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On the basis of analysis of the histological structure of 1,095 polypoid and nonpolypoid tumors, the frequency of detection of "primary" carcinoma and its clinical and histological features were studied. It is shown that one third of pTI category carcinomas are devoid of signs of a preceding adenoma. Polypoid primary carcinomas account for only 15.8% of cases. The prevailing plaque-like, flat, and ulcerated tumors invade the submucous layer more frequently than malignancy adenomas of the corresponding size and produce metastases to the lymph nodes more frequently. The tumor develops against the background of precancerous and dysplastic changes in the epithelium in the nonpolypoid mucosa and in the adenomas. The indications for economical operations in primary carcinoma, in distinct from those in malignancy adenomas, should be determined with caution.

The oncological substantiation of endoscopic and economical surgical treatment of T1N0-1M0 gastric carcinoma in 46 patients was appraised. The results were studied with due regard for the peculiarities of early gastric carcinoma (EGC) revealed in 290 patients after standard surgical management. It was established that organ-preserving treatment of ECG is possible--5-years survival was 96.2%. Endoscopic removal can be considered radical only in T1P1 tumors without invasion of the lymphatic vessels of the wall and was of a multistage character in 86.2% of cases. Careful surveillance after its completion is necessary. Surgical treatment in indicated in repeated recurrences; they were encountered in 44.8% of cases. The causes of the recurrences were noncoincidence of the macroscopic and histological boundaries of the tumor (33.6%), multicentric growth (30.4%), and invasion of the submucosa. Metastases are encountered in the lymph nodes in 9.1% of cases in economical treatment. In T1N0-1M0P1-2 carcinoma, absence of multicentric growth, and III degree dysplasia in the surrounding mucosa (reflecting increased risk of multicentric growth) the volume of organ resection may be limited on condition that P1 lymphadenectomy is performed. The results of organ-preserving treatment are comparable with those of surgical treatment conducted in a standard volume.

A brief review of literature and description of an extremely rare case of duodenum glomic tumour are presented. The tumour of the duodenum was detected roentgenologically and endoscopically in a woman of 51, 3 months after the appearance of weakness, pains, and black stool. Pancreaticoduodenal resection was performed. The tumour, 17 X 15 X X 6 cm in size, coming from the duodenum wall and growing into the choledochus wall, was found. Histologically, the tumour consisted of bundles and knots of elongated cells and roundish cells with clear perinuclear zones. Invasive growth into the choledochus wall, polymorphism, mitoses, necroses, vascularity were noted. The death resulted from bleeding 23 days after the operation. No cases of malignant glomic tumours of the duodenum could be found in the literature.

A study on alterations occurring in gastric mucosa in cases of stage I stomach cancer identified chronic gastritis involving gland atrophy of varying degree as the basic background feature, with intestinal metaplasia and dysplasia being common manifestations of precancerous lesion development. Malignant transformation of hyperplastic polyps and adenomas occurs in areas in which dysplasia of metaplastic epithelium tends to spread. Stomach cancer development from gastric ulcer seems unlikely. Morphological factors should be considered, when groups of high risk for stomach cancer development are identified among cases of chronic gastric diseases.

Background: Glomus tumors (GTs) are mesenchymal neoplastic lesions arising from the glomus bodies and generally occur in the fingers and toes. Gastrointestinal GTs are rare, and most of them originate from the stomach; however, GT arising from the duodenum is exceedingly rare. Case presentation: A 68-year-old man was admitted due to abdominal pain. Endoscopy showed a round, smooth, elevated mass in the second portion of the duodenum with central ulceration. Abdominal contrast computed tomography showed a hypervascular tumor measuring 26 mm in diameter in the second portion of the duodenum, and pancreatic invasion was suspected. Endoscopic ultrasonography of the lesion confirmed a hypoechoic mass arising from the fourth layer of the duodenal wall. A biopsy was performed for central ulceration, and immunochemical studies showed positive results for smooth muscle actin (SMA) and negative results for S100, C-Kit, and CD34. Leiomyoma or gastrointestinal stromal tumor was suspected and pancreatoduodenectomy was performed. The specimen exhibited a vascular-rich tumor, 24 × 24 × 19 mm in size, with deep ulceration in the duodenum. Histological examination showed uniform small round cells with central nuclei and a pale cytoplasm (glomus cell) with perivascular proliferation. Immunochemical studies showed that the tumor was positive for SMA and collagen type IV, and negative for C-Kit, CD34, desmin, and S100. We diagnosed the tumor as a GT of the duodenum. Conclusion: GTs of the duodenum are exceedingly rare, but should be considered in the differential diagnoses of duodenal submucosal lesions. [ABSTRACT FROM AUTHOR]