Advanced gastric carcinoma simulating early gastric carcinoma

Eighty-six cases of advanced gastric carcinoma simulating early gastric carcinoma were studied clinicopathologically. Cytophotometric DNA analysis was also performed in 33 cases. Most of these particular carcinomas were of the depressed type on gross inspection. Histologically, the tumors were of diffuse type in 60%. The rate of the carcinomas restricted to within the muscularis propria was 48% and high in comparison with those in conventional advanced gastric carcinomas. There were four main growth patterns: small invasion type (Type A, 43 cases), ulcer-connected type (Type B, 19 cases), vessel permeation type (Type C, six cases), and diffusely infiltrative type (Type D, 13 cases). There was a relationship between growth patterns, lymph node metastasis, and prognosis: Types A and B had a small percentage of lymph node metastasis and a good prognosis, whereas Types C and D a high percentage and a poor prognosis. DNA analysis revealed that two thirds of the examined cases showed a low ploidy pattern. The DNA ploidy patterns were concerned with the tumor growth pattern: high-ploidy cases were rarely seen in Types A and B yet were frequent in Types C and D. The 5-year survival rate was 73%, but results were poor in cases of tumors with blood vessel permeation, in those with lymph node metastasis, in those with the Type D or C growth patterns, and in those with high DNA ploidy pattern. Since these carcinomas can be understaged endoscopically and by gross examination, a precise study of the surgically excised tissues will aid in making an accurate prognosis.     

胃淋巴瘤与胃腺癌的临床病理对比研究

目的 对比研究原发性胃淋巴瘤(primary gastric lymphoma,PGL)与胃腺癌(gastric adenocarcinoma,GA)临床及病理特征,以期增进对该疾病的临床诊治.方法 对49例原发性胃淋巴瘤和200例胃癌患者比较其年龄、发病时间、临床症状、肿块部位、内镜及大体分型、幽门螺杆菌(Helicobacter pylori,Hp)感染及组织病理学等临床资料,并详细分析12例早期胃淋巴瘤的临床病理资料.结果 49例PGL和200例GA组患者,均表现为腹痛、腹部不适和上消化道出血等非特异性症状.PGL多发于胃体及胃窦,病灶常为多发溃疡或巨大结节,GA组病灶以胃窦部为主,常呈单发溃疡;PGL组的Hp感染率显著高于胃癌组(P＜0.05);PGL术前诊断率显著低于GA组(P＜0.05).12例早期PGL患者中,8例为Ⅱc型病变,治疗效果较好.结论 内镜检查示胃黏膜有多发糜烂溃疡时,应考虑PGL可能.早期PGL确诊后通过手术、化疗或根除Hp治疗,预后良好.     

胃神经内分泌癌与胃神经内分泌瘤及胃腺癌的CT特征及鉴别

目的 探讨胃神经内分泌癌(G NEC)与胃神经内分泌瘤(G NET)及胃腺癌(G ADC)的CT特征,为临床诊治提供参考。方法 选取2014年1月至2018年9月于南京医科大学第一附属医院老年消化科就诊的G NEC、G NET及G ADC患者各15例，分别为G NEC组、G NET组及G ADC组，对多个CT特征进行评估,以鉴别G NEC与G NET及G ACD的影像学差异。结果 3组中存在差别的CT特征有肿瘤最大径(P=0023)、肿瘤位置(贲门、胃底及胃体为上部,胃体中下部及胃窦为下部, P=0020)、病灶数量(单发、多发及散发,P=0003)、肿瘤边缘是否清晰(P<0001)、黏膜是否完整(P<0001)、淋巴结是否转移(P<0001)、转移淋巴结最大径(P=0008)和有无淋巴结的坏死(P=0006);随后进行G NEC与G NET两组间比较,经单因素分析发现G NEC的病灶更大［(472±173)cm比(208±102)cm,P<0001)］,位于胃体中下部及胃窦的概率更高(600％ 比 133％, P=0021),单发病例更多(100％ 比667％, P=0042),更易发生淋巴结转移(933％ 比 200％,P=0001)。G NEC和G ADC两组间的CT特征的单因素分析显示,G NEC的转移淋巴结直径比G ADC的大［(182±069)cm 比(123±065)cm,P=0045］,G NEC的肿瘤边缘较G ADC清晰(600％ 比0, P=0001), G NEC的肿瘤黏膜较G ADC肿瘤黏膜完整(533％ 比667％, P=0014)。结论 CT的特征有助于G NEC与G NET及G ADC的诊断。     

Early gastric cancer mimicking advanced gastric cancer.

