoma, Pulmonary Chondroma, and Extra-adrenal Paraganglioma (Carney Triad): Natural History, Adrenocortical Component, and Possible Familial Occurrence

To investigate the natural history of the triad of gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal paraganglioma, a rare syndrome of unknown cause primarily affecting young women. Mayo Clinic records, the world literature, and the author's files were searched for patients with all or 2 of the 3 tumors. Seventy-nine patients, 67 women and 12 men, were identified, 17 (22%) with the 3 tumors and 62 (78%) with 2 tumors. Forty-two (53%) had gastric and pulmonary tumors, the most common combination. The longest interval between detection of the first and second components was 26 years (mean, 8.4 years; median, 6 years). Follow-up ranged from 1 year to 49 years (mean, 20.6 years; median, 20 years). Sixty-four patients (81%) were alive, 19 (24%) apparently free of disease and 45 (57%) with residual or metastatic tumors. Thirty-two patients (41%) had had 1 or more local recurrences of the gastric sarcoma; the longest interval to first recurrence was 36 years. Twenty-one survivors (27%) had hepatic metastatic gastric sarcoma with follow-up of 1 year to 25 years (mean, 9.3 years; median, 7 years). Fifteen patients (19%) were dead, 10 (13%) of whom died of the disorder. Ten patients (13%) had nonfunctioning adrenocortical tumors. Two patients each had a sibling with 1 component of the triad. The triad is a chronic, persistent, and indolent disease. Benign adrenocortical tumors are a component of the condition. The disorder may be familial.

Fine‐Needle Aspiration Cytology of Epithelioid Leiomyoblastoma

Purpose. Epithelioid leiomyoblastomas comprise the majority of gastric sarcomas and are uncommon in other parts of the gastrointestinal tract. Diagnosis of this lesion by fine-needle aspiration cytology has been occasionally described in the literature. Two additional cases are herein reported. Subjects . A 66-year old male with an omental mass and a 47-year old male with a perihepatic tumor. Results and Discussion. Cytologic materials in both cases showed predominantly round or epithelioid cells, along with polygonal to spindle cells, occuring singly and in clusters, with oval to spindle-shaped nuclei.The nuclei were monotonous, usually banal, and centrally-located with only focal suggestion of pleomorphism and rare mitosis. Eosinophilic cytoplasm was noted in most of the cells, some demonstrating vacuolation. Electron microscopy supported a primitive smooth cell derivation of the neoplastic cells. Conclusions. The cytomorphology of the tumors of the two cases reported here is not adequately known. More cases need to be collected and studied.

SEVEN CASES OF MALIGNANT SCHWANNOMA OF THE STOMACH

A total of 47 cases of malignant schwannoma of the stomach appeared in the Japanese literature including seven operated cases in our clinic were clinically surveyed. Limited to our seven cases, gastric malignant schwannomas represented 0.3% of all gastric cancers and 8.5% of all gastric sarcomas in our clinic. In the cumulative series, the male-to-female ratio was equal and the age at hospitalization was 56.1 in an average. In over half of these cases, the tumor occurred at upper 1/3 region of the stomach and the endogastric type was most common, reached 44% in a frequency. Deep ulceration with central necrosis in the tumor was seen in 56.4%. Both submucosal tumor without any further description and Leiomyosarcoma were main preoperative diagnosis, each occupied 36%. Acurate preoperative diagnosis as malignant shcwannoma was made in only 11.6%. Immunohistochemical staining for S-100 protein in biopsied or removed materials revealed positive in 87.1%, suggesting the usefulness of this examination. Metastasis on laparotomy was found in 23.8% in the liver, 9.5% in lymph nodes and 4.8% in the peritoneum. Of the own seven patients, curative resection was feasible in four patients and the remaining three patients died of progression of the residual tumor within postoperative 2 years. Therefore, an effort for curative resection should be made at present and otherwise intra- or postoperative chemotherapy would be necessary in advanced cases.

