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.
El-Zimaity
Hala M T
HM
Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA. hzimaity@bcm.tmc.edu
Ota
Hiroyoshi
H
Graham
David Y
DY
Akamatsu
Taiji
T
Katsuyama
Tsutomu
T
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D002277:Carcinoma / Q000473:pathology*; D005260:Female; D005756:Gastritis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology*