大陣放射練醫學會ít 찮; 第 1 卷 第 1 없

Benign Tumor of the Stomach

Seung Bong An, M.D.

Department 01 Radiology aηd Nuclear Mediciηe. Seoμ1 Korea. Yonsei University Medical College and Severance Hospital. Frank T. Moore, M. D.

Chiel of Department 01 Radiology and Nuclear Medicine. City Hospital 01 Akron. Akroη ， Ohio, U. S.A

_ .. . _ ... ~ Contents ~" ' - "' ­ malignant tumors found in autopsy material, the inci­ Incidence dence of benign tumors increases. Thus, in 4,413 aut­ Pathology opsies at Bellevue Hospital Dupley et'~a 1. reported a Case Presentation benign tumor incidence of 22. 0 percent. Stewart, on Case 1) Myoma comparing 78 benign tumors with 23 ma1ignant tumors Comment on Myoma Case 11) Polyp occurring in 11. 000 autopsies, found an incidence of Comment on polyp 22.2 perent. On the same basis Rigler and Ericksen Case 11 1) Lipoma found an incidence of 23. 2 percent Comment on lipoma From the viewpoint of gastric surgery, a different Clinical Symptoms incidenceis' reported. Eusterman .and Senty reported 27 Diagnosis benign tumors or an incidence of 1. 3 percent on 2, 168 Treatment Summary operations. Dudley and Morse and Miscall also found References an incidence of benign tumors of 1. 3 percent in surgi­ cal pathological materia1. lncidence On the basis of roentgen examination in a large number of ca않s ， Kirklin 뻐d Weber stated that less than Unti1 recently benign tumors of the stomach were 2 percent of all gastric tumors were benign. Rigler and thought to be rather rare. Prior to 1913 the incidence Ericksen reported an incidence of 11 percent on 4, 236 of benign tumor of the stomach at necropsy in various x-ray examinations. Finesilver in an estimated 43, 200 European hospitals ranged from O. 0053 to O. 04 per­ examinations found a ratio of ma1ignant to benign cent. Tilger and Eliason and Wright found an incidence tumors of 66 to 1. of 3. 3 percent. ln 1930 Hillstrom found that about 5 Schindler reported an incidence of 1. 5 to 2 percent percent of all gastric tumors found at autopsy or opera­ of all patients examined dy gastroscope tion, were benign. Nadêau and McCarty stated that Pathology 1. 2 percent of all gastric tumors are benign. Lρ ckwood in a small series of cases, observed about 5 percent of Benign tU l11 0rs of the stol11ach are rounded, nodu lar, all gastric tumors found at necropsy or removed at lobulated or mush;oom-shaped and usually of S I11∞th operation were ben ign. Rieniets, more recently, found contour. The growth may arise in the I11 Ucosa, extra­ an incidence of ben ign tumor of 16. 0 percent out of mucosa, submucosa, 01' serosa of the stol11ach. It pre

200 stomachs autopsied. On direct comparison with sents endogastric or exograstric tumors. The I11 Ucosa

- 2 5 - over the tumor is thinned out, smooth and its fo1ds are effaced. These tumors often ulcerate. The size of Case Presentations the tumor varies from a mil1et seed to one fil1ing the Case No. 1 entire stomach. Chaput reported a tumor as 1arge as a A 63 year old white fema1e entered the hospita1 on feta1 head. They are sessi1e or more often peduncu1ated March 27th 1954 comp1aining of vague pain in the Eliason found that 20 percent are pzdunculated. right upper quadrant, often radiating sharp1y around There is scant agreement among patho10gist regard­ the right costa1 margin to back, occasiona1 f1atu1ence ing the c1assification of benign tumors of the stomach and b10ating after mea1s of 'two years duration. The It appears that the c1assification by Thompson and patient has been rather constipated but no b100dy sto­ Oyster, based on pure histo10gic types, is adequate 잉ld ols. the mixed varieties are c1assed as sub-groups of the The physica1 examination showed nothing remarkab- pure forms of benign tumors. The frequency of occur 1e. The b100d cell count showed RBC 4, 400, 000, WBC rence of benign tumors of the stomach under the c1as­ 4, 900, which was consisted of neutrophil 64, 1ym­ sification by Thompson and Oyster is indicated by phocyte 33, monocyte 2, and eosinophil 1. The gast­ tabu1ations of collected cases. E1iason, Wright, Gesch­ ric ana1ysis showed occu1t b100d in two specimens but ickter and Minnes have collected groups of 560 cases otherwise was norma1; free HC1 7. 19 and tota1 acidity and 931 cases respective1y. 19. 32 in two specimens respective1y. Duodena1 drainage [Tab1e 1] revea1ed yellow-green mucoid and turbid gross b100d was present, a few epithelia1 bi1e cells and many fungus Type of Tumor ! 쩍~i93 앙끓l%Ii였a효 isEg기jElj 5E6π W0a 굶%aIlg ∞ h홉st and mycelia spores. Smears of gastric f1uid demonst­ rated epithe1ia1 cells and 1eucocytes but no tumor cells EpitheIial were found. Bromsu1pha1ein excretion and cepha1in Po1yp 19. 5 5.8 f10ccu1ation were within norma1 1imits. Papil10mata 9. 5 7.8 Adenomata 4. 5 5.5 Po1yposis 1. 7 1. 9 Mesenchymal Leiomyomata 36. 6 **57.3 Neurofibromata 10. 9 Fibromata 4.5 4. 1 Lipomata 34 5.0

