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- Title
Intestinal-type gastric dysplasia in Helicobacter pylori-naïve patients.
- Authors
Shibagaki, Kotaro; Itawaki, Ayako; Miyaoka, Yoichi; Kishimoto, Kenichi; Takahashi, Yusuke; Kotani, Satoshi; Mishiro, Tsuyoshi; Oshima, Naoki; Kawashima, Kousaku; Ishimura, Norihisa; Onuma, Hideyuki; Nagasaki, Makoto; Nagase, Mamiko; Araki, Asuka; Kadota, Kyuichi; Kushima, Ryoji; Ishihara, Shunji
- Abstract
Gastric dysplasia and gastric cancer in Helicobacter pylori (Hp)-naïve patients usually exhibit a gastric phenotype, reflecting gastric mucosa without intestinal metaplasia (IM). We showed that intestinal-type gastric dysplasia (IGD) rarely occurs in the Hp-naïve stomach. In the last 10 years, we treated 1760 gastric dysplasia and gastric cancer patients, with 3.6% (63/1760) being Hp-naïve. Among these, ten were diagnosed with 14 IGDs and enrolled in this retrospective analysis. All lesions were observed by white-light endoscopy (WLE) and narrow-band imaging with magnification endoscopy (NBIME). We analyzed their endoscopic and microscopic features and patient demographics. Five men and five women aged 64 ± 21 years were included. WLE showed the depressed lesions mimicking a benign raised erosion in the prepyloric compartment. Multiple growths were confirmed in 30% (3/10) of patients. NBIME showed a near-regular microstructure and capillaries in 50% (7/14) of lesions with a gastritis-like appearance. Histologically, background mucosa was non-atrophic pyloric gland tissue, but 40.0% of samples (4/10) contained sporadic IM. Most of the lesions (8/14) were low-grade dysplasia, and others had a high-grade component, with one progressing to intramucosal carcinoma. The neoplastic surface was widely covered with foveolar epithelium in 57.1% (8/14). Immunohistochemically, neoplastic cells expressed CDX2 in all patients (14/14), MUC2 and CD10 in 92.9% (13/14), MUC5AC in 14% (2/14), and no expression of MUC6, showing an intestinal phenotype. Ki-67 was overexpressed with a mean labeling index of 58.3 ± 38.5%, and p-53 was overexpressed in 92.9% (13/14), regardless of the dysplastic grade. The IGD rarely occurs in Hp-naïve patients with distinctive clinicopathologic characteristics.
- Subjects
STOMACH cancer; PHENOTYPES; METAPLASIA; MICROSCOPY; IMMUNOHISTOCHEMISTRY
- Publication
Virchows Archiv: European Journal of Pathology, 2022, Vol 480, Issue 4, p783
- ISSN
0945-6317
- Publication type
Article
- DOI
10.1007/s00428-021-03237-9