Difference between revisions of "Intestinal metaplasia of the stomach"

From Libre Pathology
Jump to navigation Jump to search
(redirect w/ cat.)
 
(split out)
Line 1: Line 1:
#redirect [[Stomach#Intestinal metaplasia of the stomach]]
'''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

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:

Image:

Stains

  • Alcian blue (pH 2.5)/PAS +ve.[10]
    • May be used to divide into complete (type I) and incomplete (type II).[11][12]
  • Alican blue stain +ve.[citation needed]

Image:

IHC

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. 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
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. URL: http://esynopsis.uchc.edu/eAtlas/GI/1280.htm. Accessed on: 16 August 2010.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.