TUBULAR DIFFERENTIATED CARCINOMA OF THE S TOMACH OF THE INFILTRATIVE TYPE (ACCORDING TO MING)

Gastric carcinoma of the infiltrative type (according to Ming) occasio nally shows adenomatous differentiation only. Over the past 18 years, we have observed 23 cases of this tumour type, accounting for 3.6% of all surgically treated gastric carcinomas. Macroscopically they were c lassified as Borrmann IV or III, while histologically most of them wer e well differentiated. Histologically, these tumours retained the pre- existing structures of the stomach, most readily observable at the tun ica muscularis propria; a pronounced desmoplasia was also characterist ic, particularly in the submucosal and subserosal layers. In all cases the tumour tissue spread inside lymphatic vessels. All but 2 cases wi th metastatically involved lymph nodes, often small, showed infiltrati on of the lymph node sinus; in three quarters of cases the serosa was infiltrated by the tumour. Significant findings among the patients und er observation for extended periods included bilateral ovarian metasta ses in 4 of 5 women examined and tumour recurrence at the anastomosis in 6 of 9 patients in whom Billroth II operation had been performed. T he mean survival time of 16 patients was 14.9 months. Owing to the dif fuse type of tumour growth, extensive surgery is recommended as in cas es of signet ring cell cancer. The high incidence of small lymph node metastases from this type of tumour should also be taken in account at preoperative staging. Preoperative diagnosis of this tumour subtype i s difficult, because histological criteria alone do not allow clear id entification. Close cooperation with clinical investigators is necessa ry, and intraoperative assessment of the tumour - including frozen sec tion of necessary - in particular is of the outmost importance.