Dipartimento di Medicina Sperimentale, Università Degli Studi di L'Aquila.
We examined 705 surgical specimens of total and subtotal gastrectomy for gastric cancer, from the Surgical Pathology Department of L'Aquila, Atri and Avezzano, during the period from January 1972 to December 1991. For each case at least 15 samplings were taken, from the tumor itself and from the mucosa which appeared macroscopically normal. The cases were then classified according to the criteria proposed by Lauren and by Ming and the staging of the disease using the UICC's pTNM. Applying Ming's classification, it was evident a clear prevalence of the infiltrative (78.6%), rather than the expansive type (21.4%). Lauren's classification showed a slight prevalence of the diffuse type (56.5%), compared with the intestinal type. Intestinal metaplasia, chronic atrophic gastritis and dysplasia were found more frequently in the intestinal and expansive histotypes. These are the forms having a better prognosis and which in our results represent a minority of cases, therefore identifying the geographic area as a low risk area. With regards to the pTNM staging, T3's resulted the most numerous; T1's, or early gastric cancers (EGC), represented instead 15.7% of the total. Such a percentage is rather high in comparison with the mean percentage in western countries with low risk of disease. In reference to the macroscopic variants, a clear prevalence of the ulcerated forms (66.5%) was noted, in contrast with Ming and other Authors, that declare a slight prevalence of the fungating type. Also considering the histotypes there is a certain discrepancy between the data of Ming and ours; in fact, in our study the infiltrative type prevails, representing 78.6% against 33.6% found by Ming. Such a result can be usefully correlated to the high percentage of the ulcerated forms observed in our study and to the relative scarcity of fungating forms; these variants themselves, according to Ming, are usually related to the expansive type of gastric carcinoma. We also noted, in EGC, a remarkable age difference in regards to the diffuse type; the mean age of the 57 patients with this type classified as T1 was 52.2 years against the 63.0 years of the 341 patients with T > 1. The patients with T1 diffuse type carcinoma were not only 10.8 years younger than the patients with advanced gastric cancer of corresponding histotype, but were also 10 years younger than patients with EGC of intestinal type. Such data could support the hypothesis that EGC, diffuse type, has a peculiar biologic behavior.
Pathology & Laboratory Service, University of Texas Southwestern Medical Center, Dallas 75216, USA. email@example.com
BACKGROUND AND AIMS Atrophic gastritis, intestinal metaplasia, and pyloric metaplasia are frequent precursors of noncardial intestinal-type gastric adenocarcinoma in populations in which both gastric cancer and Helicobacter pylori infection are common. We hypothesized that such lesions would be less prevalent in European gastric cancer patients. METHODS Slides from patients who underwent gastrectomy for adenocarcinoma between 1997 and 2004 were reviewed. Tumors were categorized as intestinal or diffuse; non-neoplastic mucosa was evaluated for gastritis, atrophy, intestinal metaplasia and pyloric metaplasia. RESULTS We studied 81 patients: 48 Swiss (mean age 68.5 years); 17 Italians (mean age 67.8 years); and 16 Iberians (mean age 54.8 years; P<0.001). Twelve tumors were proximal (all intestinal type), 12 in the corpus (six intestinal-type), and 57 antral (30 intestinal type). Patients with diffuse cancers were younger than those with intestinal type (P<0.05). Nineteen patients (23.4%) had a normal stomach; 30% of T1 tumors and 90% of T4s arose in a normal stomach (P<0.02). H. pylori gastritis was found in 47 patients (58%); they did not differ in age, sex, national origin, cancer location or type from those without gastritis. Intestinal metaplasia correlated with H. pylori gastritis (P=0.002). Pyloric metaplasia was infrequent and limited to rare microfoci. CONCLUSIONS A quarter of the patients had a normal stomach, and pyloric metaplasia was distinctly uncommon. Approaches to prevention and early detection of gastric cancer based on bioptic or serological demonstration of atrophy and metaplasia could overlook at least 25% of the people at risk in certain populations and may need to be adapted to local conditions.
