Difference between revisions of "Intestinal metaplasia of the stomach"
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'''Intestinal metaplasia of the stomach''' is a relative common finding that is associated with modest increased risk of [[gastric carcinoma]]. | |||
It is also known as '''gastric [[intestinal metaplasia]]''' and may be abbreviated '''IM'''. | |||
==General== | |||
*Often part of surgical pathology report, e.g. "negative for intestinal metaplasia" or "intestinal metaplasia present". | |||
*May be associated with Helicobacter spp. infection -- though Helicobacter don't like intestinal type mucosa, i.e. H. pylori are not typically found in regions with intestinal metaplasia. | |||
*May be reversible - some epidemiological evidence.<ref name=pmid12477745>{{Cite journal | last1 = Walker | first1 = MM. | title = Is intestinal metaplasia of the stomach reversible? | journal = Gut | volume = 52 | issue = 1 | pages = 1-4 | month = Jan | year = 2003 | doi = | PMID = 12477745 | PMC = 1773527 }}</ref> | |||
*Associated with gastric carcinomas of [[Lynch syndrome]];<ref name=pmid3581033>{{Cite journal | last1 = Cristofaro | first1 = G. | last2 = Lynch | first2 = HT. | last3 = Caruso | first3 = ML. | last4 = Attolini | first4 = A. | last5 = DiMatteo | first5 = G. | last6 = Giorgio | first6 = P. | last7 = Senatore | first7 = S. | last8 = Argentieri | first8 = A. | last9 = Sbano | first9 = E. | title = New phenotypic aspects in a family with Lynch syndrome II. | journal = Cancer | volume = 60 | issue = 1 | pages = 51-8 | month = Jul | year = 1987 | doi = | PMID = 3581033 }}</ref> however, surveillance may not be worthwhile.<ref name=pmid12059060>{{Cite journal | last1 = Renkonen-Sinisalo | first1 = L. | last2 = Sipponen | first2 = P. | last3 = Aarnio | first3 = M. | last4 = Julkunen | first4 = R. | last5 = Aaltonen | first5 = LA. | last6 = Sarna | first6 = S. | last7 = Järvinen | first7 = HJ. | last8 = Mecklin | first8 = JP. | title = No support for endoscopic surveillance for gastric cancer in hereditary non-polyposis colorectal cancer. | journal = Scand J Gastroenterol | volume = 37 | issue = 5 | pages = 574-7 | month = May | year = 2002 | doi = | PMID = 12059060 }}</ref> | |||
Significance: | |||
*Moderate risk increase for carcinoma; risk less than for Barrett's esophagus.<ref name=pmid20203636>{{cite journal |author=Correa P, Piazuelo MB, Wilson KT |title=Pathology of gastric intestinal metaplasia: clinical implications |journal=Am. J. Gastroenterol. |volume=105 |issue=3 |pages=493–8 |year=2010 |month=March |pmid=20203636 |pmc=2895407 |doi=10.1038/ajg.2009.728 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895407/?tool=pubmed}}</ref> | |||
**Odds ratio for corpus (~5.8x) higher than antrum (2.3x) when compared to individuals without IM.<ref name=pmid21575058>{{Cite journal | last1 = Sakitani | first1 = K. | last2 = Hirata | first2 = Y. | last3 = Watabe | first3 = H. | last4 = Yamada | first4 = A. | last5 = Sugimoto | first5 = T. | last6 = Yamaji | first6 = Y. | last7 = Yoshida | first7 = H. | last8 = Maeda | first8 = S. | last9 = Omata | first9 = M. | title = Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration. | journal = J Gastroenterol Hepatol | volume = 26 | issue = 10 | pages = 1570-5 | month = Oct | year = 2011 | doi = 10.1111/j.1440-1746.2011.06767.x | PMID = 21575058 }}</ref> | |||
==Gross/endoscopic== | |||
*+/-Erythema. | |||
**Often associated with [[chronic gastritis]]. | |||
==Microscopic== | |||
Features: | |||
