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. 2020 Oct-Dec;61(4):1129-1141.
doi: 10.47162/RJME.61.4.15.

Gastric cancer - histopathological correlations between tumor and non-tumor gastric mucosa changes

Ion Păun  1 , Andrei Ionuţ Costin, Vlad Denis Constantin, Ion Lomaca, Nicolae Gabriel Ianoşi, Bogdan Socea, Cristina Violeta Tutunaru, Ovidiu Mircea Zlatian, Simona Laura Ianoşi, Carmen Daniela Neagoe, Antoanela Valentina Crafciuc, Marius Ionuţ Stancu
Affiliations

Gastric cancer - histopathological correlations between tumor and non-tumor gastric mucosa changes

Ion Păun et al. Rom J Morphol Embryol. 2020 Oct-Dec.

Abstract

Gastric cancer is a widely geographically distributed malignancy with high prevalence, therefore being a serious health problem that needs standardized methods for early diagnosis and treatment. The aim of the study was to evaluate the correlation of some epidemiological and clinical data with the histological features. The study group was made up of 66 patients that underwent surgical removal of the gastric neoplasm, and the pathological exam showed the morphological features of the tumor, as well as the ones of the unaffected mucosal tissue. Topographically, the highest incidence of the tumor was registered in the gastric antrum, but in recent years, an increased incidence of the superior gastric pole localization was recorded. The macroscopic aspects reveal that the ulcerated type 2 Borrmann is the most frequent, and alongside type 3 Borrmann, the ulcer-infiltrative type represents most of the gastric antrum cancers. The analysis of the tumor invasion showed that most carcinomas underwent surgery when the tumor invaded the serosa (pT3) or even the perigastric tissues (pT4). In our research, we chose Goseki's microscopic classification because of its best coverage of the histological heterogeneity of the gastric carcinomas, providing information about the percentage of the cellular and secretory differentiation with direct impact on the invasion of the tumor. In more than 70% of the cases, the patients showed lesions of severe chronic atrophic gastritis of the non-tumor mucosa. Lately, the incidence of Helicobacter pylori has been 5.5%, lower than indicated by mainstream literature. We observed that the incidence of type 3 incomplete intestinal metaplasia, as the most commonly involved factor in the etiopathogenesis of gastric neoplasms, was encountered in 36.3% of the cases, this percentage rising proportionally with age and being frequently associated with antrum tumors. In conclusion, the permanent analysis of the relation between epidemiological data and some histological features might be relevant for the characterization of the tumoral process or the non-tumor gastric mucosa, leading to an evaluation of the prognosis.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Distribution of gastric carcinoma cases by topography
Figure 2
Figure 2
Distribution of gastric carcinoma cases by Borrmann types
Figure 3
Figure 3
Gastric neoplasm of the vegetative body (type 1 Borrmann)
Figure 4
Figure 4
Ulcerated antrum neoplasm (type 3 Borrmann)
Figure 5
Figure 5
Ulcerated gastric angle neoplasm (type 3 Borrmann)
Figure 6
Figure 6
Distribution of gastric carcinoma cases according to the level of tumor invasion (pT)
Figure 7
Figure 7
Distribution of gastric carcinoma cases according to microscopic criteria – Goseki classification
Figure 8
Figure 8
Gastric carcinoma Goseki 1: good tubular differentiation and reduced secretory differentiation. PAS-H, staining, ×100
Figure 9
Figure 9
Gastric adenocarcinoma Goseki 2: good tubular and secretory differentiation. PAS-H staining, ×200
Figure 10
Figure 10
Gastric carcinoma, Goseki 3 areas: poorly tubular and secretory differentiation. HE staining, ×100
Figure 11
Figure 11
Carcinoma with cu signet ring cells, Goseki 4: poorly tubular differentiation (possible lack of tubular differentiation) and good secretory differentiation. HE staining, ×200
Figure 12
Figure 12
Presence of chronic atrophic gastritis lesions in the non-tumoral gastric mucosa
Figure 13
Figure 13
Aspects of severe atrophic chronic gastritis associated with high-grade dysplasia lesions against a background of intestinal metaplasia. Exulcerations and extensive hemorrhagic suffusions in the chorion. HE staining, ×100
Figure 14
Figure 14
Severe atrophic chronic gastritis. HE staining, ×100
Figure 15
Figure 15
Correlation between cases of chronic atrophic gastritis and Goseki classes
Figure 16
Figure 16
Severe chronic atrophic gastritis with a high degree of H. pylori activity: (A) H. pylori positive; (B) Details of the same case – the presence of numerous H. pylori-type germs in the foveolar mucus is observed. HE staining: (A) ×200; (B) ×400
Figure 17
Figure 17
Distribution of the types of intestinal metaplasia in the studied cases
Figure 18
Figure 18
(A) Gastric mucosa at a distance from the tumor with lesions of intestinal metaplasia, developed against a background of severe atrophic chronic gastritis (HE staining, ×200); (B) The same case as in the previous image, indicating a sialomucin-rich content of mucus (Alcian Blue pH 2.5 staining, ×100); (C) The same case, in which the weak reaction of the foveolar mucus to the Alcian Blue pH 1 staining is observed (×200)
Figure 19
Figure 19
(A) Aspects of severe atrophic chronic gastritis with large areas of intestinal metaplasia type III; (B and C) Details of the previous case. Alcian Blue pH 1 staining: (A) ×40; (B) ×100; (C) ×200
Figure 20
Figure 20
Distribution of cases of dysplasia of non-tumor mucosa
Figure 21
Figure 21
(A) High expression of PCNA in dysplastic glandular structures; (B) Details of the previous image. Anti-PCNA antibody immunomarking: (A) ×40; (B) ×200. PCNA: Proliferating cell nuclear antigen
Figure 22
Figure 22
Distribution of cases according to the degree of cell differentiation (G)
See this image and copyright information in PMC

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