Hajiani Eskandar, Sarmast Shoshtari Mohammad Hossein, Masjedizadeh Rahim, Hashemi Jalal, Azmi Mehrdad, Tahereh Rajabi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ahwaz Jundishapur University of Medical Sciences, Golestan Hospital, PO Box 89, Ahwaz, Iran. firstname.lastname@example.org
AIM To analyze the characteristics of epidemiological, clinical and survival patterns among patients with carcinoma of the stomach. METHODS We retrospectively studied the characteristics of 186 gastric adenocarcinoma patients at Ahwaz Jundishapur University Hospitals (AJSUH) from September 1, 1996 to September 1, 2002. All the patients had histopathologically-confirmed malignancy. Demographic variables, family history of gastric cancer (GC), clinicopathologic characteristics and treatment-related variables were analyzed. Univariate analysis was performed with the log-rank test and multivariate analysis with Cox regression. P<0.05 was considered statistically significant. RESULTS Male to female ratio was 2.6:1. The mean age was 60.6 years and 14% of the patients were younger than 40 years. Adenocarcinoma, gastric lymphoma, and gastric metastasis were found in 94.5%, 2.3%, and 3% patients, respectively. There was an average of 6-mo delay between the initial symptoms and the diagnosis. Among adenocarcinoma groups, intestinal type was the commonest (55.9%) and the distal third was the most common localization (88.4%). One hundred and thirty-four patients (72.1%) were males. Thirty-one patients (17%) had a family history of GC. Surgery was performed in 90% of patients (non-curative). CONCLUSION The epidemiological features of GC in south Iran mimic those in high-risk areas. There is a higher frequency of GC in young patients at our institution. Patients are detected and treated after a relatively long delay. Most patients present in advanced stages, which favors a poor overall survival. Family history of GC has a significant problem in our area. Studying the etiology of this cancer in south Iran and earlier diagnosis and subsequent better cares are recommended.
Kamal-E Bani-Hani, Rami-J Yaghan, Hussein-A Heis, Nawaf-J Shatnawi, Ismail-I Matalka, Amjad-M Bani-Hani, Kamal-A Gharaibeh
Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan. email@example.com
AIM To study the epidemiology of gastric malignancies in Jordan as a model for Middle East countries where such data is scarce. METHODS Pertinent epidemiological and clinicopathological data for 201 patients with gastric malignancy in north of Jordan between 1991 and 2001 were analyzed. RESULTS Male: female ratio was 1.8:1. The mean age was 61.2 years, and 8.5% of the patients were younger than 40 years of age. The overall age-adjusted incidence was 5.82/100 000 population/year. The age specific incidence for males raised from 1.48 in those aged 30-39 years to 72.4 in those aged 70-79 years. Adenocarcinomas, gastric lymphomas, malignant stromal tumors, and carcinoids were found in 87.5%, 8%, 2.5%, and 2% respectively. There was an average of 10.1-month delay between the initial symptoms and the diagnosis. Only 82 patients underwent curative gastrectomy. Among adenocarcinoma groups, Lauren intestinal type was the commonest (72.2%) and the distal third was the most common localization (48.9%). The mean follow up for patients with gastric adenocarcinoma was 25.1 mo (range 1-132 mo). The 5-year survival rates for stages I (n=15), II (n=41), III (n=59), and IV (n=53) were 67.3%, 41.3%, 5.7%, and 0% respectively (P=0.0001). The overall 5 year survival was 21.1%. CONCLUSION Despite low incidence, some epidemiological features of gastric cancer in Jordan mimic those of high-risk areas. Patients are detected and treated after a relatively long delay. No justification in favor of a possible gastric cancer screening effort in Jordan is supported by our study; rather, the need of an earlier diagnosis and subsequent better care.
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U. O. di Anatomia ed Istologia Patologica, Azienda USL 4, L'Aquila, Italy. firstname.lastname@example.org
The Goseki grading system, based on intracellular mucin content and tubular differentiation, was originally created to study the influence of histologic type on the mode of extension of gastric carcinoma. The prognostic value of this grading system was subsequently proposed and even recently supported, but controversies still remain about this topic. We applied the Goseki system on 114 cases of node-negative primary gastric cancer and compared Goseki groups with the other clinicopathologic features of the patients. Statistical analysis showed a significant correlation between Goseki grading and Laurèn classification, but failed to reveal any prognostic significance for this grading system. We believe that Goseki classification should not be routinely used for prognostic purposes.