Osteomata 0‘ 4 O. 17 Osteochondromata O. 1 Myomata 0.3 Myxoma 0.5 EndotheIial Hemangiomata 1. 6 [Fig. 1J Lymphangiomata 1. 5 X-ray findings(Fig. 1) An upper gastro-intestina1 Endothe 1iomata 1. 2 tract study done on March 29, 1954 showed an ova1 Angioma 1. 7 intramura1 tumor on the antero1atera1 border of the Lymphangioma O. 17 stomach in the upper portion of the body of the sto Cysts mach, which measured approximate1y two by three Simp1e 3. 2 Dermoid O. 5 centimeter. The mucosa1 pattern did appear to be Echinococcus O. 4 slight1y distorted but it is not thought that there is ** In this group authors incJ ude fibromyoma, fibroleiomy. any infi1tration type of disturbance to the l11 ucosa1 oma, adenomyoma, myoma and adenoleiomyoma. pattern. The patient was not tender in this region to - 2 6 - palpation, and the mass could not be felt through the of myomata is 60 percent. Minnes and Geschickter abdominal wall. It was constantly present and did not found leiomyomata occur in 36. 6 percent of all benign mvoe about. The mass presented no stalk or pedic1e. tumors of the stomach. Rieniets studied 200 autopsies, This finding was thought to represent a benign tumor. found 43 leiomyomas varying from O. 1 to O. 9 centi- Three days later the examination was repeated and the meters in diameter. They occur as hard, round, smooth, presence of a tumor on the greater curvature of the sessile or pedllnculated tumors which originate in the stomach was reconfirmed and the du(피enal bulb and stomach wall, project into the lumen of the stomach visualized small intestines were normal. as intragastric tumor, bllt may grow within the wall Surgery done on April 5, 1954 revealed a mass and become exogastric. Most often they occur near the measuring about one inch by two centimeters in diam- pylorus as either single or multiple tumors. All of the eter, ovoid and firm, well encapsulated and located Rieniets’ tumors were quite small but some llnusually along the greater curvature. 1t cut with resistance 없ld large myomatous tumors have been reported. Eiselberg bulged on division by a knife. There appeared to 뾰 and Blaxland each reported a case the size of a head' several consecutive layers to the tumor mass. 1t appe- Abollt 85 percent arise in the muscularis of the sub- ared to be probably a leiomyoma on the stomach wall mucous layer and project into the stomach. Nassetti itself, intramllral in position. It lies between the musc1e noted the site in 106 cases as follows: 14 on the an- fibers and the mucosa of the stomach walJ, located terior walJ, 15 on the posterior walJ, 30 on the greater along the greater Cllrvature. The tumor mass was dis- and 12 on the lesser curvature, 23 on the pylorus, 7 sected sharply and the mucosa was not entered. The near the cardia and 5 in the fllndus. Associated patho- incision was c1osed. logic changes range from ulceration or cystic formation to malignant sarcomatous degeneration. After reviewing 310 ca똥s ， Eliason and Wright were of the opinion that they are far from being as benign as their c1assification suggests. Lahey and Colcock concur in this view. One of the most striking c1 inical featllres of leiomyomata is their tendency to ulcerate and to bleed massively or ooze blood continuously. 1n the case presented above, the patient had occlll