*Goblet cells are present in the stomach - '''key feature'''.<ref>URL: [http://esynopsis.uchc.edu/eAtlas/GI/1280.htm http://esynopsis.uchc.edu/eAtlas/GI/1280.htm]. Accessed on: 16 August 2010.</ref> | |||
**In [[H&E stain|H&E]] sections the vacuole often stains light grey. | |||
**Foveolar epithelium should be present in the same fragment. | |||
*+/-Paneth cells - deep in the glands.<ref name=pmid19918317/> | |||
**Very rarely present. | |||
**Very uncommon in isolation. | |||
Notes: | |||
*Intestinal metaplasia (IM) is occasionally subdivided:<ref name=pmid10680883>{{Cite journal | last1 = Rugge | first1 = M. | last2 = Correa | first2 = P. | last3 = Dixon | first3 = MF. | last4 = Hattori | first4 = T. | last5 = Leandro | first5 = G. | last6 = Lewin | first6 = K. | last7 = Riddell | first7 = RH. | last8 = Sipponen | first8 = P. | last9 = Watanabe | first9 = H. | title = Gastric dysplasia: the Padova international classification. | journal = Am J Surg Pathol | volume = 24 | issue = 2 | pages = 167-76 | month = Feb | year = 2000 | doi = | PMID = 10680883 }}</ref> | |||
**''Complete IM'' = goblet cells and (intestinal) brush border. | |||
**''Incomplete IM'' = mucus vacuoles of various sizes, no (intestinal) brush border. | |||
*Goblet cells metaplasia starts in the neck region of the gastric glands.<ref name=pmid4175677>{{Cite journal | last1 = Stemmermann | first1 = GN. | last2 = Hayashi | first2 = T. | title = Intestinal metaplasia of the gastric mucosa: a gross and microscopic study of its distribution in various disease states. | journal = J Natl Cancer Inst | volume = 41 | issue = 3 | pages = 627-34 | month = Sep | year = 1968 | doi = | PMID = 4175677 | URL = http://jnci.oxfordjournals.org/content/41/3/627.abstract }}</ref> | |||
DDx: | |||
*[[Normal duodenum|Normal small bowel mucosa]] - no foveolar epithelium present. | |||
*[[Gastric dysplasia]], intestinal type. | |||
Image: | |||
*[http://commons.wikimedia.org/wiki/File:Gastric_adenocarcinoma.jpg Intestinal metaplasia in the stomach - crappy quality (WC)]. | |||
==Stains== | |||
*Alcian blue (pH 2.5)/PAS +ve.<ref name=pmid14736279>{{Cite journal | last1 = Rivera-Hueto | first1 = F. | last2 = Lag-Asturiano | first2 = E. | last3 = Utrilla-Alcolea | first3 = JC. | last4 = Herrerías-Gutiérrez | first4 = JM. | title = Advanced gastric carcinoma with a complete intestinal metaplasia phenotype associated with early intestinal-type carcinoma. | journal = Arch Pathol Lab Med | volume = 128 | issue = 2 | pages = 218-21 | month = Feb | year = 2004 | doi = 10.1043/1543-2165(2004)128218:AGCWAC2.0.CO;2 | PMID = 14736279 }}</ref> | |||
**May be used to divide into ''complete'' (type I) and ''incomplete'' (type II).<ref name=pmid7139576>{{Cite journal | last1 = Iida | first1 = F. | last2 = Kusama | first2 = J. | title = Gastric carcinoma and intestinal metaplasia. Significance of types of intestinal metaplasia upon development of gastric carcinoma. | journal = Cancer | volume = 50 | issue = 12 | pages = 2854-8 | month = Dec | year = 1982 | doi = | PMID = 7139576 }}</ref><ref>{{Ref Odze|276}}</ref> | |||
*Alican blue stain +ve.{{fact}} | |||
Image: | |||
*[http://commons.wikimedia.org/wiki/File:Barrett%27s_mucosa,_Alcian_blue_stain.jpg Barrett's mucosa - Alcian blue stain (WC)]. | |||
==IHC== | |||
*CDX2 +ve (-ve in normal stomach).<ref name=pmid12477745>{{Cite journal | last1 = Walker | first1 = MM. | title = Is intestinal metaplasia of the stomach reversible? | journal = Gut | volume = 52 | issue = 1 | pages = 1-4 | month = Jan | year = 2003 | doi = | PMID = 12477745 | PMC = 1773527 | |||
