Geographic pathology on the precursors of stomach cancer

Abstract

The classification of dysplasias of the gastric mucosa used in our institute includes adenomatous dysplasia, regenerative dysplasia, and cryptal dysplasia. We compared the incidence of gastric dysplasia in three regions of China which have quite different geographical environments: the loess plateau of Wuwei area in the Gansu Province, the island of the Yangtze River in the Jiangsu Province of southern China, and the coastal area of the Liaoning Province in northern China. The mortality rate of stomach cancer in these areas is more than 50 per 100,000. We found a total of 323 cases of gastric dysplasia in these three areas. Regenerative dysplasia is the most common precancerous lesion of the stomach and was found in 40% of the cases from the three high-risk areas of gastric cancer. The background lesions consist of gastric erosions, severe gastritis, gastric ulcers, and intestinal metaplasia, which indicate that some factors causing damage to gastric mucosa are very important in the histogenesis of stomach cancer. The gastric dysplasia sites involved are different in the three geographical regions studied. On the island of the Yangtze River, cardiac dysplasia and intestinal metaplasia are common (75%), and cancer of the cardia is also common. In the other two geographical areas, antral dysplasia predominates (85 to 91%). The finding of different sites of gastric dysplasia in different geographical environments may be very important in our search for etiological factors of gastric cancer and may allow for beneficial intervention in the prevention of this disease.