(Fig. 2)

The tissue examination showed (Fig. 2) (1) Grossly a firm tan-brown to white mass measuring approxi- . mately 3 by 1.5 by 1. 5 cms; (2) Microscopically a leiomyoma with rather extensive fibroblastic prolife­ Case No: H ration and hyaline fibrosis; slight focal calcification but A 56 year old male, apparently in go여 health, had no histologic proof of malignancy present severe gastro-intestinal upsets consisting of vomiting Final diagnosis: Leiomyoma in gastric walJ. and diarrhea, ranging upwards of stools 20 per day Progress: Patient was discharged on April 11, 1954 about one year ago. The last episode in February las­ in improved condition. ted about one week and patient had small amount of Comment on myoma: Myomata inc1 udes fibromyo­ blood in bowel movement. Since then has had no dist­ mata, fibroleiomyomata, adenomyomata, leiomyomata ress of stomach and bowel movement has been regular and adenoleiomyomata. According to Eliason 없 d Wri­ up to the date of admission to the hospital 011 March ght, of all benign tumors of the stomach the incidence 23, 1954.

- 27 - The physical examination was not remarkable. The normal to palpation. The stomach was opened with a abdomen was soft and no mass nor tenderness were longitudinal incision on its anterior wall. The polyp was elicited. The blood count showed RBC 5, 260, 000, readily excised including 따 base and the wound was Hemoglobin 91 percent, WBC 9, 800, which were con- c1osed. sisted of neutrophil 72, Iymphocyte 23, monocyte 3, The tissue examination revealed CFig 4) (1) Grossly and eosinophil 2. soft to firm, tan-pink to purple piece, the largest 10 by 9 by 3 mm. and the smallest 3 by 3 by 2 mm ; (2) Microscopically adenomatous polyp of the stomach, low grade inflammation, no infiltrative growth was fou nd. Progress: The patient was discharged in improved condition on March 3, 1954. Cornment on polyps: Benign adenomas of the sto­ mach also are referred to as polyps, polyposis and ade­ nopapillomas. The term “ polyp" refers to the gross appearance of the tumor, not its histologic structure. They occur as round, sessile or pedunculated, single or multiple projections into the lumen of the stomach. 1n one-half the cases of polypoid adenoma, the tumor is (Fig. 3) single and in most of the remaining cases only few The x-ray examination(Fig. 3) done on March 3, of the small tumors are present. Diffuse gastric poly­ 1954 revealed that the stomach in its central region, posis is consider어 a rare disease. The autopsy incide­ approximately four inches proximal to the pylorus, nce of polyposis is about 1. 7 to 1. 9 perænt of all presented a rounded filling defect which measured ap­ benign tumors of the stomach. Polyps occur in about proximately six millimeters in its' greatest diameter. 15 percent. Among polyps, about 80 percent are 않ssi l e ， This defect did not move about but appeared to be 10 percent peduculated, about 65 perænt are single and relatively fixed. 1t was not tender and there was no 35 percent are multiple. The most common site of central u1ceration. 1t did not appear to have a stalk gastric polyps is on the posterior wall in the region The possibi1ities of this defect would be a prominent of the pylorus. Single polyps are most common near mucosal fold, food material, polyp, or other type of the pylorus; and according to Johnson, Basch and Hig benign tumor. A rest of pancreatic cell should also be gins, multiple polyposis are more common in the mid considered. The remaining portion of the stomach and portion of the stomach. Polyposis of the stomach may duodenum appeared to be otherwise normal. On March be associated with polyposis of the intestinal tract. 9, 1954 repeated x-ray examination showed again a constant circular well-defined soft tissue filling defect in the central portion of the body of the stomach, and it was thought the most likely possibility for this le­ sion would be a polyp. There is no indication that any malignancy has yet occurred. Surgery performed on March 29, 1954 revealed the patient had an one cm. gastric polyp with a rather broad base. 1t was found one inch above the greater curvature of the stomach on the anterior gastric wall about 4 inches proximal to the pylorus. 1t was soft in consistency and showed no gross evidence of malign­ ancy. The rest of the stomach, duodenum, pancreas,

liver, ga llbladder and 1 와ge and small bowel were all (Fig. 4)