Alimentary tract malignancies in children

Alimentary tract malignancies in children are unusual. From 1952 to 1996, 54 patients (55 cases) underwent surgery at The Children's Hospital, Columbus for intestinal malignancy. Their records were reviewed retrospectively. The mean age at diagnosis was 9.3 years (range, 1 to 17 years). There were 35 boys and 19 girls (M:F ratio, 1:8). Mean follow-up was 108 months. Laparotomy was performed in all but one child. The primary tumor sites included the colon (31 cases), small bowel (12 cases), appendix (9 cases), and stomach (3 cases). Seventy-five percent of the tumors were non-Hodgkin's lymphomas (41 cases), followed by appendiceal carcinoid (9 cases), colon adenocarcinoma (3 cases), and gastric sarcoma (2 cases). Lymphoma occurred in 28 of 31 nonappendiceal large bowel tumors and was the only tumor type seen in the small intestine. There were 21 Burkitt's, 11 lymphoblastic, 6 small cell, and 5 large cell lymphomas. There was a statistically significant increase in the frequency of small bowel lymphoma after 1982 (10 of 20) in comparison with that before 1982 (2 of 21), P < .05. This coincided with an increase in Burkitt's lymphoma from 5 of 21 (pre-1982) to 16 of 20 (post-1982), and a decrease in lymphoblastic lymphomas from 7 of 21 (pre-1982) to 2 of 20 (post-1982), P < .05. Localized disease and complete resection favored survival in lymphoma, whereas age, sex, and urgency of operation had no influence on survival. This study highlights the predominance of lymphoma as the most common, small and large bowel tumor and highlights the emergence of nonendemic Burkitt's as a major entity in pediatric intestinal malignancy.

Gastrointestinal cancer.

There are great differences in incidence and prognosis of cancer among the component sites of the digestive tract. Furthermore, a number of the histologic types of tumors at these sites differ in their incidence and prognosis. The SEER data from 1973 to 1987 on frequency, incidence, staging, and survival for the various histologic types of 194,452 cancers of the esophagus, stomach, and intestines were studied. There was an increased incidence of adenocarcinomas of esophagus, gastric cardia, small intestine, and colon; incidence rates for rectal adenocarcinoma and esophageal squamous cell carcinoma remained stable; and rates for gastric adenocarcinoma decreased. Blacks had higher incidence rates than whites for gastric adenocarcinoma; squamous cell carcinoma of the esophagus; carcinoids of the small intestine, colon, and rectum; and gastric sarcomas. Whites, especially males, had higher incidence rates for adenocarcinomas of the esophagus and gastric cardia than did blacks. Blacks had lower rates for rectal adenocarcinomas than did whites, but slightly higher rates than whites for rectal mucinous carcinomas and colonic adenocarcinomas. Data on race, sex, survival, and time trends indicate that mucinous colorectal carcinomas are biologically different from other adenocarcinomas. Males had poorer overall survival than did females for most histologic types of digestive tract tumors. Appendiceal mucinous adenocarcinomas with distant metastases were associated with a high (50%) 5-year survival. The poor prognosis of cases diagnosed as colonic carcinoid raises the possibility that some of these actually may be carcinomas. Studies of digestive tract cancer require analysis by histologic type for adequate assessment.

Diagnosis and Surgical Treatment of Gastric Sarcoma

Gastric sarcoma is rare, accounting for no more than 1-3% of all gastric malignancies. Approximately one half of all gastrointestinal sarcomas develop in the stomach. Upper GI series and endoscopy can identify the presence of a gastric lesion, but endoscopic biopsy usually fails to establish a histological diagnosis. The vast majority of gastric sarcomas are of myogenic origin. It may be difficult to determine the benign or malignant character of a stromal tumor, even if intraoperative frozen section is performed. Surgical treatment should be aimed at complete removal of the tumor with at least a 2-cm margin. Systematic lymphadenectomy is not indicated. Tumor grading and size are independent predictors of prognosis. Tumor biology varies widely and 5-year recurrence-free survival has been reported from 20-68%. Chemotherapy or radiotherapy in an adjuvant setting or for treatment of recurrence are largely ineffective.

A clinicopathologic and immunohistochemical study of gastrointestinal stromal tumors

The clinicopathologic and immunohistochemical features in 120 cases of gastrointestinal stromal tumor (GIST) were reviewed. Excluding 24 cases of gastric schwannoma, 96 cases of GIST consisting of 62 benign tumors and 34 sarcoma (low grade, 17; high grade, 17), with 9 cases arising in the esophagus, 57 in the stomach, 28 in the small intestine, and 2 in the colon, were studied. All esophagus and colon tumors were benign and resembled a conventional leiomyoma histologically. However, the gastric and small intestine benign tumors mostly showed histologic features of cellular or epithelioid leiomyoma. Immunohistochemically, desmin caused a positive reaction in all esophagus and colon tumors, but only 26% of gastric and small intestine tumors. However, muscle-specific actin (HHF35) caused a positive reaction in most GIST (92%). The 10-year survival rates of the patients with gastric sarcoma and those with intestinal sarcoma were 74% and 17%, respectively. These results showed that histologic and immunohistochemical features were distinctly different, depending on the location in the gastrointestinal tract; that most GIST, excluding schwannoma, had smooth muscle differentiation; and that sarcomas had a more favorable prognosis when they occurred in the stomach rather than the intestine.

