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3D Printed Adenocarcinoma of Stomach
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3D Printed Adenocarcinoma of Stomach
Clinical History
An 82-year old female presents with an episode of melena (dark tarry faeces).
She had a 6-month history of dyspepsia and nausea. Recently she had noted weight loss and early satiety. Soon after
admission she had a large melena episode and died.
Pathology
This is a post mortem specimen sliced to include a sagittal view of the oesophagus,
stomach, proximal duodenum and pancreas. A large 7x5cm ulcer is evident on the lesser curve of the stomach. The
ulcer is shallow and broad with raised rolled edges and necrotic debris at the base. There is loss of gastric rugae
radiating along the mucous from the ulcer. Dissection of the ulcer reveals elevation of the edge by pale homogenous
tumour tissue. There were two eroded arteries present within the ulcer crater with evidence of recent haemorrhage.
The pancreas is adherent to the serosal aspect of the ulcer. Histology taken from the lesion (sites visible as
regular 3cm defects) demonstrated an ulcerating, well-differentiated adenocarcinoma of the stomach with direct
invasion into the pancreas.
Further Information
Gastric adenocarcinoma is the most common malignancy of the stomach. The
incidence varies widely with geography: with a much higher incidence in Japan, Chile, Eastern Europe when compared
to North America, Africa, South East Asia and Northern Europe. Risk factors include smoking, high salt diets, H.
Pylori infection, Gastro Esophageal Reflux Disease (GERD), atrophic gastritis and intestinal metaplasia of the
gastric mucosa.
There are two distinct classifications: intestinal and diffuse gastric adenocarcinoma. Intestinal
adenocarcinoma resembles glandular tissue similar to colonic or oesophageal adenocarcinoma. Intestinal types tend to
be bulky: growing as either an ulcerated or exophytic tumour. Intestinal type occur most frequently in endemic
areas, has a male predominance and a mean age of 55 years at presentation. Intestinal type can occur from precursor
lesions, such as dysplasia and/or adenomas with dysplasia. Diffuse type gastric cancers have an infiltrative growth
pattern and are composed of ‘signet ring’ cells – i.e. cells that have large vacuoles full of mucin leading to
displacement of the nucleus to the cell‘s periphery. The cells appear to have lost adhesion between each other, and
can therefore be widely distributed within the stomach mucosa. A mass may not be appreciated in this diffuse type as
a desmoplastic reaction can occur around the tumour cells, causing a thickened and rigid stomach wall with loss of
rugae, creating a “leather bottle” appearance also know of linea plastica. Diffuse type has equal incidence across
sexes and countries, and does not have precursor lesions. Germ line mutations in CDH1, which causing loss of
function of E-cadherin leading to the loss of cell adhesion, can result in an increased risk of diffuse gastric
cancer, which can be familial. Patients with Familial Adenomatous Polyposis (FAP) with germ line mutation in
adenomatous polyposis coli (APC) gene have an increased risk in developing intestinal type gastric adenocarcinoma.
Early symptoms include dyspepsia, dysphagia and nausea. Later symptoms include weight loss, anorexia, early satiety, fatigue, anaemia and haemorrhage. Treatment depends on tumour stage with surgical resection for early tumours and chemotherapy for later stage cancers.
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The models are very detailed and delicate. With normal production machines you cannot realize such details like shown in these models.
The printer used is a color-plastic printer. This is the most suitable printer for these models.
The plastic material is already the best and most suitable material for these prints. (The other option would be a kind of gypsum, but this is way more fragile. You even cannot get them out of the printer without breaking them).The huge advantage of the prints is that they are very realistic as the data is coming from real human specimen. Nothing is shaped or stylized.
The users have to handle these prints with utmost care. They are not made for touching or bending any thin nerves, arteries, vessels etc. The 3D printed models should sit on a table and just rotated at the table.