Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, Busan, South Korea.
Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, Busan, South Korea.
Pathol Res Pract. 2018 Jan;214(1):95-99. doi: 10.1016/j.prp.2017.10.022. Epub 2017 Oct 28.
Endoscopic resection is a safe and effective method to treat gastric epithelia dysplasia (GED). However, the development of metachronous and synchronous lesions after treatment has become a major concern. In this study, we investigated clinicopathologic features of 105 GED lesions from endoscopic resections between January 2008 and December 2009. Our goal is to find histologic factors that predict synchronous and metachronous lesions after ESD treatment. We assessed the degree of intestinal metaplasia (IM) and atrophy, type of IM, presence of gastritis cystica profunda, and crypt dysplasia in the adjacent mucosa.
We divided 105 GED lesions into three groups: a single group without metachronous or synchronous GED or adenocarcinoma (n=35); a multiple synchronous group (n=30, group with synchronous occurrence of GED or adenocarcinoma after treatment); and a multiple metachronous group (n=40, group with metachronous occurrence of GED or adenocarcinoma after treatment). The multiple metachronous and synchronous groups showed larger sizes (p=0.003) and higher grades (p=0.021) as compared with the single group. Furthermore, marked IM and atrophy in adjacent mucosa were more easily seen in the multiple metachronous and synchronous groups as compared with the single group (p<0.0001). Interestingly, the presence of incomplete type of IM (p=0.025) and crypt dysplasia (p<0.0001) in background mucosa was associated with occurrence of metachronous and synchronous lesions following endoscopic resection of GED.
The histological features of background mucosa, such as intestinal metaplasia, atrophy, and crypt dysplasia could be used as indicators of occurrence of metachronous and synchronous lesions after endoscopic treatment of GED.
内镜下切除是治疗胃上皮内瘤变（GED）的安全有效的方法。然而，治疗后同时性和异时性病变的发展已成为主要关注点。本研究对 2008 年 1 月至 2009 年 12 月间内镜下切除的 105 例 GED 病变的临床病理特征进行了研究，旨在寻找预测内镜下黏膜剥离（ESD）治疗后同时性和异时性病变的组织学因素。我们评估了肠上皮化生（IM）和萎缩的程度、IM 类型、胃底腺囊性增生的存在以及相邻黏膜隐窝异型增生。
我们将 105 例 GED 病变分为三组：无同时性或异时性 GED 或腺癌的单一组（n=35）；多个同时性组（n=30，治疗后同时发生 GED 或腺癌）；多个异时性组（n=40，治疗后异时发生 GED 或腺癌）。与单一组相比，多个异时性和同时性组的病变较大（p=0.003），分级较高（p=0.021）。此外，与单一组相比，多个异时性和同时性组的相邻黏膜中更易出现明显的 IM 和萎缩（p<0.0001）。有趣的是，背景黏膜中不完全型 IM（p=0.025）和隐窝异型增生（p<0.0001）的存在与 GED 内镜切除后同时性和异时性病变的发生有关。
背景黏膜的组织学特征，如肠上皮化生、萎缩和隐窝异型增生，可作为 GED 内镜治疗后同时性和异时性病变发生的指标。
