title: Critical pathogenic steps to high risk Helicobacter pylori gastritis and gastric carcinogenesis.
abstract: Helicobacter pylori (H. pylori) gastritis may progress to high risk gastropathy and cancer. However, the pathological progression has not been characterized in detail. H. pylori induce persistent inflammatory infiltration. Neutrophils are unique in that they directly infiltrate into foveolar epithelium aiming the proliferative zone specifically. Neutrophilic proliferative zone foveolitis is a critical pathogenic step in H. pylori gastritis inducing intensive epithelial damage. Epithelial cells carrying accumulated genomic damage and mutations show the Malgun (clear) cell change, characterized by large clear nucleus and prominent nucleolus. Malgun cells further undergo atypical changes, showing nuclear folding, coarse chromatin, and multiple nucleoli. The atypical Malgun cell (AMC) change is a novel premalignant condition in high risk gastropathy, which may progress and undergo malignant transformation directly. The pathobiological significance of AMC in gastric carcinogenesis is reviewed. A new diagnosis system of gastritis is proposed based on the critical pathologic steps classifying low and high risk gastritis for separate treatment modality. It is suggested that the regulation of H. pylori-induced neutrophilic foveolitis might be a future therapeutic goal replacing bactericidal antibiotics approach.
authors.affiliation: Inchul Lee, Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
authors.forename: Inchul
authors.initials: I
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D063646:Carcinogenesis; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D018450:Disease Progression; D004847:Epithelial Cells / Q000382:microbiology; D005756:Gastritis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D007249:Inflammation; D009504:Neutrophils / Q000378:metabolism / Q000473:pathology; D011230:Precancerous Conditions / Q000382:microbiology; D011379:Prognosis; D013274:Stomach Neoplasms / Q000382:microbiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Atypical Malgun cell; Cancer; Gastritis; Helicobacter pylori; Neutrophilic foveolitis; Pathology; Premalignant; Stomach