- 28 - Bnmn 없d Pearl noted a genera1ized polyposis in 7 further medical observation. percent of ca않s . h.ysical examination(Fig 5) showed no exophthalmus The most important c1 inical aspect of adenoma is its but the t.강 ro id was diffusely enlarged in the midline tendency to undergo malignant change. Diffuse poly­ of the neck. 'l '.~ ~h~ ‘~ abdomen was obese but not tender posis of the stomach is not commonly associated with and no mass was l-"l 1)ated. Her blood count showed carcinoma. According to Walters, multiple gastric pol­ RBC 4, 870, 000, Hemogl u 、 'n 97 percent, WBC 9, 200 yposis are rarely malignant, whereas single gastric consisting of neutrophil 75, ly ‘'lhocyte 15, monocyte polyps are frequentJy ma1ignant. Miller, Eliason 없d 5, eosinophile 5, 월fas떠t디in댄g blood 잃s ug앵a‘ ‘끼격쩌n댄ge때d from 120 Wright reported ma1ignancy in 35 percent of 23 ca않S to 1η7채5mg / 100m비1니1 따a t different exami니in없a tllιιlιιJι- and the of gastric polyps. Brunn and Pearl reported 12 percent Kahn was negative. and McRoberts revealed a grade one malignancy in 4 The x-ray examination done on March 29, 19v ... cases out of five. According to Bockus, the cauliflow revealed a well defined smooth tumor on the anterola­ er- 1ike papilloma is comparatively rare but transforma­ teral aspect of the greater curvature in the mid portion tion into malignant tumor probably occurs frequently, of the body of the stomach measuring approximately and some fungating cau 1iflower1ike carcinoma may ori­ 1 by 1. 5 by 4 centimeters and was located more ante­ ginate as benign papillomas. The diffuse type of poly­ eiorly than laterally. It is thought to be intramurally posis may show a familial tendency. Schindler and located 없ld to distort the mucosal pattern s1ightly but Mac Glone reported cases of hyperplastic diffuse poly­ not to invade or ulcerate the mucosa. The patient was posis occurring in the same family. The majority not locally tender in this region and the tumor mass occur above the age of 40 with males predominating. could not be palpated through the abdominal wall. The According to Schindler, adenomatous polyps are more peristalsis was not seen to pass through this region. prone to develop in cases of atrophic gastritis rather The tumor was rather firm, but the surrounding gast­ than in a normal mucosa. ric wall did not appear to be infi1trated or fixed. Case No. JH This finding probably represents a benign tumor, such A 68 year old white female, obese and chronically ill as myoma, fibroma, adenoma or lipoma. This study with diabetes and rheumatoid arthritis gave a history does show a deformity of the distal third of the duod­ of duodenal ulcer which had been asymptomatic. For enal cap evidently the residual of an old healed duod the past six years the patient has been complaining enal ulcer. Three days later examination was repeated of heat intolerance, nervousness. oalpitation, sweating and a benign tumor on the greater curvature of the palms and a lump in the midline of the neck. She stomach was reconfirmed, and it is doubtful that the was admitted to the hospital on March 27, 1954 for tumor is accounting for this patient’s symptoms. The operation performed on April 12, 1954, on the

greater curvature of the stomach 없ld on the posterior wall, revealed a nodule measuring about one inch in diameter. It was between the serosa and mucosa and it consisted of grossly fatty tissue. Otherwise, the sto­ mach was normal to palpation. The pancreas was mo­ vable, and the gallblladder was thin walled and contained no stones and the 1iver was normal. A vertical incision was made in the posterior serosa of the stomach over the tumor and the tumor was shelled out by resection. The tissue examination revealed (1) Grossly f1at, round, yellow, fatty mass measuring 2.5 by 1 centim­ rters in size; (2) Microscopically adipose tissue with relati vely large cells and very few septa. No ma1igna­ (Fig. 5) ncy was present.

