Saulino David, Chen Rong, Wang Kai, Shen Minqian, Zhang Xuefeng, Westerhoff Maria, Cheng Jerome, Lin Jingmei, Zhang Xuchen, Feely Michael, Liu Xiuli
Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA.
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
Gastroenterology Res. 2021 Feb;14(1):13-20. doi: 10.14740/gr1359. Epub 2021 Feb 19.
Gastric cancer is one of the Lynch syndrome (LS)-associated malignancies. Previous studies have suggested that LS patients with gastric cancer also had chronic atrophic gastritis in the background mucosa, but further histologic characterization was not attempted. This study aims to understand the histologic features of background chronic gastritis in LS patients with gastric adenocarcinoma.
Eleven LS-associated gastric cancer cases were collected from five institutions. Demographics and clinical features were retrieved by review of medical charts. Pathological material was reviewed for tumor location and histologic type. In addition, non-neoplastic gastric mucosa was assessed for inflammation (chronic and active), atrophy, intestinal metaplasia (IM) in the antrum and body, as well as pyloric gland metaplasia and enterochromaffin-like (ECL) cell hyperplasia in the body.
Eleven LS patients with gastric cancer (four male and seven female) with a mean age of 63 years (range: 23 - 83) were included. Ten (90.9%) had personal cancer histories; however none of the patients had family history of gastric cancer. Eight (72.7%) patients underwent gastrectomy and three had endoscopic resection. Nine (81.8%) patients had tumor in the fundus and/or body and two had tumor present in the antrum. Seven (63.6%) cases were intestinal type or mixed type carcinoma, and the remaining four were signet ring cell carcinoma. Eight (of 11, 72.7%) patients had chronic gastritis, five (45.4%) had atrophy, and four (36.3%) had intestinal metaplasia. Four of five patients with both antrum and body mucosa available for evaluation (80%), demonstrated body-predominant chronic gastritis. Four patients had germline alterations and all of these patients had chronic gastritis, including one () gastritis and three negative gastritis.
None of LS patients with gastric cancer in our cohort had a family history of gastric cancer. Gastric adenocarcinomas in LS patients were primarily located in the fundus and/or body. Two-thirds of these tumors were of intestinal type and had a background chronic, -negative gastritis. These results support a chronic atrophic gastritis with intestinal metaplasia-dysplasia-carcinoma sequence in LS-related gastric tumorigenesis, particularly in -mutated LS patients.
胃癌是林奇综合征（LS）相关的恶性肿瘤之一。既往研究提示，患胃癌的LS患者背景黏膜中也存在慢性萎缩性胃炎，但未进一步进行组织学特征分析。本研究旨在了解患胃腺癌的LS患者背景慢性胃炎的组织学特征。
从五家机构收集了11例与LS相关的胃癌病例。通过查阅病历获取人口统计学和临床特征。对病理材料进行肿瘤位置和组织学类型评估。此外，对非肿瘤性胃黏膜进行炎症（慢性和活动性）、萎缩、胃窦和胃体肠化生（IM）、胃体幽门腺化生和嗜银样（ECL）细胞增生评估。
纳入11例患胃癌的LS患者（4例男性和7例女性），平均年龄63岁（范围：23 - 83岁）。10例（90.9%）有个人癌症史；然而，所有患者均无胃癌家族史。8例（72.7%）患者接受了胃切除术，3例接受了内镜切除。9例（81.8%）患者肿瘤位于胃底和/或胃体，2例肿瘤位于胃窦。7例（63.6%）病例为肠型或混合型癌，其余4例为印戒细胞癌。11例中有8例（72.7%）患者有慢性胃炎，5例（45.4%）有萎缩，4例（36.3%）有肠化生。5例胃窦和胃体黏膜均可用于评估的患者中有4例（80%）表现为以胃体为主的慢性胃炎。4例患者有胚系改变，所有这些患者均有慢性胃炎，包括1例（ ）胃炎和3例阴性胃炎。
我们队列中的患胃癌的LS患者均无胃癌家族史。LS患者的胃腺癌主要位于胃底和/或胃体。这些肿瘤中有三分之二为肠型，背景为慢性、 阴性胃炎。这些结果支持在LS相关的胃癌发生过程中存在慢性萎缩性胃炎-肠化生-发育异常-癌序列，特别是在 突变的LS患者中。
