Adenocarcinoma of the stomach - Erler Zimmer

Adenocarcinoma of the stomach - Erler Zimmer

Clinical History

An 82-year-old female presented with melena (dark tarry faeces) along with a 6-month history of dyspepsia and nausea. Notably, she experienced weight loss and early satiety. Shortly after admission, a large melena episode occurred, leading to her demise.

Pathology

This post-mortem specimen includes a sagittal view of the oesophagus, stomach, proximal duodenum, and pancreas. A prominent 7x5cm ulcer is evident on the lesser curve of the stomach, characterized by a shallow and broad structure with raised rolled edges and necrotic debris at the base. Loss of gastric rugae radiates along the mucous from the ulcer. Dissection reveals the elevation of the edge by pale homogeneous tumor tissue. Two eroded arteries within the ulcer crater indicate recent hemorrhage. Additionally, the pancreas adheres to the serosal aspect of the ulcer. Histology from the lesion demonstrates an ulcerating, well-differentiated adenocarcinoma of the stomach with direct invasion into the pancreas.

Further Information

Gastric adenocarcinoma is the most common stomach malignancy, with varying global incidence. Risk factors include smoking, high salt diets, H. pylori infection, GERD, atrophic gastritis, and intestinal metaplasia of the gastric mucosa.
Two classifications exist: intestinal and diffuse gastric adenocarcinoma. Intestinal type resembles glandular tissue and tends to be bulky, occurring most frequently in endemic areas. Diffuse type exhibits infiltrative growth and is composed of 'signet ring' cells, leading to a thickened stomach wall with a 'leather bottle' appearance. Germ line mutations in CDH1 can result in an increased risk of diffuse gastric cancer. Patients with FAP and APC gene mutations have an elevated risk of developing intestinal type gastric adenocarcinoma.

Early symptoms include dyspepsia, dysphagia, and nausea, while later symptoms encompass weight loss, anorexia, early satiety, fatigue, anemia, and hemorrhage. Treatment depends on the tumor stage, involving surgical resection for early tumors and chemotherapy for later-stage cancers.