Extensive intestinal metaplasia in gastric carcinoma and in other lesions requiring surgery. A study of 3421 gastrectomy specimens from dwellers of the Atlantic and Pacific basins

Abstract

Background: Extensive intestinal metaplasia (EIM) has been reported in gastrectomies from patients dwelling in the Pacific and Atlantic basins. Aims: To compare all the results in an attempt to explain the findings. Method: All sections from 3421 gastrectomies were reviewed at various hospitals: 1946 in the Atlantic and 1475 in the Pacific basin. Sections with EIM showed IM encompassing one or more entire low power field (>5 mm in length/section) in one or more section. Results: In the Atlantic basin, EIM was present in 18.8% (153 of 814) of specimens with intestinal carcinoma (IC) and in 10.3% (65 of 630) of those with diffuse carcinoma (DC). In the Pacific basin, EIM was found in 62.9% (412 of 655) of gastrectomies with IC and in 33.3% (160 of 481) of those with DC. The numbers of specimens with EIM were significantly higher in the Pacific than in the Atlantic basin for both carcinoma phenotypes, particularly among elderly patients (>60 years). Conclusions:The proportion of gastrectomies with EIM was higher among populations at a higher gastric cancer risk than in those with a lower cancer risk. EIM was mostly associated with IC rather than DC or with miscellaneous gastric diseases (841 control gastrectomies) in both basins. The proportion of gastrectomies with EIM was significantly higher in Vancouver than in New York and in Santiago de Chile than in Buenos Aires, even though these populations reside at approximately the same geographical latitude, but in different basins. Environmental factors seem to accelerate the evolution of EIM.

Gastric duodenal metaplasia in duodenal adenomas

“…That metaplastic subset might be a remnant mucosal alteration that has antedated the neoplastic transformation. This possibility seems to be validated by the various reports indicating that metaplasias in disparate mucosas in the gastrointestinal tract may precede neoplasias, such as in the oesophagus (intestinal metaplasia in Barrett's oesophagus-dysplasia-carcinoma sequence 12 ), in the stomach (intestinal metaplasia-dysplasia-carcinoma sequence 13 ) and in the colonic mucosa (metaplastic-hyperplastic polyposis colidysplasia-carcinoma sequence 14 15 ). Recently Sakurai et al 16 found adenocarcinomas developing in duodenal Brunner gland hyperplasia.…”

Duodenal Gastric Metaplasia and Duodenal Neuroendocrine Neoplasms: More Than a Simple Coincidence?

“…A high frequency (40.5%) of DGM has been found in duodenal adenomas [8]. It might be possible that metaplasia precedes the neoplastic transformation as has been reported in other gastrointestinal malignancies including esophagus (intestinal metaplasia in Barrett's esophagus-dysplasia-carcinoma sequence [9] and stomach [10] and colorectal cancer [11]). Furthermore, DGM has been associated with genetic alterations, such as GNAS and KRAS mutations, which are involved in different types of tumors including duodenal adenocarcinoma.…”

Inflammation and Gastric Cancer

“…In more advanced stages, the glands become bordered by irregular goblet cells resembling the colonic phenotype [ 181 ]. A systematic review of ten observational studies found that individuals with incomplete metaplasia had a four- to eleven-fold greater risk of gastric cancer than those with complete metaplasia or absence of incomplete type metaplasia [ 182 , 183 ]. Incomplete metaplasia is commonly seen among early gastric adenocarcinomas.…”