Călăraşu Florenţa, Rădulescu Doiniţa, Călăraşu Alexandru
Spitalul de Urgenţă Sf. Apostol Andrei Galaţi, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină.
Rev Med Chir Soc Med Nat Iasi. 2005 Jul-Sep;109(3):603-10.
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.
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).
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.
Since it represents a risk factor for carcinogenesis the identification of intestinal metaplasia in the context of the gastric ulcer is extremely important.
肠化生被认为是胃癌发生的中间阶段。因此，我们旨在研究消化性溃疡患者中诊断出的肠化生病变。
我们对一组212例临床诊断为胃溃疡并接受部分胃切除术的患者进行了研究。从溃疡周边、底部及溃疡周围获取的组织块用10%福尔马林固定并包埋于石蜡中。标本常规苏木精-伊红（HE）染色及采用特殊方法（范吉森染色、马松染色、戈莫里染色、过碘酸-雪夫染色和阿尔辛蓝染色）染色。
36例（16.9%）存在肠化生。其表现为单一病变（10例）、合并慢性胃炎（23例）及发育异常（3例）。大多数病例（70%）表现为I型（完全型）化生，其特征为存在肠上皮细胞、杯状细胞和潘氏细胞。腺管结构规则，隐窝直，由成熟的吸收细胞和产生涎黏蛋白的杯状细胞衬里。20%的病例表现为II型（不完全型）化生，隐窝扭曲，由少数吸收细胞、杯状细胞和稀疏的潘氏细胞衬里。10%的病例呈现III型（不完全型，结肠型）化生，隐窝扭曲，细胞密度增加且有分层。恶性溃疡相邻黏膜中的杯状细胞主要含硫酸黏蛋白，还有少量中性黏蛋白和涎黏蛋白。讨论了肠化生在胃溃疡恶变中的意义及参与情况。
由于肠化生是致癌的危险因素，因此在胃溃疡背景下识别肠化生极为重要。
