Simple glandular tumours of the stomach may be single or multiple, and they are specially liable to form polyps They may be found in any part of the stomach, but are nut infrequently found to occur at the pyloric end, where they may give rise to pyloric obstruction and dilatation of the stomach.
In a case of my own, a sessile adenoma gave rise to pyloric obstruction with gastric dilatation, which was cured bv removal of the growth, the longitudinal incision being afterwards stitched up transversely , as" "iii the ordinary operation of pyloroplasty. In another case under the care of a colleague a pedunculated adenoma the size of a cherry acting like a ball-valve produced similar symptoms, which were cured by its removal.
When the tumour is large it may form a freely-movable epigastric tumour as in a case reported by Sutton, and in another reported by Dr. Hinds.
The symptoms may resemble those of cancer by inducing coffee-ground vomiting and wasting as in a case reported by Chaput at the Societe de Chirurgie, in Paris, 1894. The patient was a man, aged sixty-four years. The symptoms were chiefly emaciation and vomiting of coffee-ground material, and an epigastric tumour was observed. At the operation an adenoma covered with normal mucous membrane was found attached by a small pedicle to the posterior wall of the stomach.
Adenoma may pass on into carcinoma or be associated with it, as in a specimen now in the Leeds Museum.
Hay em described two cases in which the growth resembled Brunner's glands.
Ebstein collected twenty-four cases of mucous polypi, fifteen in men and eight in women, in one the sex not being mentioned. He stated that the frequency of these tumours increases after forty years of age; in one half the tumours were solitary, in the rest multiple, even up to 200 in number.
Polypi growing from the mucous membrane of the stomach of a gentleman, seventy-six years of age, who suffered from constant dyspepsia.
Polypus near pylorus which caused fatal intussusception of duodenum in a man aged twenty-one.
The mucous membrane over them may be smooth or villous.
When adenoma is polypoid it should be removed and the pedicle ligatured. If forming a sessile tumour it should be freely excised and the healthy edges of mucous membrane and stomach wall brought together by suture.
If the pylorus be invaded by a sessile adenoma the growth should be freely excised and a gastroenterostomy performed, but if the deeper layers of the stomach wall are invaded, pylorectomy or partial gastrectomy should be performed.