Gastric carcinomas of intestinal type concur with distant changes in the gastric mucose. A multicenter study in the Atlantic Basin

Population studies in the Pacific Basin showed that gastric carcinomas of i ntestinal type often concur with distant mucosal changes (DMCs). In the pre sent work the presence of DMCs was investigated in populations dwelling in the Atlantic Basin. A total of 1737 gastrectomy specimens were reviewed: 62 7 in New York, 435 in Reykjavik, 198 in Buenos Ail es, 186 in Florence, 174 in London and the remaining 117 in Stockholm. A total of 17282 sections we re carefully scrutinized. The following DMCs were investigated: intramucosa l glandular cysts, gastric cells with ciliated metaplasia, with large ol sm all mucus negative vacuoles, and extensive intestinal metaplasia (IM). The highest frequencies of DMCs were found in Florence for specimens with intes tinal type carcinoma: 41.3% had intramucosal cysts, 22.4% had cells with ci liated metaplasia, 12.9% cells with large vacuoles, and 50.9% had high IM. The highest frequency of gastric cells with small vacuoles was recorded in New York (9.1%), also in specimens with intestinal type carcinoma. Signific antly lower DMCs percentages were found in specimens with carcinomas of dif fuse type, and miscellaneous gastric diseases. The occurrence of DMCs was n ot influenced to a significant degree by the number of sections available p er gastrectomy. Since environmental factors trigger the evolution of intest inal type carcinomas and as DMCs also occurred in specimens without carcino ma- although at a significantly lower rate- it is conceivable that DMCs are also evoked by environmental factors (before a gastric carcinoma ensues). DMCs were found in specimens having intestinal carcinomas either in the car dia, the corpus or the antrum. Thus, DMCs seem to provide the adequate "soi l" for the development of gastric carcinomas of intestinal type, independen tly of the future localization of that tumor in the stomach.