[A case of ulcerative tuberculosis of the stomach in a patient with multiple pulmonary tuberculomas].
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Biomedical subjects
Publications and source records attributed to A M Nesvetov.
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Surgical biopsy of 536 pulmonary tuberculosis patients was analysed. It was found that in 90% of them tuberculosis developed in the malformed segment of lung tissue. Among the defects, basic matter was composed of small hypoplasia zones (2-3 cm) which were detected only morphologically. In 89% of the cases, zones of hypoplasia and cysts were located in the 1st and 2nd lung segments, which formed in the first postnatal months. In all cases tuberculosis affected the malformed bronchus, which was probably the primary site of tuberculosis process dissemination.
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On the material of 144 cases of early gastric cancer its two main histological types are described: enterocellular and mucoidocellular (diffuse). Both these types are differed one from the other by trends of differentiation of tumor cells with the maintained covering function of the epithelium in intestinal carcinoma and the secretory function--in mucoid one. Intestinal cancer shows the structure of adenocarcinoma and is characterized by an expansive exophytic growth. Mucoid carcinoma produces fibrous bands, chains and free cell clusters and shows an endophytic, diffuse-infiltrative growth. In intestinal and mucoid type of cancer a stable (differentiated), progressive (actively proliferating) and regressive variants can be distinguished, the development of which is closely related with local immune reactions in the gastric wall.
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The morphology of immune response in tumor tissue was studied in the resected material obtained from 244 patients with stomach cancer. In nearly 80% of cases of carcinoma, the following five morphological types were observed: (1) acute inflammation (immediate--onset hyperergy); (2) time--delayed hyperergy; (3) plasmocytic--eosinophilic cellular infiltration with tumor mucination; (4) chronic granulomatous inflammation and (5) lymphadenoid and fibrose tissue envelope of tumor. There established a relationship between the type and degree of immune reactions and the histology of tumor. Progressing, regressing and stable reactions should be distinguished. Tumor regression and immune response were observed in foci; however, complete resolution was registered in 2.5% of cases only.
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Based on the operation material of 152 subjects with early gastric cancer the lesions preceding it were followed up. It was found that these have a decisive influence on the anatomical shape of blastoma. Polypoid cancer arises on the background of polyps or chronic gastritis, while gastric ulcer underlie flat and ulcerous cancer. Carcinoma arising in the zone of gastric ulcer made up 79% of all cases of cancer. Early cancers of different origin are distinguished by the histological structure, manner of growth and the rate of proliferation, whereas patients with such lesions--by age and sex. The development of flat or ulcerous tumor due to ulcer is related with the localization of ulcer in the stomach. So, flat cancer arises in healed or healing mostly pyloric ulcer, while ulcerous cancer--in callous ulcer of the gastric angle. Special attention is given to some difficulties in diagnosis of flat carcinoma making 61% of all early gastric cancers.
Parallel histological and electron microscopy studies of 18 gastric cancers have demonstrated that the Lauren classification may be reproduced at ultrastructural level, which allow the type of carcinoma to be identified even in microscopically obscure cases. Intestinal type of cancer is characterized by marked intercellular connections, a brushy margin from enteroid microvilli and the cell cytoplasm rich in polyribosomes. A diffuse type is characterized by detached cells and the presence of mucoid secretion granules in them. The cells per se are similar to mucoid epithelium of gastric glands. Detection of tumor cells showing the signs of both enterocytes and mucoid epithelium of the stomach as well as the elements differentiating toward basic cells speaks in favour of histogenetic affinity of separate types of gastric cancer.