Early gastric stump cancer: macroscopic and microscopic appearance.

Six cases of early gastric stump cancer are presented. The clinical data and macroscopic and microscopic features are described in detail. All the early cancers were located near the gastro-enterostoma. All the carcinomas were of the intestinal type in accordance with Lauren's criteria, and of type II in accordance with the classification of the Japanese Gastroenterological Society. Two carcinomas were multicentric. No metastases were found. In 4 patients no suspicious lesion was found at the site of the carcinoma, stressing the importance of routine multiple biopsies even when no abnormalities are present. In 4 patients, severe dysplasia was found simultaneously with or prior to the carcinoma in one of the stomal biopsies, stressing the significance of severe dysplasia as a morphological marker for cancer. In addition, dysplastic changes were found surrounding the carcinoma in all the surgical specimens. All the patients are well and alive at least 4 years after resection of the carcinoma. All the carcinomas were found more than 20 years after the initial gastric operation. Early detection of gastric stump cancer is readily possible. Early gastric stump carcinoma has a good prognosis. Surveillance of gastric stump cancer can be intensified by identification of postgastrectomy patients with dysplastic mucosal alterations. Severe dysplasia in particular is a dependable marker for cancer.