- 2 9 - as size, intragastric or extragastric protrusion and wh­ ~ther they are located near of far froni the gastric orif­ ices. The intragastric tumors are likely to cause more symptoms than extragastric growths. If they are situa ted at or near the cardiac orifice, they may cause dys­ phagia; in the region of the pyloric orifice, they may cause intermittent or persistent pyloric obstrllction. On­ Iy 15 perænt of the benign tumors of the stomach reported in the literature were associated with the sy­ mptoms of pyloric obstruction. A pedunculated tllmor sitllated near the outlet of the stomach may cause obs­ trllction of the intermittent ball-valver type, or it may (Fig. 6J pass into the dllodenum and indllce gastric intllssllsce­

Final diagnosis: Lipoma of the stomach. ption. Thus, pedllnculated tllmor of the pyloric antrum Progress: Patient was discharged on April 17, 1954 may cause intermittent pain, vomiting and retention in improved condition. follow어 by a qlliet interval as the tllmor recede into Comment on lipoma: Lipomata are among the lea the more proximal stomach. 1n Eusterman 뻐d Senty’s st common of benign gastric neoplasms. Kirshbaum cases, obstruction occurred in 25 percent; in Kiefer’s found the autopsy incidence of lipoma of the stomach series and Judd and Hoerner’s cases, vomiting occurred is about O. 018 percent. Approximately 5 percent of in 33 percent and 34 percent respectively. lipomata of the gastro-intestinal tract occur in the sto. Tendency to bleed is one of the remarkable features. mach. In 1, 125 gastric tumors Hunermann found 4 li­ Ulceration of the mucosa over the tumor is the source pomas or approximately O. 36 percent. In a series of 1 of the hemorrhage. Bleeding may range from oozing 81 cases of gastrointestinal lipomas collected by Comf­ resulting in anemia to massive hemorrhage which, wh ort in 1931, there were 22 cases of gastric lipoma but ile grave, usually is not fatal. In Eusterman and Sent­ only five of the latter caused symptoms. Four cases of y’s cases, recurring hemorrhage was present 37 percent gastric lipoma were encountered in 3, 924 necropsies in Judd and Joerner’s series, 22 percent. In Brunn 때d reported by Eliason and Wright. Badner and Caplan Pear’s series of diffuse polyposis, by contrast, hemate reported a caæ ()f lipoma of the stomach in 1952 and mesis occurred in only 8 percent of the cases. Haring claimed his case to be the fifty-fifth reported case. Th C이 l ected 41 cases of gastric polyp having the blood ey are usually sessile pedunculated, single or multiple picture of primary pernicious anemia. This association tumors ranging from hazelnut to walnut size. The ma has led to the hypothesis of the sequence of atrophic jority of gastric lipomas originate in the submucosa. In gastritis, gastric polyp 없ld gastric cancer. Gastric ana­ 9 cases observed by Kirshbaum, 8 cases were located Iysis frequentJy shows an achyJia. in the submucosa. Spitzmuller reported a case of subm­ ucous lipoma measuring 20 by 27 æntimeters. It is ge Diagnosis nerally located in the body and pyloric antrum of the 1n most cases, physical examination is of no help. If stomach. It is usually noted in individuals over 40 ye­ the tumor is Jarge enough, it may be palpated, but ars. The sex incidence is about equal with perhaps a that is extremely rare. The most significant step to­ slightly greater frequency in males. Malignant change ward diagnosis is x-ray examination. A very small from lipomata is very rare benign tumor is difficuJt and sometimes impossibJe to

、 isualize, however, even a very small tumor near the Clinical Symptoms pylorus wil1 usually produce a definite filling defect Unfortunately benign tumor of the stomach does not Schl떠nger says benign tumors can only be diagnosed induce symptoms which are pathognomonic. The c1 ini­ as such when the contour shows smooth round Jines cal behavior of benign tllmors depends on such factors The criteria for reontgen diagnosis of benign tumor at

- 3 0 - enunciated in 1924 by Moore have been quoted tion whether the tumor is malignant or not, so that extensively, gastric re3ection is the operation of choice. Balfollr and These criteria are: (1) Filling defect which is cir- He21deroon remarked that while the possibility of mal- cumscribed or Pllnched Ollt. (2) Filling defect on the ignant degeneration makes partial gastrectomy advisa- gastric wall leaving curvatures regular and pliant. (3) ble, when the tumor is the: only lesion, transgastric loc Rugae surrounding the tumcr which are more nearly al excision may be utilized. Judd and Hoerner recom- normal in arrangement and distribution than in inflam mended that local excision bξ applied when the tumor matory or malignant lesions. (4) Minimal disturbance are small, simple, uncomplicated and of no apparent in peristalsis but with retention rather common. (5) c1 inical significance or when the lesion is near the car- Absence of niche, incisura or other evidence of spasm. dia or is inaccessible. Subtotal gastric resection has been (6) Rarely a tllmor sufficiently large to be palpated. advised by Dlldley, Miscall and Morse because of the