The clinicopathological features of 37 early gastric cancers mimicking advanced gastric cancer were reviewed retrospectively, and were compared with 596 other early gastric cancers and 126 mp gastric cancers, defined as gastric cancer invading the muscularis propria of the stomach. A greater tumour size (P < 0.005), submucosal invasion (P < 0.005), lymph node and lymph vessel invasion (P < 0.005) and vascular invasion (P < 0.025) were found more frequently in early gastric cancers mimicking advanced gastric cancers than in other early gastric cancers. There were no significant differences in the clinicopathological findings between early gastric cancers mimicking advanced gastric cancers and mp gastric cancers. Patients with early gastric cancers mimicking advanced gastric cancers showed a lower survival rate than patients with other early gastric cancers, but a higher survival than those with mp gastric cancers. The macroscopic appearance of an advanced gastric cancer was an indicator of massive submucosal invasion and lymph node metastasis in early gastric cancer. As early gastric cancers mimicking advanced gastric cancers showed similar clinicopathological findings to mp gastric cancers, these cancers should be treated as mp gastric cancers.     

Metachronous gastric MALT lymphoma and early gastric cancer

In a recent paper published in this journal, Copie-Bergman etal. [1] presented four cases of metachronous early gastric cancerdeveloping after gastric MALT lymphoma. In these patients, theyfound (minimal) residual lymphoma in all surgical specimens,suggesting that such patients might have an increased risk     

A rare gastric neoplasm: gastric medullary carcinoma

A 57-year-old female patient with early stage gastric medullary carcinoma is presented with review of the literature.     

Sonic hedgehog expression in gastric cancer and gastric adenoma

Hedgehog protein is essential to gastrointestinal tract development, and disruption of the hedgehog signaling pathway is associated with gastrointestinal tumorigenesis. Here, we analyzed the degree of hedgehog expression in gastric cancer and precancerous tissue. From August 2005 to May 2006, 52 gastric cancers and 16 gastric adenomas were obtained from surgically or endoscopically resected specimens. Immunohistochemical staining using sonic hedgehog (Shh) antibody was performed in cancerous and noncancerous tissue portions. Hedgehog expression was assessed based on the summed scores of the intensity and proportion of Shh staining. According to Lauren's classification, Shh expression was stronger in the intestinal type than in the diffuse type (p<0.001). Although Shh expression was not related to the location, size, metastatic status, or mucin phenotype of the gastric cancer, the expression was stronger in the tubular type of gastric cancer than in the mucinous and signet-ring cell types (p=0.001). Shh expression was stronger in gastric adenoma than in the diffuse-type gastric cancer (p<0.001), but revealed no difference with that of the intestinal-type gastric cancer (p=0.30). Shh expression was strongest in all types of intestinal metaplasia of noncancerous tissues. Shh expression is related to the intestinal type of gastric cancer. The stronger Shh expression in intestinal metaplasia and gastric adenoma indicates that hedgehog protein is involved at an early phase of gastric carcinogenesis.     

Helicobacter pylori-induced gastric inflammation and gastric cancer

Helicobacter pylori (H. pylori) infect over half of the world’s population. The prevalence of H. pylori infection and the predominant genotype of H. pylori virulence factors vary considerably across different geographical regions.     

Changes in gastric mucosa that antedate gastric carcinoma.

Endoscopic biopsy specimens of the gastric mucosa from 13 patients who were found at follow-up examination to have gastric carcinoma were compared for abnormal histologic features, type of intestinal metaplasia, and presence of immunoreactive carcinoembryonic antigen (CEA), with specimens from 40 tumor-free controls. Villus-like changes and angular infolding, cytologic nuclear pleomorphism, distinct nuclear border, irregular thickness of the nuclear membrane, irregular chromatin clumping, prominent nucleoli, and distinct nucleoli were manifestations of the carcinoma group. Angular infolding, distinct nuclear border, irregular thickness of the nuclear membrane, and distinct nucleoli were also observed in the latent stage before detection of carcinoma. The individual features, however, lacked specificity. Histochemically, a IIB subtype of intestinal metaplasia, and immunoreactive CEA in the cytoplasm of foveolar epithelium appeared exclusively in the patients with carcinoma. These findings indicate that the gastric epithelium of patients with gastric carcinoma tends to be morphologically and histochemically abnormal even before the recognition of classical dysplasia. This can be described as abnormal epithelium and is believed to provide the soil on which gastric carcinoma develops.     

