Benign Tumors of the Stomach

Abstract

The microscopic distinction between benign and malignant neoplasms of the stomach is occasionally impossible, often hazy, and, even in those instances in which it is clear-cut, there is a strong possibility that a lesion appearing benign may eventually become malignant. It would seem, therefore, almost foolhardy to attempt to distinguish them roentgenologically were it not for our experience which indicates that frequently, at least, even this differentiation may be made. The roentgenologic diagnosis “benign gastric tumor” has been confirmed frequently enough so that this terminology seems eminently justified. The demonstration by roentgen examination of the stomach of a benign tumor no larger than a hemp seed (2), or of a carcinoma which is barely distinguishable macroscopically (20), gives an indication of the possibilities of this method and lends encouragement to attempts at making such fine distinctions. An apt illustration of the faithfulness with which the roentgenogram may reproduce the gross pathology of stomach tumors is shown in Figure 1. The film (Fig. 1-A) shows a small kidney-shaped defect in the cardiac end near the lesser curvature, which is sharply defined, and shows no evidence of infiltration of the gastric wall. The photograph of the opened stomach removed at autopsy is shown in Figure 1-B The typical appearance of a pedunculated benign polyp is shown, corresponding most exactly with the filling defect demonstrated in the roentgenogram. The symptomatology, diagnostic signs, and pathology of benign tumors of the stomach have been repeatedly amplified in excellent papers on this subject during the past ten years (1, 4, 6, 7, 10, 12, 15, 16, 19, 21), and we do not propose here to review these phases of this subject. We wish merely to present some evidence of the actual incidence of benign gastric tumors, and to call attention again to the frequency with which they undergo malignant degeneration. When one of us (L. G. R.) reported 15 cases in 1930 (19), there were already in the literature records of almost a thousand and from one clinic alone some fifty cases had been described (6). Nevertheless, non-malignant tumors of the stomach are still considered relatively rare, and they obtain little attention in the ordinary text-book. Data as to the incidence of benign gastric tumors are variable. Eusterman and Senty (8), in 1922, reported that 1.3 per cent of all the tumors of the stomach were benign. Kirklin and Weber (11) give the incidence as less than 2 per cent, while Dwyer (5) found only three cases in over five thousand gastro-intestinal examinations, the ratio to malignant tumors being 1 to 39. Lockwood (12) reported an incidence of about 4.3 per cent, and Eusterman, in discussing this paper, indicated his conviction that the incidence is higher than has been generally believed.