[The significance of intestinal metaplasia related to gastric ulcer].

PURPOSE

Intestinal metaplasia is considered an intermediary stage of gastric carcinogenesis. Thus, we aim to investigate lesions of intestinal metaplasia diagnosed at patients with peptic ulcer.

MATERIAL AND METHODS

Our study was achieved on a group of 212 patients, clinically diagnosed with gastric ulcer and having partial gastrectomy. The fragments obtained from the circumference, the basis and from around the ulcer were formalin-fixed (10%) and paraffin included. The specimens were stained routinely (HE) and with special methods (van Gieson, Masson, Gomori, PAS and Alcian Blue).

RESULTS

Intestinal metaplasia was present in 36 cases (16.9%). It was noted as a unique lesion (in 10 cases), in association with chronic gastritis (23 cases) and with dysplasia (3 cases). Most of the cases (70%) displayed type I (complete) metaplasia characterized by the presence of enterocytes, goblet and Paneth cells. The glandular architecture was regular, with straight crypts, lined by mature, absorbtion cells and goblet cells producing sialomucins. 20% of the cases displayed type II (incomplete) metaplasia, with distort crypts, lined by a few absorptive and goblet cells and sparse Paneth cells. 10% of the cases presented type III (incomplete, colonic type) metaplasia with twisted crypts, increased cell density and stratification. The goblet cells in the adjacent mucosa of the malignant ulcers contained mainly sulphomucins, together with a few neutral mucins and sialomucins. The signification and the involvement of the intestinal metaplasia in the malignant transformation of the gastric ulcer are discussed.

CONCLUSION

Since it represents a risk factor for carcinogenesis the identification of intestinal metaplasia in the context of the gastric ulcer is extremely important.