Patterns of gastric atrophy in intestinal type gastric carcinoma

BACKGROUND: Multifocal atrophic gastritis (MAG) is currently considered a precancerous lesion leading to intestinal type gastric carcinoma. The current study aimed to describe the topography of atrophy in stomachs with early gastric carcinoma. METHODS: Resected stomachs from patients with intestinal type gastric carcinoma were routinely processed, sectioned (an average of 108 sections/stomach), and stained with a triple stain. Sections were scored on a visual analog scale for Helicobacter pylori and intestinal metaplasia. The type of epithelium (antral, oxyntic, transitional) was recorded. Atrophy was defined as the loss of normal glandular components and included intestinal metaplasia and/or pseudo-pyloric metaplasia of the corpus. Pseudo-pyloric metaplasia was identified by the presence of pepsinogen I in mucosa that was topographically corpus but phenotypically antrum. RESULTS: Sixteen stomachs with intestinal type gastric carcinoma were examined. In none of the specimens examined was MAG (independent foci of atrophy) identified. In the majority (88%), atrophy was present as a continuous sheet. Islands of intestinal metaplasia (multifocal intestinal metaplasia) were present within a sheet of pseudo-pyloric metaplasia. A few specimens (12%) had a non-atrophic corpus with almost total replacement of antral epithelium with intestinal metaplasia. Multifocal dysplasia distant from the original tumor was found both in areas with and without intestinal metaplasia. CONCLUSIONS: Contrary to popular belief, atrophy in intestinal type gastric carcinoma is not present as independent foci, but rather as a continuous sheet. Previous studies failed to identify pseudo-pylori metaplasia as a marker for atrophy.     

胃癌和胃淋巴瘤的CT表现对比分析

背景与目的:进展期胃癌与胃淋巴瘤的CT表现在鉴别诊断上较困难,均可表现为胃壁增厚、腔内肿块、胃腔狭窄、淋巴结肿大、远处脏器转移等。本研究通过对比胃癌与胃淋巴瘤的CT表现差异,以提高对胃肿瘤,特别是胃淋巴瘤的CT诊断水平。方法:回顾性分析27例进展期胃癌和25例胃淋巴瘤患者的CT表现,观察病变部位、病变大体形态、胃周径侵犯范围、病灶的最大厚度、粘膜是否光整、粘膜皱襞是否增厚、浆膜受侵情况、有无坏死、病变强化程度、强化是否均匀、其他器官受累情况、腹部淋巴结情况。结果:23例(85.2%)胃癌近胃腔表面见"白线"征,门静脉期"白线"区范围较动脉期大;所有胃淋巴瘤患者均未见"白线"征。13例(48.1%)胃癌非"白线"区门静脉期强化程度高于动脉期。所有胃癌患者胃壁侵犯范围均<50%,23例(85.2%)胃淋巴瘤患者胃壁侵犯范围>75%。所有27例(100%)胃癌患者均见胃粘膜溃疡,1例(4%)胃淋巴瘤见胃粘膜溃疡。11例(44.0%)胃淋巴瘤有2个区或以上的胃周淋巴结肿大,8例(32.0%)胃淋巴瘤患者有肾门下腹膜后淋巴结肿大;所有胃癌患者均未见2个区或以上胃周肿大淋巴结,亦未见肾门下腹膜后淋巴结肿大。结论:胃癌与胃淋巴瘤的CT表现各有其特点,包括有无胃粘膜"白线"征、粘膜溃疡、胃壁侵犯范围、胃周肿大淋巴结分布、有无肾门下腹膜后肿大淋巴结等,这些特点对于二者的鉴别诊断具有一定的参考价值。     

IL-6和IL-8在正常胃组织、胃溃疡及胃癌组织中的表达

目的 探讨白细胞介素（IL）-6和IL-8在正常胃组织、胃溃疡及胃癌组织中的表达情况.方法 采用酶联免疫吸附法（ELISA）测定正常对照组（33例）、胃溃疡患者（30例）和准备手术的胃癌患者（52例）血浆中IL-6和IL-8的表达水平,并随访胃癌患者术后1周的IL-6、IL-8表达水平;免疫组织化学法检测胃癌周围正常组织（45例）、胃溃疡组织（35例）和胃癌组织（45例）标本中IL-6和IL-8的表达.结果 胃癌患者（术前和术后）血浆中IL-6、IL-8的表达明显高于胃溃疡和正常对照组（均P＜0.0l）,胃癌患者术后IL-6和IL-8水平较术前明显降低（P＜0.01）.癌周正常组织、胃溃疡和胃癌组织中IL-6和IL-8蛋白阳性表达率依次上升,且差异有统计学意义（x2=38.87,P＜0.01;x2=42.23,P＜0.01）.结论 IL-6和IL-8在胃癌患者血浆和胃癌组织中均表达上调,检测患者血浆和病理组织中的IL-6、IL-8水平有助于判断病情和评估预后.     

