A case of columnar‐celled carcinoma of the stomach showing squamous‐celled metaplasia

Abstract

A MARRIED woman, &. 39 years, was admitted into St. George's Hospital on 22ncl November 1904, with pain and vomiting after food, of about three months' duration. An abdominal tumour had been noticed two months before admission. Eighteen years previously an ovarian cyst had been removed in the hospital. She was a somewhat wasted woman, with dry, harsh skin, showing general pigmentation. The skin of the abdomen was atrophied, thrown into folds, and considerably pigmented, but did not present the warty, pigmented condition characteristic of acanthosis nigricans. I n the left hypochondriac, epigastric, umbilical, and to some extent in the left lumbar regions, there was a large, firm tumour, which was superficial, and easily felt through the flaccid abdominal walls. I t was adherent to the umbilicus, which was fixed, and had some hard nodules in its neighbourhood. The note over the tumour was that of modified stomach resonance. A test breakfast showed absence of free hydrochloric acid, and the presence of lactic acid. The patient continued to suffer pain, which necessitated opium, and to vomit except when fed per rectum, and went steadily down hill. On 23rd December a fluctuating tender swelling appeared in the epigastrium at the upper border of the tumour, and on the following day, when the skin had become red and edematous,