Kudo Yasuyuki, Morohashi Satoko, Takasugi Kaori, Tsutsumi Shinji, Ogasawara Hiroshi, Hanabata Norihiro, Yoshimura Tetsuro, Sato Fuyuki, Fukuda Shinsaku, Kijima Hiroshi
Departments of Pathology and Bioscience, Hirosaki University Graduates School of Medicine, Zaifu-cho, Hirosaki, Aomori, Japan.
Biomed Res. 2011 Apr;32(2):127-34. doi: 10.2220/biomedres.32.127.
Recent advances in endoscopic submucosal dissection (ESD) techniques contribute to endoscopic treatment of early gastric cancer (EGC). Recognition of chronic atrophic gastritis as the background is important for high-quality detection and diagnosis of EGC. But, relationships between EGC and atrophy of the background gastric mucosa caused by Helicobacter pylori are not well understood. The present study demonstrated histopathological phenotypes of EGC, as well as chronic atrophic gastritis as background mucosa of EGC. We evaluated mucosal heights, number of glands, and degree of intestinal metaplasia (IM) of the background gastric mucosa, using 81 cases of EGC resected by ESD. Gastric phenotype cancer cases showed IM of the background gastric mucosa less frequently, compared with intestinal phenotype cancer cases (score of IM, 1.15 vs. 1.65, P = 0.012). The average mucosal heights around EGC were lower in moderately to poorly differentiated adenocarcinoma cases than well differentiated adenocarcinoma cases (442.6 µm vs. 500.2 µm, P = 0.011). The mucosal atrophy indicated by average heights of background mucosa was low in the gastric phenotype cancer cases, compared with the intestinal phenotype cancercases (452.8 µm vs. 505.6 µm, P = 0.018). In the fundic gland area, the mucosal heights were low in the gastric phenotype cancer cases, compared with the intestinal phenotype cancer cases (413.2 µm vs. 495.5 µm, P = 0.015). Our results using EGC specimens indicated that gastric phenotype cancer and moderately to poorly differentiated adenocarcinoma had atrophic background mucosa with lower mucosal heights and less IM. The atrophic gastric mucosa with less IM is thought to play an important role in gastric carcinogenesis, especially tumoriogenesis of gastricphenotype cancer.
内镜黏膜下剥离术（ESD）技术的最新进展推动了早期胃癌（EGC）的内镜治疗。认识到慢性萎缩性胃炎是背景对于高质量检测和诊断EGC很重要。但是，EGC与幽门螺杆菌引起的胃黏膜萎缩之间的关系尚未完全明确。本研究展示了EGC的组织病理学表型，以及作为EGC背景黏膜的慢性萎缩性胃炎。我们使用81例经ESD切除的EGC病例，评估了胃背景黏膜的黏膜高度、腺体数量和肠化生（IM）程度。与肠型癌症病例相比，胃型癌症病例的胃背景黏膜IM较少（IM评分，1.15对1.65，P = 0.012）。中分化至低分化腺癌病例的EGC周围平均黏膜高度低于高分化腺癌病例（442.6 µm对500.2 µm，P = 0.011）。与肠型癌症病例相比，胃型癌症病例中由背景黏膜平均高度指示的黏膜萎缩程度较低（452.8 µm对505.6 µm，P = 0.018）。在胃底腺区域，与肠型癌症病例相比，胃型癌症病例的黏膜高度较低（413.2 µm对495.5 µm，P = 0.015）。我们使用EGC标本的结果表明，胃型癌症和中分化至低分化腺癌具有萎缩性背景黏膜，其黏膜高度较低且IM较少。IM较少的萎缩性胃黏膜被认为在胃癌发生中起重要作用，尤其是胃型癌症的肿瘤发生。
