18991              CARCINOMA OF THE STOMACH

The patient was a woman aged 70 who was well until 2 days before admission when she suddenly became breathless.  Next day she was nauseated and repeatedly vomited dark brown material not obviously containing blood.  There was mild epigastric tenderness.  She was transfused and later developed melaena.  Later still there was abdominal distension and further copious vomiting containing altered blood.  She died on the 6th day.

The specimen consists of the stomach.  There is a fungating carcinoma 5 cms in diameter on the posterior wall just below the centre of the lesser curvature.  The surface of the tumour is irregular and there is considerable superficial necrosis and congestion.  There is a long linear acute ulcer measuring 6 x 1 cms on the lesser curvature extending from about 1 cm below the cardio-oesophageal junction, and there is a small acute ulcer 6 mm in diameter containing slough on the posterior wall 5 cms below the linear ulcer.  The reverse of the specimen shows direct extension of the tumour to the serosal coat of the stomach, but no metastases were found at postmortem.  Histology shows a columnar-celled adenocarcinoma with a good deal of mucin formation.