Department of Experimental Medicine, University of L'Aquila, Coppito, Italy. L.Ventura@mail.dex-net.com
Granular cell tumor (GCT) is a relatively rare neoplasm, and almost always benign in its prognostic behavior. Location of this tumor in the breast presents serious problems for differential diagnosis, both from a clinical point of view and at gross pathological examination, because of its resemblance to carcinoma. Fine needle aspiration biopsy and intraoperative frozen section examination may not be of any further help. The histogenesis of these lesions has been widely debated in the past, but no universally accepted conclusion has been reached. Most GCTs appear to be derived from Schwann cells, but many different neoplastic and non-neoplastic lesions show granular cell changes. Therefore, GCT should not be considered as a single entity but as the result of a cytoplasmic change due to still unknown metabolic alterations that may occur in various cell types. No firm conclusions can be drawn regarding the suspected hormonal influence on the development of breast GCT. The authors describe three typical cases of breast GCT that occurred in patients of different ages, and discuss the most important questions concerning this lesion.
S Guadagni, M A Pistoia, G Amicucci, P Leocata, L Ventura, T Ventura, A Chiominto, M Deraco, M Vaglini
Department of Surgery, University of L'Aquila, Milan, Italy.
AIMS AND BACKGROUND The aims of this study were to investigate the role of N-nitroso compounds (NOC) and Helicobacter pylori (H. pylori) in gastric stump carcinogenesis. METHODS AND STUDY DESIGN Analyses of biochemical parameters such as pH and NOC concentration were carried out on 65 fasting gastric juice samples obtained at endoscopy from 45 patients previously submitted to partial gastrectomy for benign peptic ulcer disease (23 Billroth I, 22 Billroth II/Reichel-Polya) and 20 normal controls. Biopsy specimens were taken to determine histology and H. pylori status. RESULTS Significantly higher mean pH values and NOC concentrations were found in partial gastrectomies compared to normal controls. In relation to surgical methods, higher mean pH values and NOC concentrations were observed in the gastric juice of patients with Billroth II compared to Billroth I gastrectomies. Independently of the type of surgical reconstruction, higher mean NOC levels were recorded in patients with more severe histological changes and H. pylori infection. CONCLUSIONS All these data suggest that high levels of NOC in gastric juice and H. pylori infection could be cofactors in gastric stump carcinogenesis.
Histopathological study of 110 cystectomy specimens for bladder cancer by an original mapping method.
Dept. of Urology, Charing Cross Hospital, London, UK.
The management of cystectomy specimens represents the first and most important step in the study of bladder cancer and related lesions. We carried out a study on 110 patients, applying an original mapping protocol which allowed to determine the exact topography of lesions, recognizing even the smallest ones and putting in evidence some rare histotype. A prevalence of high-grade, high-stage tumors was noted, as well as a remarkable frequency of precancerous lesions, mostly found in Brunn's nests. This latter finding could mean that in many cases a flat carcinoma becomes invasive within a Brunn's nest rather than in surface urothelium. We were also able to accurately evaluate prostatic pathology, finding incidental malignant lesions of this gland in 24.2% of the cystectomized males. The apparently worst prognosis of the patients who underwent chemotherapy depends on the fact that they had grades and stages higher than the untreated subjects. In conclusion, we believe that a more extensive sampling of cystectomy specimens gives highly reliable prognostic data and represents an unreplaceable tool in understanding bladder neoplasms.
Department of Pathology, San Salvatore Hospital, L'Aquila, Italy.
Gastric lipomas are uncommon lesions, usually single and located in the antrum. Common symptoms include upper digestive bleeding, anemia, and intestinal obstruction. Alternatively, they may remain asymptomatic, and detectable only at autopsy. A case of a 72-year-old man, who died of myocardial infarction, was found at autopsy to have multiple gastric lipomas of the corpus and antrum, with a single lesion measuring 10 x 6.5 x 3 cm.
Department of Pathology, San Salvatore Hospital, L'Aquila, Italy.