Interferon-Induced Phenotypic Changes in Human Tumor Cells Relative to the Effects of Interferon on c-rasOncogene Expression

Three human tumor cell lines derived from an osteosarcoma (OHA cells), a bladder carcinoma (EJ cells), and a gastric sarcoma (SHAC cells) were passaged serially in the presence of human interferon-alpha (IFN-alpha) for extended periods of time. The long-term IFN-alpha treatment induced a partial reversion of OHA tumor cell phenotype as exemplified by inhibition of cell proliferation, lack of cellular overlapping in confluent cultures and marked reduction in tumorigenicity. In contrast, under the same conditions, long-term IFN treatment did not reverse but even potentiated some of the phenotypic characteristics (including tumorigenicity) of EJ and SHAC cells. In the three tumor cell lines, the transforming ability, genomic level, or expression of activated oncogenes, c-Ki-ras, c-Ha-ras, and N-ras, respectively, were unaltered with long-term IFN-alpha treatment. Our data indicate that IFN-induced phenotypic changes are not necessarily associated with changes in oncogene expression.

Nitrosamide-induced sarcomas in the gastric pylorus of hamsters. A histological and ultrastructural survey on the histogenesis.

A histological and ultrastructural survey on the histogenesis of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced gastric sarcomas in hamsters was attempted. Within 3 months after the beginning of oral administration of MNNG, simple spindle cell proliferation in the submucosal zone of the pyloric region of the glandular stomach was evident. By 5-6 months, the cells had acquired a sarcomatous appearance. Ultrastructurally, the spindle cells in the early stage, were divided into 3 types, i.e., angiogenic cells, fibroblastic cells, and primitive mesenchymal cells. Similarly, those in the late-appearing sarcomatous tumors were also classified into different types of angiogenic, fibroblastic, histiocytic and miscellaneous cells. Among the cell population of the 2 major groups, angiogenic cells were the most predominant cell type. Some morphological transition appeared to occur between the corresponding cell types at the early and late stages. DNA content of cell nuclei of the representative forms of the nitrosamide-induced sarcomas was higher than that of early appearing spindle cells. Thus, the evidence suggests that the early appearing spindle cells are precursors for the gastric sarcomas.

Sarcoma of the stomach: Clinicopathologic study of 43 cases

The records of 43 patients with histologically proved primary gastric sarcoma treated at M. D. Anderson Hospital and Tumor Institute between 1945 and 1975 were reviewed. Weight loss, abdominal pain, and hematemesis or melena were the most common symptoms, and palpable epigastric mass was the most common physical sign. Ninety-five percent of the gastric tumors were leiomyosarcomas. The median survival time and the five-year survival for the 29 patients who had curative gastrectomy were 33 months and 38%, respectively. Morphologic and histologic factors that adversely influenced the length of disease-free interval and survival following curative surgery included 1) primary tumor 8 cm or greater in diameter, 2) tumor extension to serosa of the stomach, and 3) low grade of differentiation of the primary tumor. Seventy-seven percent of recurrences in patients with curative tumor resection occurred within two years of resection of the primary. Of the 17 patients with advanced disease who received chemotherapy, two (15%) had objective tumor regression of greater a median survival time of eight months for patients who failed to respond. New approaches that may improve the results of treatment of gastric sarcoma are discussed.

Primary lymphomas and sarcomas of the stomach.

The records of patients with primary gastric lymphoma and sarcoma treated at M. D. Anderson Hospital and Tumor Institute between 1945 and 1975 were reviewed. Weight loss, abdominal pain, nausea, and vomiting were the most common presenting symptoms, while palpable abdominal mass was the most common sign. The lymphomas were predominantly located in the distal portion of the stomach, in contrast to the sarcomas, which were commonly located in the body and the proximal portion of stomach. Curative gastric resection was performed in 96% of patients with lymphoma and in 67% of patients with sarcoma. Diffuse histiocytic lymphoma and leiomyosarcoma were the most common histologic types. Patients with lymphoma survived significantly longer than patients with sarcoma (median 75 vs 22 months, P = 0.009). Adjuvant radiotherapy seemed to improve the survival of patients with lymphoma, while curative gastric resection provided the only hope for long-term survival for patients with gastric sarcoma. The place of adjuvant chemotherapy after curative resection of gastric lymphoma and sarcoma remains to be investigated.