}}</ref> | |||
**Strong assoc. with ''[[Helicobacter gastritis]]'' as well as IM.<ref name=pmid12047325>{{Cite journal | last1 = Satoh | first1 = K. | last2 = Mutoh | first2 = H. | last3 = Eda | first3 = A. | last4 = Yanaka | first4 = I. | last5 = Osawa | first5 = H. | last6 = Honda | first6 = S. | last7 = Kawata | first7 = H. | last8 = Kihira | first8 = K. | last9 = Sugano | first9 = K. | title = Aberrant expression of CDX2 in the gastric mucosa with and without intestinal metaplasia: effect of eradication of Helicobacter pylori. | journal = Helicobacter | volume = 7 | issue = 3 | pages = 192-8 | month = Jun | year = 2002 | doi = | PMID = 12047325 }}</ref> | |||
Others: | |||
*Lysozyme +ve - marks paneth cells.<ref name=pmid19918317>{{Cite journal | last1 = Rubio | first1 = CA. | last2 = Befrits | first2 = R. | title = Increased lysozyme expression in gastric biopsies with intestinal metaplasia and pseudopyloric metaplasia. | journal = Int J Clin Exp Med | volume = 2 | issue = 3 | pages = 248-53 | month = | year = 2009 | doi = | PMID = 19918317 }}</ref> | |||
==Sign out== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- BODY-TYPE MUCOSA WITH INTESTINAL METAPLASIA, FOCAL. | |||
- MINIMAL CHRONIC GASTRITIS (BODY OF STOMACH). | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- ANTRAL-TYPE MUCOSA WITH INTESTINAL METAPLASIA, EXTENSIVE. | |||
- MILD CHRONIC (ANTRAL) GASTRITIS. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- SUPERFICIAL GASTRIC MUCOSA WITH EXTENSIVE INTESTINAL METAPLASIA AND MODERATE | |||
CHRONIC INACTIVE INFLAMMATION. | |||
- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==See also== | |||
*[[Stomach]]. | |||
*[[Duodenum]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Stomach]] | |||
[[Category:Gastrointestinal pathology]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
Revision as of 20:29, 23 July 2013
Intestinal metaplasia of the stomach is a relative common finding that is associated with modest increased risk of gastric carcinoma.
It is also known as gastric intestinal metaplasia and may be abbreviated IM.
General
- Often part of surgical pathology report, e.g. "negative for intestinal metaplasia" or "intestinal metaplasia present".
- May be associated with Helicobacter spp. infection -- though Helicobacter don't like intestinal type mucosa, i.e. H. pylori are not typically found in regions with intestinal metaplasia.
- May be reversible - some epidemiological evidence.[1]
- Associated with gastric carcinomas of Lynch syndrome;[2] however, surveillance may not be worthwhile.[3]
Significance:
- Moderate risk increase for carcinoma; risk less than for Barrett's esophagus.[4]
- Odds ratio for corpus (~5.8x) higher than antrum (2.3x) when compared to individuals without IM.[5]
Gross/endoscopic
- +/-Erythema.
- Often associated with chronic gastritis.
Microscopic
Features:
- Goblet cells are present in the stomach - key feature.[6]
- In H&E sections the vacuole often stains light grey.
- Foveolar epithelium should be present in the same fragment.
- +/-Paneth cells - deep in the glands.[7]
- Very rarely present.
- Very uncommon in isolation.
Notes:
- Intestinal metaplasia (IM) is occasionally subdivided:[8]
- Complete IM = goblet cells and (intestinal) brush border.
- Incomplete IM = mucus vacuoles of various sizes, no (intestinal) brush border.
- Goblet cells metaplasia starts in the neck region of the gastric glands.[9]
DDx:
- Normal small bowel mucosa - no foveolar epithelium present.
- Gastric dysplasia, intestinal type.