The agar technique represents an important method to obtain optimal orientation of small specimens during paraffin embedding and to avoid tissue loss during processing. This method is advisable for ocular, temporal artery, gastrointestinal, cervical, and skin biopsies and may be applied with formalin-fixed specimens as well as with fresh tissue. Microwave oven can be successfully used to make the small specimen orientation technique with agar quicker and easier. Ann Diagn Pathol 5:107-109, 2001.
Servizio di Anatomia e Istologia Patologica, Ospedale San Salvatore, L'Aquila.
Ectopic adrenal tissue is a not uncommon clinical finding, especially in children. These aberrant rests have been reported in various locations, such as kidney, testis and related structures, female genital tract and supradiaphragmatic region. The most common site in the male genital district is the spermatic cord. We report a case of ectopic adrenal in the spermatic cord, occasionally found in an asymptomatic 42-years-old man. No other pathologic condition of urogenital tract was present. The nodule measured 0.5 cm in diameter and was histologically arranged in three well defined layers, with predominance of the zona fasciculata. No adrenal medullary tissue was observed. The pathogenesis of this ectopic tissue near the testis can be explained by the embryologic relationship between adrenal cortex and the gonad. Finally, we reviewed the relevant literature and the main clinical implications of this condition.
Dipartimento di Chirurgia, Università degli Studi di Roma Tor Vergata, Italy.
A case of adenosarcoma of the uterus in a 59-year-old woman is here reported. Adenosarcoma is a low malignant potential tumor with a benign glandular and a malignant stromal component. The treatment is usually hysterectomy with bilateral salpingo-oophorectomy. Debated is the usefulness of adjuvant chemotherapy, while radiation treatment is not beneficial. Long term follow-up is necessary for these patients because of high recurrence risk, mostly in cases with myometrial invasion.
Servizio di Anatomia ed Istologia Patologica, Ospedale S. Maria di Collemaggio, USL 6.
Primary adenocarcinoma arising in the jejunal limb of a Roux-en-Y esophagojejunostomy: a case report.
Department of Surgery, L'Aquila University Medical School, Italy.
Adenocarcinoma of the small bowel is uncommon. Due to the paucity and lack of specificity of symptoms, patients are usually seen late in the course of their illness when curative therapy, mainly represented by wide surgical resection, is unlikely. The authors report a case of primary adenocarcinoma arising in the jejunal limb transposed for a Roux-en-Y esophagojejunostomy reconstruction eight years after a total gastrectomy performed for an advanced gastric cancer (pT2N1M0), with mixed histological pattern (tubular-mucinous) and negative CEA staining of cancer cells. Evidence for excluding the possibility of a recurrence of the primitive gastric cancer was based on the different histologic pattern, positive CEA staining of cancer cells and other features of the second neoplasm. Early diagnosis of the neoplasm was made possible by its favorable anatomic location and the early onset of symptoms, which prompted effective surgical therapy (wide resection). The authors, furthermore, analyze and discuss the possible pathogenesis of the neoplasm, based on the evidence of slow jejunal limb emptying, elevated concentration of N-Nitroso compounds and contamination by N-nitrosating bacteria in the jejunal limb juice, suggesting that each of these factors could have had a role to play in the development of the jejunal malignancy.
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J Dig Dis. 2012 Oct ;13 (10):510-6 22988924
Hak Hyun Lee, Sun-Young Lee, Hyeon Young Yoon, Sung Noh Hong, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park, Chan Sup Shim, Hye Seung Han
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
OBJECTIVE : To investigate the association between mucosal color change and the characteristics of early gastric cancer (EGC). METHODS : Data of consecutive patients with EGC resected between August 2005 and October 2010 at Konkuk University Medical Center were analyzed retrospectively. The characteristics of EGC relative to mucosal color change were analyzed. RESULTS : Whitish discoloration of the cancer was linked to female to male gender ratio (P = 0.009), large tumor size (P < 0.001), deep invasion (P = 0.046) and depressed contours (P < 0.001) compared with EGC without discoloration or with hyperemic change. In addition, a whitish discoloration was also related to signet ring cell carcinoma (P < 0.001) and diffuse type carcinoma based on Lauren's classification (P < 0.001). On multiple linear regression analysis, diffuse type based on Lauren's classification (P = 0.017) and depth of invasion (P = 0.003) were significant independent factors for whitish discoloration. CONCLUSIONS : Mucosal color change is an important clue in the diagnosis of EGC. EGC with whitish discoloration needs more attention due to its link with the diffuse type of Lauren's classification.
