Glandular Masses Research Articles

Model of Gastric Tubules in Early Gastric Cancer

In the study of early gastric cancer in relation to gastric ulcer, I have previously reported2 what appear to me to be segregated masses of gastric mucosa cut off from the surface by necrosis and subsequent formation of scar-tissue, and yet containing living epithelial cells apparently capable of functionating. Some doubt might well exist as to whether these were not misinterpretations of oblique sections. I long ago satisfied myself that this was not true by following throughout such isolated portions of tubules in serial sections. Of several such specimens I made photographs and of others drawings with the camera lucida covering the entire series. Last summer Mr. James A. Wynn reconstructed from the drawings of one such series a model, the photograph of which is herewith shown (fig. 1). This reconstruction was made from drawings of sections through the edge of a large chronic gastric ulcer in one small area, on the opposite side of which there was unmistakable evidence of beginning cancer. The tubules bore the same relation to the normal surface of the mucosa that they here bear to the surface of the upper side of the case surrounding the model. It will be observed that a number of them have been completely reconstructed and that they do not communicate with the surface. Some of the smaller ones contain atrophic epithelium. The larger ones are very much larger than the ends of other gastric tubules from a nearby normal region reconstructed on the same scale, and shown in the photograph. The epithelium of the dilated tubules was much swollen. Some of the tubules were cystic and filled with mucus. Since the segregated glandular masses contained epithelium capable of functionating and still connected with their nerve and blood supplies, their possible relationship in cases of gastric ulcer to the pain occurring during digestion is suggested. Food in the stomach may cause the same sort of pain in these areas as is present in the parotid gland when a patient with mumps eats sour foods.