RESUMO
OBJECTIVE: Gastritis, intestinal metaplasia, atrophy, and dysplasia are disorders that frequently precede the full development of gastric adenocarcinoma. On the other hand, primary gastric lymphomas seem to arise from mucosa-associated lymphoid tissue. It is well accepted that these histological changes are caused by Helicobacter pylori infection. The objective of this study is to determine the frequency and characteristics of epithelial and lymphoid tissue disorders of the gastric mucosa surrounding primary carcinomas and lymphomas. METHODS: We studied 111 gastrectomies from patients harboring primary adenocarcinomas (30 intestinal and 30 diffuse type) and 51 gastric lymphomas. For comparative purposes, we analized 86 stomachs from patients who died of diseases other than gastric malignancies. Histopathological disorders of the gastric mucosa adjacent to primary neoplasms such as atrophy, intestinal metaplasia, and dysplasia were recorded. Lymphoid follicles were classified in two groups, with or without expansion. Expansion was characterized by increased size, irregular borders, enlarged marginal zone, and expanded germinal centers. Differences were statistically evaluated with chi2 and Fisher exact tests, odds ratio, and relative risk, with 95% CI. p values <0.05 were considered statistically significant. RESULTS: Most intestinal-type adenocarcinomas showed atrophy (76.6%) and intestinal metaplasia (86.6%) and less frequently, dysplasia (23.3%), in the surrounding gastric mucosa. Expansive lymphoid follicles were more frequent among lymphomas than in adenocarcinomas (56.8% vs 25%); however, a high percentage of lymphomas were also associated with atrophy (50.9%), intestinal metaplasia (62.7%), and rarely dysplasia (11.8%). On the contrary, diffuse-type adenocarcinoma displayed less frequently atrophy (33%), intestinal metaplasia (50%), and dysplasia (3%). Gastric mucosa from patients without any gastric neoplasia was almost normal (84%), whereas the remaining 16% showed, both or alone, atrophy and intestinal metaplasia. CONCLUSION: Histopathological disorders of the gastric mucosa are not specific for any neoplasm, but intestinal-type adenocarcinomas frequently showed atrophy, intestinal metaplasia, and not uncommonly, dysplasia of the surrounding non-neoplastic gastric mucosa. Diffuse-type adenocarcinomas did not frequently show such lesions. Primary lymphomas displayed expansive lymphoid follicles and also a high percentage of atrophy and intestinal metaplasia of the surrounding gastric mucosa. The presence of intestinal metaplasia, atrophy, and lymphoid follicles with expansion in endoscopic biopsies could suggest a higher suceptibility for the development of gastric intestinal-type adenocarcinoma or gastric lymphoma. Patients harboring such histopathological changes must receive eradication therapy against H. pylori and probably closer follow-up.
Assuntos
Adenocarcinoma/patologia , Mucosa Gástrica/patologia , Neoplasias Intestinais/patologia , Linfoma/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/microbiologia , Adolescente , Adulto , Idoso , Feminino , Gastrite/epidemiologia , Gastrite/patologia , Gastrite Atrófica/epidemiologia , Gastrite Atrófica/patologia , Centro Germinativo/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Helicobacter pylori , Humanos , Neoplasias Intestinais/microbiologia , Linfoma/microbiologia , Masculino , Metaplasia/epidemiologia , Metaplasia/patologia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/epidemiologia , Neoplasias Gástricas/microbiologiaRESUMO
CONTEXT: Recently, we have observed intestinal metaplasia, atrophy, and dysplasia in the mucosa adjacent to primary gastric lymphoma (PGL) in gastrectomy specimens. OBJECTIVE: To determine the frequency and type of epithelial disorders at the histopathologic level in the mucosa adjacent to PGL in endoscopic specimens. DESIGN: We studied 54 endoscopic biopsies from patients harboring PGL. We searched for the following morphologic changes in the gastric mucosa: intestinal metaplasia; atrophy; dysplasia; epithelial erosion; and atypical regeneration of the glandular epithelium. Other nonepithelial findings such as lymphoid follicles, Helicobacter pylori, and lymphoma grade, were also recorded. For comparative purposes, 50 endoscopic biopsies with gastric