MULTIPLE EARLY GASTRIC STUMP CARCINOMAS AFTER GASTRECTOMY FOR PEPTIC-ULCER

The remnant stomach after partial gastrectomy is considered to have a predilection for the development of primary gastric carcinoma. However , early gastric stump carcinomas are uncommon because the diagnosis of gastric stump carcinoma is more difficult than that of carcinoma in t he intact stomach. Triple early gastric stump carcinomas, as in the pr esent case, are exceedingly rare and may provide some clues for furthe r investigation of carcinogenesis in the gastric stump. We studied abo ut the histological appearance, genetic alterations (P-53 gene, c-erbB -2 gene and K-ras gene), and expression of tumor-associated antigens ( carcinoembryonic antigen, carbohydrate antigen 19-9, and sialyl-Tn) in this rare case. The three carcinomas differed from each other histolo gically. With respect to genetic alterations, c-erbB-2 was amplified i n one lesion, but no mutations of K-ras and P-53 gene were detected. T he three carcinomas also differed from each other on the expression of tumor-associated antigens. In noncancerous mucosal epithelium at the anastomosis showing hyperplasia and cystic formation of glandular epit helial cells, no genetic alterations mere detected, but sialyl-Tn and carbohydrate antigen 19-9 were expressed. These results suggest that t here may be different processes of carcinogenesis of the three carcino mas even though they occurred under identical environmental conditions to those that have increased cancer risk. (Am J Gastroenterol 1998;93 :1575-1578. (C) 1998 by Am. Coll. of Gastroenterology).