A Cohort Study and Meta-Analysis between Histopathological Classification and Prognosis of Gastric Carcinoma.
Lei Liu, Zhi Wei Wang, Jun Ji, Jia Nian Zhang, Min Yan, Jun Zhang, Bing Ya Liu, Zheng Gang Zhu, Ying Yan Yu
Department of Surgery and Shanghai Institute of Digestive Surgery, Shanghai Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 200025, Shanghai. Ruijin er Road, No. 197, 200025, China. email@example.com.
Background and Aim To determine the correlation of histopathological classification and patient outcomes, we performed a meta-analysis of histological subtypes on postoperative survival in gastric cancer. Methods A dataset composed of 11073 gastric cancers from 21 publications, combined with our cohort was included in the meta-analysis. We evaluated the association between the 5-year survival rate and the subtypes of gastric cancer based on histological grading or Lauren classification. All literatures were from Pubmed and Embase (up to December 2011). Results In our cohort from Shanghai Ruijin Hospital, the differentiated gastric cancer revealed a significantly higher accumulative 5-year survival rate, compared to that in poor-differentiated cases (62.6% vs 44.8%, P＜0.001). Intestinal-type gastric cancer shown a higher accumulative 5-year survival rate, compared to that in diffuse-type cases (61.7% vs 41.1%, P＜0.001). In overall meta-analysis, the poor-differentiated gastric cancer significantly increased the postoperative 5-year death risk, compared to the differentiated cases (OR=1.24, 95% CI 1.13-1.36, P＜0.001). The 5-year death risk was increased in the diffuse-type cases relative to the intestinal-type cases (OR=1.29, 95% CI 1.11-1.49, P＜0.001). Conclusions Gastric cancer with a differentiated histology or intestinal-type shows a better prognosis than individual with a poor-differentiated histology or a diffuse-type. Accurate histologic classification is desirable for gastric cancer handling.
Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, No. 321 Zhongshan Road, Nanjing 210008, People's Republic of China.
BACKGROUND It has been suggested that STAT3 signaling plays important roles in regulating epigenetic aberrance during tumorigenesis, especially in the expression of certain key epigenetic enzymes such as DNMTs, HDACs, and HMTs. However, there has been no report on the relationship of STAT3 signaling and epigenetic aberrance in gastrocarcinogenesis. AIM The purpose of this study was to explore the interrelationship of STAT3 signaling pathway and epigenetic aberrance in gastrocarcinogenesis. METHODS Immunohistochemistry was utilized to examine the protein expressions of pSTAT3, DNMT1, HDAC1, and EZH2 in 153 tissue specimens, including 20 of normal gastric epithelium tissue, 21 of intestinal metaplasia (IM), 24 of dysplasia (DYS), 23 of early gastric cancer (EGC) and 65 of advanced gastric cancer (AGC), and then analyze their possible relationship with clinicopathological factors. RESULTS We found that the four protein expressions were obviously enhanced following the malignant process of gastric carcinogenesis. Pearson correlation analysis of all the pathological groups showed that expression of pSTAT3 was highly associated with DNMT1, but not with HADC1 and EZH2. However, significant correlations were detected among the expression of DNMT1, HDAC1, and EZH2. Further analysis of each pathological group demonstrated that pSTAT3's expression was dramatically related with DNTM1 in the IM (P = 0.021) and EGC groups (P = 0.013) and correlated with EZH2 in the DYS group (P = 0.020). Furthermore, pSTAT3's expression was associated with T staging (P = 0.015) in the AGC group, whereas DNMT1 was associated with gender (P = 0.021), HDAC1 with Lauren classification (P = 0.007), and EZH2 with T staging (P = 0.003) and lymphatic staging (P = 0.038). CONCLUSIONS The STAT3 signaling pathway may correlate with epigenetic aberrance during gastrocarcinogenesis.
Int J Cancer. 2012 Feb 23;: 22362223
Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea.