Image:
Stains
- Alcian blue (pH 2.5)/PAS +ve.[10]
- Alican blue stain +ve.[citation needed]
Image:
IHC
- CDX2 +ve (-ve in normal stomach).[1]
- Strong assoc. with Helicobacter gastritis as well as IM.[13]
Others:
- Lysozyme +ve - marks paneth cells.[7]
Sign out
STOMACH, BIOPSY: - BODY-TYPE MUCOSA WITH INTESTINAL METAPLASIA, FOCAL. - MINIMAL CHRONIC GASTRITIS (BODY OF STOMACH). - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
STOMACH, BIOPSY: - ANTRAL-TYPE MUCOSA WITH INTESTINAL METAPLASIA, EXTENSIVE. - MILD CHRONIC (ANTRAL) GASTRITIS. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
STOMACH, BIOPSY: - SUPERFICIAL GASTRIC MUCOSA WITH EXTENSIVE INTESTINAL METAPLASIA AND MODERATE CHRONIC INACTIVE INFLAMMATION. - NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ 1.0 1.1 Walker, MM. (Jan 2003). "Is intestinal metaplasia of the stomach reversible?". Gut 52 (1): 1-4. PMC 1773527. PMID 12477745. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773527/. Cite error: Invalid
<ref>tag; name "pmid12477745" defined multiple times with different content - ↑ Cristofaro, G.; Lynch, HT.; Caruso, ML.; Attolini, A.; DiMatteo, G.; Giorgio, P.; Senatore, S.; Argentieri, A. et al. (Jul 1987). "New phenotypic aspects in a family with Lynch syndrome II.". Cancer 60 (1): 51-8. PMID 3581033.
- ↑ Renkonen-Sinisalo, L.; Sipponen, P.; Aarnio, M.; Julkunen, R.; Aaltonen, LA.; Sarna, S.; Järvinen, HJ.; Mecklin, JP. (May 2002). "No support for endoscopic surveillance for gastric cancer in hereditary non-polyposis colorectal cancer.". Scand J Gastroenterol 37 (5): 574-7. PMID 12059060.
- ↑ Correa P, Piazuelo MB, Wilson KT (March 2010). "Pathology of gastric intestinal metaplasia: clinical implications". Am. J. Gastroenterol. 105 (3): 493–8. doi:10.1038/ajg.2009.728. PMC 2895407. PMID 20203636. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895407/?tool=pubmed.
- ↑ Sakitani, K.; Hirata, Y.; Watabe, H.; Yamada, A.; Sugimoto, T.; Yamaji, Y.; Yoshida, H.; Maeda, S. et al. (Oct 2011). "Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration.". J Gastroenterol Hepatol 26 (10): 1570-5. doi:10.1111/j.1440-1746.2011.06767.x. PMID 21575058.
- ↑ URL: http://esynopsis.uchc.edu/eAtlas/GI/1280.htm. Accessed on: 16 August 2010.
- ↑ 7.0 7.1 Rubio, CA.; Befrits, R. (2009). "Increased lysozyme expression in gastric biopsies with intestinal metaplasia and pseudopyloric metaplasia.". Int J Clin Exp Med 2 (3): 248-53. PMID 19918317.
- ↑ Rugge, M.; Correa, P.; Dixon, MF.; Hattori, T.; Leandro, G.; Lewin, K.; Riddell, RH.; Sipponen, P. et al. (Feb 2000). "Gastric dysplasia: the Padova international classification.". Am J Surg Pathol 24 (2): 167-76. PMID 10680883.
- ↑ Stemmermann, GN.; Hayashi, T. (Sep 1968). "Intestinal metaplasia of the gastric mucosa: a gross and microscopic study of its distribution in various disease states.". J Natl Cancer Inst 41 (3): 627-34. PMID 4175677.
- ↑ Rivera-Hueto, F.; Lag-Asturiano, E.; Utrilla-Alcolea, JC.; Herrerías-Gutiérrez, JM. (Feb 2004). "Advanced gastric carcinoma with a complete intestinal metaplasia phenotype associated with early intestinal-type carcinoma.". Arch Pathol Lab Med 128 (2): 218-21. doi:10.1043/1543-2165(2004)128218:AGCWAC2.0.CO;2. PMID 14736279.
- ↑ Iida, F.; Kusama, J. (Dec 1982). "Gastric carcinoma and intestinal metaplasia. Significance of types of intestinal metaplasia upon development of gastric carcinoma.". Cancer 50 (12): 2854-8. PMID 7139576.
- ↑ Odze, Robert D.; Goldblum, John R. (2009). Surgical pathology of the GI tract, liver, biliary tract and pancreas (2nd ed.). Saunders. pp. 276. ISBN 978-1416040590.
- ↑ Satoh, K.; Mutoh, H.; Eda, A.; Yanaka, I.; Osawa, H.; Honda, S.; Kawata, H.; Kihira, K. et al. (Jun 2002). "Aberrant expression of CDX2 in the gastric mucosa with and without intestinal metaplasia: effect of eradication of Helicobacter pylori.". Helicobacter 7 (3): 192-8. PMID 12047325.