(7) Splitting of barillm as it passes over the wall. (8) high incidence of malignant degeneration. Hunt rep::>r- Gastric polyposis pre3ents a typical mottled appearance ted that about sixty percent of the tumors, mostly py but must be differentiated from partic1es of food in a loric, have been removed jJy partial gastrectomy and stomach fi lled with secretion. (9) Close and complete that sleeve resection had been used in a small propor- approximation of the walls of the barium fi11ed stom- tion of cases. Kiefer concluded that the type of opera ach. He stated that if these signs are not characterist- tion to choose is wide excision or resection, Bockuss. ic, they are at least suggestive. Lahey, and Coicock noted that total gastrectomy may However, the differentiation between benign and ma- be necessary in a few cases. Iignant tumors on the basis of the roentgen defect is Kiefer pointed out that malignancy always is a poss- not always possible. Often leiomyomas and intramural ibility and that the demarkation of benign leiomyoma, adenocarcinoma cause identical roentgen findings. and fibromas from the malignant leiomyosarcomas and Gastroscopic examination furnishes an essential adju fibrosarcomas is indistinct. Bockus stated that simple nct to x-ray and gives complementary information

ach to become malignant is great as previously stated, the final diagnosis of the benign tumor of the stomach Summary must be relied on microscopic examination간n addition A review of the literature of benign gastric tumors to roentgen examination and gastroscopic findings. has been presented along with three cases of benign gastric tumors, that is, leiomyoma, polyp and lipoma. Treatment The x-ray findings were suggestive of typical benign Once the diagnosis of gastric tumor has been estab­ tumors of the stomach in all three cases, in which the lished, the treatment is primarily surgical. The only c1 iniα1 1 findings were vague digestive complaints. divergence of opinion which exists with reference to References surgical treatment relates to the type of operation em­ ployed. Bockus qualified his recommendation of surgery 1) Alvarex, L.F., Lestra, ].S., and Leon, P. : Uicerated by saying that if x.ray and gastroscopic ev idence of gastric Iipoma, Gastroenterology 11 : 746-75 1. 194 benign tumor is found, occasionally operation may be 8. postponed but frequent re-examinations should be carr­ 2) Bockus, H.C.: Gastroenterology, Philadelphia, 1943

ied out. Furthermore, he stated ~;.at it is impossible W.B. Saunders Company. for the surgeon to determine by inspection 없d palpa- 3) Comfort, M. W.: Submuco\\s Lip :Jmata of the Gas

- 31 ,-- tro-intestinal tract, Surg., & Obst. 52 : 101-118, 1 rs of the stomach, Am. J. Cancer 28 : 136- 149, 1 93 1. 936. 4) Culver G.D. , and Dobrak, A.: Submucosal gastric 9) Moore, A.B. · A roentgenoIogic/ study of benign lipoma, Am. J. Roentgenology, 64 : 938-939, 1950. tumors of the stomach Am. J. Roentgenology 11 : 5) Eliason, E.L., and Wright, Z.W.M.: Benign tumors 61 -66, 1924. of the stomach, Surg., Gynec. & Obst. 41 : 461-47 10) Palazzo, W.L.: Lipomas of the gastro-intestinal 2, 1925. tract, Am. ]. Roentgenology 62 : 823-830, 1946. 6) Feldman, M.F.: Clinical roentgenology of the dig­ 11) Pearl, F. L., and Brunn, H.: Multiple gastric poly estive tract 1945, The Williams & Wilkins Com­ posis, Surg., Gynec, & Obst. 76: 257-281, 1943. pany. 12) Portis, S.A.: Disease of the digestive system, 1944 7) Hobbs, W.H., and Cohen, S.E.: Gastroduαienal In­ L않 & Febiger, Philadelphia. vagination due to a submucous lipoma of the stom 13) Thompson, H.L., and Oyster, J.O. : Neoplasms of ach, Am. J. Surg. 71 : 505-519, 1946. the stomach other than carcinoma, Gastroenterolo­

8) Minnes, ].F., and Geschickter, C.F ’ Benign tumo- gy 15 : 185-243, 1950.

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