Risk of gastric cancer among patients with gastric intestinal metaplasia

Plenty of studies have assessed the association between intestinal metaplasia (IM) and gastric cancer risk, while the results were inconsistent. We aimed to assess the risk of gastric cancer among patients with IM. Systematic literature searches were conducted in PubMed, Embase and Cochrane databases. Baseline characteristics and outcomes from the included studies were extracted independently by two investigators. Either a fixed‐effects or a random‐effects model was used to composite the pooled OR for gastric cancer risk. Finally, a total of 21 studies, which comprised 402,636 participants and 4,535 gastric cancer patients, were finally included in the current meta‐analysis. Compared with those participants without IM, IM patients were at a higher risk of gastric cancer (pooled OR = 3.58, 95% CI 2.71–4.73). We observed that incomplete IM (pooled OR = 9.48, 95% CI 4.33–20.78) but not complete IM (pooled OR = 1.55, 95% CI 0.91–2.65) was significantly associated with a higher gastric cancer risk. Besides, it appeared that gastric cancer risk was higher among patients with IM in the corpus (pooled OR = 7.39, 95% CI 4.94–11.06) than those with IM in the antrum only (pooled OR = 4.06, 95% CI 2.79–5.91). And the pooled ORs for gastric noncardia cancer and gastric cardia cancer were 4.98 (95% CI 3.12–7.95) and 1.93 (95% CI 1.15–3.24), respectively. In conclusion, patients with IM were at a higher risk of gastric cancer, especially for incomplete IM and IM in the corpus. The current evidence supports the use of IM subtypes in the surveillance of gastric cancer.     

环氧合酶-2在胃癌与癌前病变和其他胃黏膜组织中表达的研究

目的:研究胃癌与癌前病变和其他胃黏膜组织中环氧合酶-2(COX-2)的表达情况,探讨COX-2蛋白作为肿瘤分子标记物对胃癌和癌前病变进行辅助诊断的意义.方法:收集胃镜活检的正常胃黏膜、慢性浅表性胃炎、慢性萎缩性胃炎、胃黏膜肠化生、胃黏膜不典型性增生和胃癌组织,用免疫组织化学染色法检测COX-2蛋白在各种组织中的阳性表达情况.以正常胃黏膜组织和正常兔血清作阴性对照.结果:COX-2蛋白在胃癌前病变和和胃癌组织中的表达阳性率为48%-84%.胃癌和胃黏膜不典型性增生标本中COX-2蛋白表达阳性率显著高于正常胃黏膜、慢性浅表性胃炎、慢性萎缩性胃炎和胃黏膜肠上皮化生标本(P<0.05).而胃癌组织COX-2蛋白表达的阳性率与胃黏膜不典型性增生组之间无显著性差异(P>0.05).此外,慢性萎缩性胃炎和胃黏膜肠化生标本与正常胃黏膜和慢性浅表性胃炎标本之间COX-2蛋白表达阳性率亦有显著性差异(P<0.05);所有病变组的COX-2蛋白表达阳性率均比正常胃黏膜组显著性地升高 (P<0.05).结论:胃癌与癌前病变组织中COX-2蛋白的表达显著升高,COX-2蛋白可作为肿瘤标记物对胃癌和胃癌前病变进行辅助诊断.     

Antigen MG7 in gastric cancer and gastric precancerous lesions

Earlydetectionandearlydiagnosisofgastriccancerareessentialtodecreasethemortalityandincreasesurvivalrateofgastriccancer.TheZhuangheregioninLiaoningProvinceisahighriskareaofgastriccancerandanimportantresearchbaseforgastriccancerpreventionandtreatmentinChina[1].AlargescalescreeningofgastriccancerinthisareawascarriedoutbytheCancerInstituteofChinaMedicalUniversitypreviously.Inthepresentstudy,thegastricmucosasamplesfromthescreeningwereusedtoinvestigatethedynamicexpressionofgastriccancer-associat…     

IgM-producing gastric plasmacytoma

A case of gastric plasmacytoma is reported in an 81-year-old woman. Immunofluorescent and immunoelectrophoretic studies showed that the tumor cells produced IgM-lambda molecules, whereas no monoclonal immunoglobulin could be detected both in the serum and in the urine. Of more than 60 reported cases of gastric plasmacytoma, only a few reports referred to the production of monoclonal immunoglobulin by the tumor cells. This case is the first one of IgM-producing gastric plasmacytoma. Moreover, the produced IgM was found to be 7S-IgM. It is extremely rare that 7S-IgM alone is detected in the absence of 19S-IgM.     

Primary gastric lymphoma

The pathogenesis of gastric MALT lymphoma starts with accumulation of MALT following infection of the stomach byH. pylori. Rarely this lymphoid infiltrate contains cells with a growth advantage possibly due to a genetic change (trisomy 3?). The result is a monoclonal lymphoproliferative lesion which is responsive toH. pylori driven T-cell help. Because its growth is dependent on the presence of local antigen, gastric MALT lymphoma remains localized for long periods and it is during this phase that the lymphoma can be treated by eradication ofH. pylori. Further genetic changes, as yet uncharacterized may lead to escape from T-cell dependency and ultimately high grade transformation