Intestinal metaplasia of the stomach

Intestinal metaplasia of the stomach
	External resources
EHVSC	10167 (focal)

Intestinal metaplasia of the stomach
	Diagnosis in short
	; Intestinal metaplasia of the stomach. H&E stain.
LM	goblet cells with foveolar epithelium
LM DDx	contaminant from the duodenum, gastric dysplasia, gastric carcinoma, gastric heterotopia of the duodenum
Stains	alcian blue/PAS +ve
IHC	CDX2 +ve
Site	stomach
Associated Dx	gastric carcinoma, chronic gastritis, Helicobacter gastritis
Clinical history	+/-chronic gastritis
Endoscopy	+/-erythema
Clin. DDx	gastritis, gastric dysplasia

Intestinal metaplasia of the stomach is a relative common finding that is associated with a 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, possibly a contaminant from a concurrent duodenal biopsy.
Gastric dysplasia, intestinal type.
Gastric heterotopia of the duodenum.

Images

Stomach IM - intermed. mag. (WC)
Stomach IM - high mag. (WC)

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

Barrett's mucosa - Alcian blue stain. (WC)

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]

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Focal

Stomach, Antrum, Biopsy:
- Antral-type gastric mucosa with intestinal metaplasia (focal) and 
  moderate chronic inactive inflammation.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Block letters

STOMACH, BIOPSY:
- BODY-TYPE GASTRIC 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 GASTRIC MUCOSA WITH FOCAL INTESTINAL METAPLASIA AND MILD CHRONIC
  INACTIVE INFLAMMATION.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Extensive

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.

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/.
↑ 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.

[pmid12477745-1] 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/.

[pmid3581033-2] 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.

[pmid12059060-3] 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.

[pmid20203636-4] 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.

[pmid21575058-5] 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.

[pmid19918317-7] 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.

[pmid10680883-8] 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.

[pmid4175677-9] 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.

[pmid14736279-10] 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.

[pmid7139576-11] 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.

[pmid12047325-13] 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.

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