Su Jin Chung, Min Jung Park, Seung Joo Kang, Hae Yeon Kang, Goh Eun Chung, Sang Gyun Kim, Hyun Chae Jung
Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
We investigated risk factors for gastric cancer (GC) and effect of annual endoscopic screening on detection and treatment modality of GC. Asymptomatic adults who underwent upper endoscopy during health checkups at Seoul National University Hospital Healthcare System Gangnam Center were enrolled. We compared clinicopathologic characteristics of GC according to screening interval (repeated vs. infrequent, annual vs. biennial). After age- and sex-matching, relative risk was computed by hazard ratio (HR) using Cox proportional regression with multivariate adjustment. Of the 58,849 subjects who received screening endoscopy, 277 (0.47%) were found to have GC. Intestinal type comprised 55.4%(102/184) followed by diffuse type (n = 65, 35.3%). Age ≥50 years, family history and smoking independently increased the risk of GC for both types, whereas male gender [HR = 4.81, 95% confidence interval (CI): 2.72-8.03] and intestinal metaplasia (IM)(HR = 10.87, 95% CI: 3.36-22.30) were significant predictors for intestinal type only. Proportion of early gastric cancer (EGC) was 98.6%(71/72) in annual screening group and 80.7%(46/57) in biennial screening group (p < 0.01). In the former, tumor size was smaller (1.7 ± 1.3 vs. 2.3 ± 1.8 cm; p < 0.01] and proportion of intramucosal cancer was larger (75.0 vs. 56.1%; p = 0.04). Endoscopic resection was performed more frequently in annual screening group (56.9 vs. 33.3%; p = 0.02). IM along with male gender and older age was a strong risk factor for intestinal type GC. Annual screening group improved detection of early-stage and endoscopically treatable GC suggesting that intensive screening and surveillance may be useful for high-risk subpopulations with epidemiologic risk factors or premalignant lesions such as IM.
Arch Med Sci. 2011 Apr ;7 (2):287-93 22291769
Double contrast-enhanced ultrasonography evaluation of preoperative Lauren classification of advanced gastric carcinoma.
Pintong Huang, Shiyan Li, Wilbert S Aronow, Zongmin Wang, Chandra K Nair, Nianyu Xue, Xuedong Shen, Chengchun Chen, David Cosgrove
Department of Ultrasonography, the 2 Affiliated Hospital of Zhejiang University, Zhejiang, China.
INTRODUCTION The clinical value of double contrast-enhanced ultrasonography (DCUS) in determining the Lauren classification of advanced gastric carcinoma needed investigation. MATERIAL AND METHODS Fifty-eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination in which an oral contrast agent was combined with an intravenous agent, and the findings were compared with the postoperative pathological findings using haematoxylin-eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining. RESULTS Of 58 patients, 34 (59%) were the intestinal type and 24 (41%) the diffuse type on pathological examination of resected specimens. Among intestinal type patients, 30 (88%) showed homogeneous vascular enhancement and 4 (12%) heterogeneous enhancement with the "sandwich" pattern in 2 patients (50%) and "barrier" pattern in 2 patients (50%). In the diffuse type, 22 of 24 patients (92%) enhanced heterogeneously, with stippled and peripheral enhancement in 9 (41%), the "sandwich" pattern in 8 (36%) and "barrier" pattern in 5 (23%). Two of 24 patients (8%) with the diffuse type enhanced homogeneously. The proportion of heterogeneous enhancement was significantly different between the 2 subtypes of tumour (p = 0.0001). The sensitivity and specificity of heterogeneous enhancement in diagnosing the diffuse type of advanced gastric cancer were 92% and 88%, respectively. Youden's index was 0.8. CONCLUSIONS Double contrast-enhanced ultrasonography is a new and useful method to determine Lauren classification in patients with gastric carcinoma.
The prevalence of pancreatic acinar differentiation in gastric adenocarcinoma: report of a case and immunohistochemical study of 111 additional cases.