Gastric epithelioid leiomyoma and leiomyosarcoma (leiomyoblastoma)

A series of 127 surgical specimens of epithelioid leiomyomatous tumors (leiomyoblastomas) of the gastric wall from the files of the Armed Forces Institute of Pathology (AFIP) were studied as to biologic behavior, morphogenesis, and histologic features of value in distinguishing benign and malignant variants. These tumors affect middle-aged men primarily and usually present with upper gastrointestinal bleeding or peptic ulcer-like symptoms. They are composed of a mixture of round epithelioid and spindle cells, many of which have clear cytoplasm. The cells are ensheathed by delicate reticular fibers. The presence of a perithelial or glomoid pattern in some tumors suggests a possible relationship to angiomyoma, glomus tumors, and "pericytoma." The epithelioid leiomyoma, the benign form, often arises in the mid- and distal stomach, especially on the anterior wall. Microscopically, it is recognized by the presence of large epithelioid cells and infrequent mitotic figures. Of 103 epithelioid leiomyomas, only one metastasized and thus was biologically malignant. The epithelioid leiomyosarcoma often arises in the proximal stomach and also distally, especially on the posterior wall. Two histologic types of epithelioid leiomyosarcoma are distinguished from the benign epithelioid leiomyoma by the small size of the cells and occasional higher mitotic counts. One sarcoma variant is a small cell caricature of the leiomyoma. The other is more anaplastic, assoicated with a loss of reticular fibers surrounding the cells and an alveolar arrangement. Epithelioid leiomyosarcomas are the most common type of gastric sarcoma. They are aggressive neoplasms; 63% metastasized, usually within 2 years after diagnosis.

Relation of the acidity of gastric juice to cancer and ulcer of the gastroduodenal tract.

The author has statistically studied the acidity of gastric juice obtained from 1, 100 cases of gastric cancer, 29 cases of gastric polyps, one case of gastric sarcoma, one case of gastric myoma, 5 cases of duodenal cancer, 570 cases of gastric ulcer, 90 cases of gastroduodenal ulcer and 505 cases of duodenal ulcer, and the following conclusions were obtained. (1) In neoplasm, anacidity and hypoacidity appeared in an overwhelming majority of cases; 84.4% of gastric cancer, 89.6% of gastric polyps and 100% of duodenal cancer were of anacidity and hypoacidity. On the contrary, in ulcer, hyperacidity and super-hyperacidity were quite often found; 41.8% of gastric ulcer, 69.7% of duodenal ulcer and 65.5% of gastroduodenal ulcer cases were found to have hyperacidity or super-hyperacitity. (2) Of gastric cancer 60.5% were found to have anacidity during the entire investigation. Some of gastric cancer patients who had once normoacidity or hyperacidity showed anacidity or hypoacidity later and vice versa. It was found that almost all of the gastric cancer patients had anacidity at some stage. (3) 58.6% of gastric ulcer, 85.1% of duodenal ulcer and 86.8% of gastroduodenal ulcer cases showed hyperacidity or super-hyperacidity all the time. On the contrary, 7.3% of gstric ulcer, 2.8% of duodenal ulcer and 1.5% of gastroduodenal ulcer cases showed hypoacidity or anacidity. It should be noted that the number of ulcer patients who had hypoacidity or anacidity could be found to be less if the gastric juice examination was repeated frequently. (4) It has been demonstrated that the gastric secretion is controlled by the autonomic nervous system as other clinical signs and symptoms. In an individual with sympathicotonic type of constitution, anacidity or hypoacidity with clinical signs and symptoms of a sympathicotonic type appears, and a parasympathicotonic type of constitution shows hyperacidity or super-hyperacidity with clinical signs and symptoms of a parasympathicotonic type.

A case of early gastric reticulum-cell sarcoma followed up study mith x-ray and gastroendoscope during the early stage

A case of early gastric reticulum-cell sarcoma followed up study mith x-ray and gastroendoscope during the early stage