A man, aged sixty-four, was admitted into hospital with the following history. Nine months previously he had begun to experience discomfort after meals with colicky pains and excessive flatulence. After continuing in this state for seven months he had been suddenly attacked by haematemesis, which lasted for two days. Since that time he had suffered severe pain after food, had lost his appetite, and had frequently vomited. He had also become much emaciated and very weak, and had noticed a tumour in the abdomen for nearly three months.
On examination the patient was found to be extremely thin and markedly cachectic. In the epigastrium a large tumour could be seen, which extended from the left costal margin to the right of the median line and downwards to the level of the umbilicus. On palpation it had a hard smooth surface, could be easily moved from side to side, and to a lesser degree in the vertical direction, and was resonant on percussion. No fluctuation could be detected in it, and manipulation gave rise to pain. There were no signs of dilatation of the stomach.
Cancer of the parietes of the stomach was diagnosed, and an operation was undertaken with a view to its removal. When the anterior wall of the organ had been incised, a large pedunculated tumour was found attached to the posterior surface. The pedicle was cut and the mass removed, the patient making an excellent recovery. The tumour itself was the size of the foetal head at term, and presented a lobulated surface and a short thick stalk. The section showed numerous small cysts, and microscopical examination proved it to be a simple adenoma.-Chaput.
Mucous polypi affecting the region of the great curvature do not appear to influence the duration of life, since in nearly one third of the recorded examples the patient attained the age of sixty years. In those cases, however, where urgent symptoms existed, or where the pedunculated tumour was of large size, the disease helped materially to shorten the period of existence. In most instances the fatal result was due to exhaustion arising from pain and vomiting. Fatal haemorrhage has only once been recorded (Ellison), and the same remark applies to the frequency of perforation. The most important sequela is carcinoma. Lemaitre has recorded a case in point, and Menetrier has made some important observations upon the mode of development of the malignant disease. In one case of multiple polypi which came under his notice a deep ulcer the size of a five-franc piece with an irregular pulpy base was found upon the lesser curvature. On microscopical examination the sides of the ulcer showed hypertrophied gland tissue similar to that in the polypi, but at the base the tubular processes, instead of being confined to the mucous membrane, were seen to have penetrated the muscularis mucosae and to ramify in the submucous coat. The epithelium presented an atypical appearance, and secondary deposits of adeno-carcinoma were found in the lymphatic glands and in the liver. In another case, where the adenomatous disease occurred as a raised patch in the gastric wall (en nappe), the various gradations between simple adenoma and carcinoma could be easily traced. Spontaneous cure of the polypoid condition may be brought about by detachment of the growths (Beardsley), while a similar affection of the small intestine may lead to fatal intussusception, as in the following case :-