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Although pancreatic acinar metaplasia in the gastric mucosa is well recognized in chronic gastritis, gastric carcinoma with acinar differentiation is very rare. We encountered a case of gastric adenocarcinoma with prominent histologic and immunohistochemical features of pancreatic acinar differentiation in the absence of identifiable heterotopic pancreatic tissue. Distinct glandular and diffuse patterns of adenocarcinoma were also present, and there was focal mucin production. The tumor strongly expressed pancreatic exocrine enzymes trypsin and chymotrypsin, and focal neuroendocrine staining was also present. To investigate the prevalence of acinar differentiation in histologically typical gastric cancers, we performed immunohistochemical staining for trypsin and chymotrypsin on a tissue microarray containing 111 conventional gastric adenocarcinomas (60 intestinal, 28 mixed, 22 diffuse type, and 1 undifferentiated). No obvious morphologic evidence of acinar differentiation was identified in any of the 111 cases. Although some cases showed equivocal staining for at least 1 pancreatic exocrine enzyme on the initial tissue microarray sections, repeat immunohistochemical staining on representative whole-tissue sections failed to reproduce positive staining. Thus, acinar differentiation is rare in gastric adenocarcinomas, other than in histologically unusual cases such as the one we report, and in others from the literature, which are reviewed.
Department of Pathology, M.L.N. Medical College, Allahabad. firstname.lastname@example.org
The present study was taken with an aim to assess the prevalence of H. pylori in patients with gastric carcinoma and correlate it with gross appearance and histological type. Endoscopic biopsies from 54 patients with gastric carcinoma and 50 age and sex matched controls were taken after thorough upper gastrointestinal examination. Gross appearance of the tumour was noted and two biopsies each from the site of malignancy and from normal appearing areas were taken. Sections were stained with Haematoxylin & Eosin and Loeffler's methylene blue for histopathological details and presence of H. pylori. Prevalence of H. pylori in controls was slightly higher than the patients group (80% Vs 78%). Ulcerated type of gross appearance had maximum prevalence of H. pylori (88%). Prevalence of H. pylori was more in diffuse type of gastric cancer than intestinal type (86% Vs 68%). A significant association between H. pylori and grades of gastritis was noted (P < 0.01) in controls as well as in patient group but it failed to show a significant association with tumour grades, intestinal metaplasia, site of the tumour and age of the patients. So, it can be inferred that prevalence of H. pylori infection is not directly associated with pathogenesis of gastric cancer but it may act as a co-carcinogen by damaging the mucosa and thereby making it more susceptible to effects of carcinogen.
Trop Gastroenterol. ;28 (2):69-71 18050843
Correlation between endoscopic suspicion of gastric cancer and histology in Nigerian patients with dyspepsia.
Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. email@example.com
Gastric mucosal biopsies of 77 dyspeptic patients whose endoscopic features were suggestive of cancer and 56 patients with uncomplicated duodenal ulcer (DU) were subjected to histopathological analysis. Gastric cancer was confirmed in 18 (23.4%) of the 77 patients but not in 59 (76.6%). 4 (5.2%) of the 18 patients had early gastric cancer (EGC). Histopathological findings in the stomach biopsy of the 59 patients in whom cancer could not be confirmed were compared with those of the 56 patients with DU. Intestinal metaplasia (IM) was present in 32.2% of the 59 cases with endoscopic suspicion of gastric cancer and in 16.1% of the 56 DU controls (P < 0.05). Mucosa-associated lymphoid tissue (MALT) occurred in 28.8% of the cancer-resembling cases and in 12.5% of the DU patients (P < 0.05). The difference in the prevalence of gastric mucosal atrophy and Helicobacter pylori infection between the two groups (83% vs. 71.4%) did not reach statistical significance (P > 0.10). All 18 patients with gastric cancer were positive for Helicobacter pylori and the prevalence of the infection approached 95% in those with IM and MALT. This study shows that IM and MALT present with endoscopic appearances that resemble that of gastric cancer and that along with the latter, their main aetiological agent is Helicobacter pylori.
Department of Pathology, Sindh Medical College, Karachi.
