Morphologic, histologic, and molecular similarities between adenocarcinomas arising in the gastric stump and the intact stomach.
BACKGROUND
Patients with gastric remnants resulting from partial resections have an increased risk for carcinoma. It is unclear whether adenocarcinoma arising in the gastric stump (GSca) differs from intact stomach carcinoma (Gca). The goal of this study was to examine the pathologic and molecular features of GSca and compare them with Gca.


METHODS
Adjacent nonmalignant areas and tumors from 14 patients who were 19-55 years postgastrectomy (mean, 32.1 years) were compared with 14 Gca by pathologic and molecular analysis. Formalin fixed, paraffin embedded specimens were immunohistochemically stained for p53 followed by topographic genotyping. Exons 5-8 were amplified by the polymerase chain reaction and directly sequenced.


RESULTS
No differences were noted between the two groups regarding gender, types of metaplasia, dysplasia, morphology, or histologic tumor type. However, a higher incidence of cystic dilatation and foveolar hyperplasia were present in GSca. p53 gene point mutations occurred in 5 of 14 (35.7%) GSca patients. GSca p53 mutations included missense point mutations (G:A transitions in four patients and G:C transversion in one patient) with allelic loss. In four of the five patients with p53 mutations, the same mutation was also observed in the adjacent area. p53 point mutations were present in 4 of 14 Gca (28.6%), in exons 5, 6, and 8. In one case, the same mutation was also detected in the adjacent nonmalignant mucosa.


CONCLUSIONS
Similarities in clinical, pathologic, and molecular features between GSca and Gca suggest the possibility that they share similar mechanisms of carcinogenesis. p53 gene alterations in premalignant areas may denote a possible early role of this gene in gastric carcinoma.
Safatle-Ribeiro
A V
AV
Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pennsylvania, USA.
Ribeiro Júnior
U
U
Reynolds
J C
JC
Gama-Rodrigues
J J
JJ
Iriya
K
K
Kim
R
R
Bakker
A
A
Swalsky
P A
PA
Pinotti
H W
HW
Finkelstein
S D
SD
D000230:Adenocarcinoma / Q000737:chemistry / Q000235:genetics* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018530:Gastric Stump / Q000473:pathology*; D016158:Genes, p53 / Q000235:genetics*; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D017354:Point Mutation / Q000235:genetics*; D013274:Stomach Neoplasms / Q000737:chemistry / Q000235:genetics* / Q000473:pathology*; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*
D016159:Tumor Suppressor Protein p53