Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma

Abstract

A total of 191 gastric adenomas in 178 patients was studied macroscopically by endoscopy and histopathologically by endoscopic biopsy. Among the lesions, 85 in 74 patients were followed‐up for six months to 12 years. Gastric adenomas were found to be more frequent in the aged, with a rate of 0.1% in the third decade but 3.7% in the ninth decade, on gastroscopic examination. Gastric cancers coexistent with the gastric adenomas were seen in 14 cases (8%), and were more frequent in male than in female patients (sex ratio, 12:2). Only eight of the 85 lesions (9%) revealed macroscopic changes. Four of these showed a reduction in size, while the other four lesions showed enlargement. In 21 of the 85 lesions (25%), histologic changes were observed. Four (5%) changed from moderate dysplasia (Group III) to nondysplastic or intestinal metaplasia (Group I), eight lesions (9%) revealed histologic changes (Group III to IV, or vice versa) without malignant transformation, and nine lesions (11%) showed malignant changes. Neither submucosal invasion nor lymph node metastasis was found. These lesions consisted of carcinoma in situ with small foci in the lesions exhibiting moderate dysplasia, and a gradual transition from severe dysplasia to cancer was seen in resected lesions obtained by endoscopic polypectomy or surgical resection. In addition, a gradual increase in dysplasia of tissue from moderate to severe was revealed by repeated gastroscopic biopsy. These findings suggest that the gastric adenomas underwent malignant changes with gradual transformation from moderate through severe dysplasia.

Three independent genetic profiles based on mucin expression in early differentiated-type gastric cancers—a new concept of genetic carcinogenesis of early differentiated-type adenocarcinomas

“…However, in Japan, it is known that gastric adenoma is not a precursor lesion of early gastric carcinoma. 31 Thus, we believe that the intestinal phenotype of early gastric cancers does not derive from gastric adenoma. We suggest that intestinal-phenotype cancers have genetic profiles that set the cells on different pathways from those leading to the development of gastric adenomas, although both tumors may share common genetic alterations in their initial tumorigenesis.…”

Microsatellite Instability in the Adenoma-Carcinoma Sequence of the Stomach

“…In the gastric adenoma-carcinoma sequence, TGF-␤ RII gene mutation occurred early in the adenoma stage and it persisted after malignant transformation. (Lab Invest 2000, 80:57-64).G astric adenoma is a precancerous lesion, 11% to 40% of which transforms into carcinoma (Kamiya et al, 1982;Ming and Goldman, 1965). The intestinal type of gastric carcinoma is different from the diffuse type in patterns of histopathology and genetic alterations.…”

Four Endoscopic Predictors of Carcinoma as a Final Diagnosis after Endoscopic Resection of Forceps Biopsy-proven Gastric Adenomas

“…[1][2][3] This discrepancy between forceps biopsy samples and post-resection specimens is likely unavoidable and an inevitable limitation of forceps biopsy, due to the small amount of tissue sampled. [4][5][6]17 In this investigation, which was based on white light endoscopic images, we found that some specimen features, including size of 15 mm or greater, depressed appearance, central concavity, and nodular surface, were useful for predicting carcinoma as a final diagnosis in FBP adenomas, regardless of histologic grades.…”

“…[1][2][3] Accurate diagnosis and classification of epithelial neoplasms requires whole specimens; this discrepancy is therefore inevitable, as forceps biopsies obtain only small parts of the entire lesion. [4][5][6] Recent research has shown that advanced endoscopic imaging technology may be useful in diagnosing gastric epithelial neoplasm more precisely before dissection.…”