OBJECTIVE To note the association of Helicobacter pylori in patients having carcinoma of stomach. METHODS A descriptive study was carried out at the Department of Histopathology, Ziauddin Medical University, Karachi from April 1992 to May 1998. Histological evaluation of 50 cases of carcinoma of stomach was compared with 50 cases each of chronic gastritis and histological normal gastric mucosa. Only those cases of carcinoma of stomach were included that contained sufficient non-neoplastic mucosa in addition to tumour tissue. Three glass slides with serial sections of each case of carcinoma of stomach, chronic gastritis and normal gastric mucosa were freshly cut and stained with H&E, PAS and Giemsa stains. All slides were examined by light microscopy. RESULTS Helicobacter pylori were identified in 35 cases (70%) of carcinoma of stomach, in 42 cases (84%) of chronic gastritis, and in 12 cases (24%) of normal gastric mucosa. The presence of H. pylori in cases of carcinoma of stomach and chronic gastritis was highly significant (P < 0.001) as compared to normal gastric mucosa. Chronic gastritis was observed in the non-neoplastic mucosa in 48 cases (96%) with carcinoma of stomach. Of 50 cases with carcinoma of the stomach, intestinal type of carcinoma was found in 30 cases (70%), and diffuse type in 15 cases (30%). No significant difference was noted in the prevalence of H. pylori between intestinal type (69%) and diffuse type (71%) gastric carcinoma. Significant Helicobacter pylori associated chronic gastritis was observed in intestinal type (94%) and diffuse type (100%) of gastric carcinoma. The prevalence of H. pylori was insignificant in the presence or absence of mucosal atrophy and intestinal metaplasia in both types of gastric carcinoma. CONCLUSION A significant number of H. pylori were found in patients of carcinoma of stomach. Both intestinal and diffuse types of gastric carcinoma showed strong association with H. pylori. Chronic gastritis appears to be the background lesion while atrophy and intestinal metaplasia indicate long term infection.
Irami Araújo-Filho, José Brandão-Neto, Laíza Araújo Mohana Pinheiro, Italo Medeiros Azevedo, Flávio Henrique Miranda Araújo Freire, Aldo Cunha Medeiros
Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
BACKGROUD: There is substantial evidence that infection with Helicobacter pylori plays a role in the development of gastric cancer and that it is rarely found in gastric biopsy of atrophic gastritis and gastric cancer. On advanced gastric tumors, the bacteria can be lost from the stomach. AIMS: To analyze the hypothesis that the prevalence of H.pylori in operated advanced gastric carcinomas and adjacent non-tumor tissues is high, comparing intestinal and diffuse tumors according to Lauren's classification METHODS: A prospective controlled study enrolled 56 patients from "Hospital Universitário", Federal University of Rio Grande do Norte, Natal, RN, Brazil, with advanced gastric cancer, treated from February 2000 to March 2003. Immediately after partial gastrectomy, the resected stomach was opened and several mucosal biopsy samples were taken from the gastric tumor and from the adjacent mucosa within 4 cm distance from the tumor margin. Tissue sections were stained with hematoxylin and eosin. Lauren's classification for gastric cancer was used, to analyse the prevalence of H. pylori in intestinal or diffuse carcinomas assessed by the urease rapid test, IgG by ELISA and Giemsa staining. H. pylori infected patients were treated with omeprazole, clarithromycin and amoxicillin for 7 days. Follow-up endoscopy and serology were performed 6 months after treatment to determine successful eradication of H. pylori in non-tumor tissue. Thereafter, follow-up endoscopies were scheduled annually. Chi-square and MacNemar tests with 0.05 significance were used. RESULTS: Thirty-four tumors (60.7%) were intestinal-type and 22 (39.3%) diffuse type carcinomas. In adjacent non-tumor gastric mucosa, chronic gastritis were found in 53 cases (94.6%) and atrophic mucosa in 36 patients (64.3%). All the patients with atrophic mucosa were H. pylori positive. When examined by Giemsa and urease test, H. pylori positive rate in tumor tissue of intestinal type carcinomas was higher than that in diffuse carcinomas. In tumor tissues, 34 (60.7%) H. pylori-positive in gastric carcinomas were detected by Giemsa method. H. pylori was observed in 30 of 56 cases (53.5%) in tissues 4 cm adjacent to tumors. This difference was not significant. Eradication of H. pylori in non-tumor tissue of gastric remnant led to a complete negativity on the 12th postoperative month CONCLUSIONS: The data confirmed the hypothesis of a high prevalence of H. pylori in tumor tissue of gastric advanced carcinomas and in adjacent non-tumor mucosa of operated stomachs. The presence of H. pylori was predominant in the intestinal-type carcinoma.