adenocarcinoma and 50 biopsies with chronic gastritis associated with H pylori infection were also studied. RESULTS: The 54 biopsies included 28 (52%) low-grade and 26 (48%) high-grade PGLs. We found intestinal metaplasia in 32 biopsies (59%), atrophy in 20 biopsies (37%), dysplasia in 2 biopsies (4%), erosion of the epithelium in 33 biopsies (61%), and atypical regenerative changes of the glandular epithelium in 10 biopsies (19%). Lymphoid follicles were found in 21 biopsies (39%), and H pylori was demonstrated in 31 biopsies (57%). When groups were compared, the frequency of epithelial changes in biopsies from patients with PGL and adenocarcinoma was similar. Intestinal metaplasia or atrophy were present in only 10% of biopsies from patients with gastritis, and dysplastic glands were not identified. CONCLUSIONS: Biopsies from patients with PGL showed chronic damage of the gastric mucosa at diagnosis, including precancerous conditions. Intestinal metaplasia and atrophy were among the most frequent disorders, but dysplasia was also occasionally present. Endoscopists and pathologists must be acquainted with such changes and look for them in the initial biopsy, as well in subsequent samples. This practice is particularly important when reviewing biopsies from patients with low-grade mucosa-associated lymphoid tissue (MALT)-lymphomas who are eligible for eradication treatment for H pylori.
Assuntos
Mucosa Gástrica/patologia , Linfoma de Zona Marginal Tipo Células B/patologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Biópsia , Feminino , Mucosa Gástrica/microbiologia , Gastroscopia , Infecções por Helicobacter/patologia , Infecções por Helicobacter/virologia , Helicobacter pylori , Humanos , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
The clinicopathologic findings in eight Mexican patients with immunoproliferative small intestinal disease (IPSID) are analyzed. Four of these cases have been previously reported and the remainder were found in a retrospective review of 42 lymphoproliferative disorders of the small bowel (9.5% of the cases at our institution). There were six male and two female patients with an average age of 30 years. Laparotomy with intestinal resection was performed in seven cases. Malignant lymphoma was documented in five and the early phase of IPSID in two patients. The remaining case was diagnosed by means of several endoscopic biopsies. It is concluded that although IPSID seems to be a rare disease in the mestizo population of our country, it may not be exceptional and its diagnosis has probably been overlooked.
Assuntos
Doença Imunoproliferativa do Intestino Delgado , Adulto , Feminino , Humanos , Imuno-Histoquímica , Doença Imunoproliferativa do Intestino Delgado/diagnóstico , Doença Imunoproliferativa do Intestino Delgado/etnologia , Doença Imunoproliferativa do Intestino Delgado/patologia , Intestino Delgado/patologia , Masculino , MéxicoRESUMO
In order to know the frequency and distribution of the histologic types of Hodgkin disease (HD) in the general Hospital of Mexico City and to compare the results with those of other countries; 96,909 surgical specimens were reviewed; 422 were of HD, from which only 309 (0.31%) could be reclassified according to the modified Rye classification, 214 (69%) were male and 95 (31%) female (M:F = 1:2.25). The mean age for the group was 26 years, for females was 30 and for males 24. The graphic for age and sex showed a unimodal curve in both sexes. The most frequent histologic type was mixed cellularity with 175 cases (56.6%), followed by the NE type with 83 (26.9%), the DL with 26 (8.4%) and finally the PL type with 25 (8.1%). In all the groups predominated the males as reported by other authors, but they reported a bimodal curve of age distribution and ours was unimodal as reported in Peru, Colombia, Uganda. The mean age is also one decade younger than in other countries, probably because almost 50% of the Mexican population are youngsters. The distribution of histologic types is similar to those of South Africa, Colombia, Uganda, Zambia and to the poor black population from USA, where the most frequent type is the mixed cellularity. The frequency of the other histologic types differs from the reports of Denmark Sweden, USA and England were the NE type predominates.(ABSTRACT TRUNCATED AT 250 WORDS)