TY - JOUR
T1 - Napoleon Bonaparte's gastric cancer
T2 - A clinicopathologic approach to staging, pathogenesis, and etiology
AU - Lugli, Alessandro
AU - Zlobec, Inti
AU - Singer, Gad
AU - Lugli, Andrea Kopp
AU - Terracciano, Luigi M.
AU - Genta, Robert M.
PY - 2007/1
Y1 - 2007/1
N2 - Background: Numerous hypotheses on the cause of Napoleon Bonaparte's death have been proposed, including hereditary gastric cancer, arsenic poisoning, and inappropriate medical treatment. We aimed to determine the etiology and pathogenesis of Napoleon's illness by a comparison of historical information with current clinicopathologic knowledge. Investigations: Evaluation of Napoleon's clinical history, original autopsy reports, and of historical documents. The clinicopathologic data from 135 gastric cancer patients were used for comparison with the data available on Napoleon. Diagnosis: At least T3N1M0 (stage IIIA) gastric cancer. Napoleon's tumor extended from the cardia to the pylorus (>10 cm) without infiltration of adjacent structures, which provides strong evidence for at least stage T3. The N1 stage was determined by the presence of several enlarged and hardened regional (perigastric) lymph nodes, and the M0 stage by the absence of distant metastasis. Analysis of the available historical documents indicates that Napoleon's main risk factor might have been Helicobacter pylori infection rather than a familial predisposition. Conclusions: Our analysis suggests that Napoleon's illness was a sporadic gastric carcinoma of advanced stage. Patients with such tumors have a notoriously poor prognosis.
AB - Background: Numerous hypotheses on the cause of Napoleon Bonaparte's death have been proposed, including hereditary gastric cancer, arsenic poisoning, and inappropriate medical treatment. We aimed to determine the etiology and pathogenesis of Napoleon's illness by a comparison of historical information with current clinicopathologic knowledge. Investigations: Evaluation of Napoleon's clinical history, original autopsy reports, and of historical documents. The clinicopathologic data from 135 gastric cancer patients were used for comparison with the data available on Napoleon. Diagnosis: At least T3N1M0 (stage IIIA) gastric cancer. Napoleon's tumor extended from the cardia to the pylorus (>10 cm) without infiltration of adjacent structures, which provides strong evidence for at least stage T3. The N1 stage was determined by the presence of several enlarged and hardened regional (perigastric) lymph nodes, and the M0 stage by the absence of distant metastasis. Analysis of the available historical documents indicates that Napoleon's main risk factor might have been Helicobacter pylori infection rather than a familial predisposition. Conclusions: Our analysis suggests that Napoleon's illness was a sporadic gastric carcinoma of advanced stage. Patients with such tumors have a notoriously poor prognosis.
KW - Gastric cancer
KW - Helicobacter pylori infection
KW - Hereditary gastric cancer syndrome
KW - Napoleon Bonaparte
KW - TNM stage
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U2 - 10.1038/ncpgasthep0684
DO - 10.1038/ncpgasthep0684
M3 - Article
C2 - 17203089
AN - SCOPUS:33846049943
SN - 1743-4378
VL - 4
SP - 52
EP - 57
JO - Nature Clinical Practice Gastroenterology and Hepatology
JF - Nature Clinical Practice Gastroenterology and Hepatology
IS - 1
ER -