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Over the past 10 years, we have experienced 11 cases of early gastric cancer limited to the mucosa and submucosa, with a widespread lymph node metastasis over the perigastric node. These cases represented 3.8% of all the early gastric cancer cases treated at our hospital during this period. The average age of these patients was 49.1 years, and consisted of 7 males and 4 females. Of these 11 cases, 10 cases (90.9%) were, macroscopically, the depressed type. Histologically, 7 cases (63.6%) were poorly differentiated carcinoma. Curative resections were possible in 8 cases (72.7%). The cumulative 5-year survival rate was poorer than for other types of early gastric cancer, and amounted to 66.7% in cases that were curative, and 0% for non-curative cases.

Twenty-two cases of primary gastric lymphoma have been clinicopathologically reviewed and factors influences the prognosis were examined. An increased tumor size of more than 10 cm, an increased tumoral penetration, a lymph node involvement, and stage IV classification decreased the survival rates. All patients given stage I classification have remained alive without having received chemotherapy. The survivors of stages IIIIV amounted to only three patients who were treated by surgery and systemic chemotherapy. A radical operation is the choice of treatment for a gastric lymphoma but aggressive chemotherapy should be supplemented for advanced cases.

A case of perforated early gastric cancer and a collective review of the relevant Japanese literature is reported. A 83-year-old woman with free air discovered by an abdominal X-ray, was referred to our hospital. On operating, a perforated ulcer was found within and lesions, indicative of a IIc + III type early gastric cancer. Macroscopically, there was an elevated lesion at the antrum of the stomach as well. Histologically, these lesions were connected and moderately differentiated adenocarcinoma. Another lesion was also found at the anterior wall and diagnosed as IIb type gastric cancer.

A 37-year-old male was admitted to our hospital because of an abdominal tumor, about the size of a fist, located anterior to the pancreas head. This tumor oppressed the antrum of the stomach to the left, and an operation was performed, the tumor being diagnosed as a leiomyosarcoma of the stomach, determined from image findings. After histopathological examination, however the tumor proved to be an adenocarcinoma. An early gastric cancer was found at the anterior wall of the antrum during the operation, and the tumor was thought to be a metastatic lymph node. Lymph node metastasis also was observed at the root of the mesentery.

Adenocarcinoma, malignant lymphoma and leiomyosarcoma are the main malignant tumors found most frequently in the small intestine and adenocarcinoma should be differentiated from these lesions as well as benign tumors. Ten cases with primary adenocarcinoma of the duodenum and 14 of the small intestine (the jejunum and ileum) were diagnosed and treated surgically in our clinic during recent 22 years. Analysing the clinical signs, symptoms and roentgenological features of these patients, the diagnosis, treatment and prognosis for these lesions were discussed and reviewed. To enhance the 5-year survival rate for these patients, the early diagnosis in the curative stage should be established.

A case of leiomyosarcoma of is reported. A 78-year-old man was admitted with a history of constipation and deformation of the stools. Barium contrast study and sigmoidoscopy showed a submucosal tumor of the rectum. On computed tomography and angiography, the tumor was suspected of being leiomyosarcoma. Abdominoperineal resection was performed. Microscopic examination revealed a leiomyosarcoma of the rectum and widespread lymph node metastases were found. Leiomyosarcoma of the rectum is an uncommon tumor. In our country, 89 cases have been reported. Six had lymph node metastases initially and another six subsequently. We have referred to the literature on leiomyosarcoma of the rectum.

We report two cases of carcinoid tumor of the stomach together with a collective review of the Japanese literature. Case 1 was preoperatively diagnosed as carcinoid, and the lesion, measuring 10 X 7 mm, and located in the body of the stomach, had no metastases. Case 2 was preoperatively diagnosed as gastric cancer and was recognized as a submucosal tumor measuring 5.8 X 4.7 cm in the antrum of the stomach. There were metastases to the brain and the skin, and the patient died on the 50th day after the operation. From a collective review of previous cases, it was ascertained that small carcinoid tumors sometimes had metastases. For this reason, we feel gastrectomy should be performed together with local lymph node resection.

Seventeen cases of a recurrent gastric cancer that were treated by a resection of the remnant stomach have been studied retrospectively. For first management 12 cases were given a Billroth 2 procedure, 4 cases a Billroth 1 procedure and 1 case a fundectomy. For the recurrent cancer, 13 cases were given a total resection of the gastric remnant and 4 cases a partial resection. The overall mortality rate was 12% and the survival rate was 58% at 1 year, and 8% at 5 years. We thus have concluded that a resection of the remnant stomach should be carried cut in cases of a recurrent gastric cancer whenever possible.

Adult intussusceptions due to metastatic intestinal-tumor are very rare. A 71-year-old man with an intussusception due to intestinal metastasis of renal carcinoma is reported. To our knowledge, this is the third such patient in the Japanese literature. The patient was suffered from an intestinal obstruction six months after his renal carcinoma was detected. Laparotomy was performed, revealing that he had developed a jejunojejunal intussusception due to metastasis of renal carcinoma. The early diagnosis of metastatic intestinal tumor is difficult. It is important to bear in mind that patients with malignant tumor may already have metastasis.