Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.

Confusion and prospects for carcinogenesis of gastric adenoma and dysplasia: What is the correct answer currently?

There are differences in the diagnoses of superficial gastric lesions between Japan and other countries.In Japan,superficial gastric lesions are classified as adenoma or cancer.Conversely,outside Japan,the same lesion is classified as low-grade dysplasia(LGD),high-grade dysplasia,or invasive neoplasia.Gastric carcinogenesis occurs mostly de novo,and the adenoma-carcinoma sequence does not appear to be the main pathway of carcinogenesis.Superficial gastric tumors can be roughly divided into the APC mutation type and the TP53 mutation type,which are mutually exclusive.APC-type tumors have low malignancy and develop into LGD,whereas TP53-type tumors have high malignancy and are considered cancerous even if small.For lesions diagnosed as category 3 or 4 in the Vienna classification,it is desirable to perform complete en bloc resection by endoscopic submucosal dissection followed by staging.If there is lymphovascular or submucosal invasion after mucosal resection,additional surgical treatment of gastrectomy with lymph node dissection is required.In such cases,functionpreserving curative gastrectomy guided by sentinel lymph node biopsy may be a good alternative.

Endoscopic submucosal dissection of gastric adenomas using the clutch cutter

To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) using the clutch cutter (CC) (ESD-CC) for gastric adenoma (GA). METHODSFrom June 2007 to August 2015, 122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study. The CC was used for all ESD steps (marking, mucosal incision, submucosal dissection, and hemostatic treatment), and its therapeutic efficacy and safety were assessed. RESULTSBoth the en-bloc resection rate and the R0 resection rate were 100% (122/122). The mean surgical time was 77.4 min, but the time varied significantly according to tumor size and location. No patients suffered perforation. Post-ESD-CC bleeding occurred in six cases (4.9%) that were successfully resolved by endoscopic hemostatic treatment. CONCLUSIONESD-CC is a technically efficient, safe, and easy method for resecting GA.

Clinical features of gastric adenoma detected within 3 years after negative screening endoscopy in Korea

Background:Early detection and management of gastric adenoma are important for preventing gastric cancer.The present study aimed to evaluate the predictors of missed gastric adenoma on screening endoscopy in Korea and identify the risk factors associated with interval precancerous gastric lesions.Methods:All cases of gastric adenomas diagnosed via screening endoscopy between 2007 and 2019 were reviewed.Among them,those who had undergone endoscopy within 3 years were included in the present study.Missed gastric adenoma was defined as gastric adenoma diagnosed within 3 years after negative screening endoscopy.Results:In total,295 cases of gastric adenoma were identified.Of these,95(32.2%)were missed gastric adenoma cases(mean age,60.6 years;average interval between final and index endoscopies,12.6months);the remaining 200(67.8%)were newly detected adenoma cases.Univariate analysis revealed thatmale sex,endoscopist experience,observation time,and presence of gastric intestinalmetaplasia(pathologically proven)were associated with missed gastric adenoma.Multivariate analysis revealed that gastric intestinal metaplasia(odds ratio[OR],2.736;95%confidence interval[CI],1.320–5.667;P=0.007)and shorter observation time of the index screening endoscopy(B,0.011;OR,0.990;95%CI,0.986–0.993;P<0.001)were independent risk factors for missed gastric adenoma.The optimal cut-off for the observation time for detecting gastric adenoma was 3.53minutes(area under curve,0.738;95%CI,0.677–0.799;P<0.001).Conclusions:Gastric intestinal metaplasia is an indication of missed gastric adenoma.Therefore,careful inspection of gastric mucosa with gastric intestinal metaplasia and proper observation time can lower the possibility of missing the gastric adenoma during screening.

Oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor: A case report

Gastric adenocarcinoma is one of the most common malignancies worldwide.Histochemical and immunohistologic analyses classify the phenotypes of gastric adenocarcinoma into several groups based on the variable clinical and pathologic features.A new and rare variant of gastric adenocarcinoma with chief cell differentiation(GA-CCD)has recently been recognized.Studies reporting the distinct clinicopathologic characteristics proposed the term oxyntic gland polyp/adenoma because of the benign nature of the GACCD.Typically,GA-CCD is a solitary mucosal lesion that develops either in the gastric cardia or fundus.Histologically,this lesion is characterized by tightly clustered glands and anastomosing cords of chief cells.Immunohistochemically,GA-CCD is diffusely positive for mucin(MUC)6 and negative for MUC2and MUC5AC.However,other gastric tumors such as a gastric neuroendocrine tumor or fundic gland polyp have been difficult to exclude.Because GA-CCD tends to be endoscopically misdiagnosed as a neuroendocrine tumor or fundic gland polyp,comprehensive assessment and observation by an endoscopist are strongly recommended.Herein,we report a rare case of oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor that was successfully removed by endoscopic mucosal resection.

Gastric dysplasia may be an independent risk factor of an advanced colorectal neoplasm

AIM: To evaluate the relationship between gastric dysplasia and Helicobacter pylori (H pylori) and the occurrence of colorectal adenoma, and to defi ne the necessity for colonoscopy in patients with gastric dysplasia or H pylori infection.METHODS: From May 2005 to February 2008, 133 patients with established gastric dysplasia by gastroduo-denoscopy (EGD) were additionally investigated by colonoscopy. The authors compared results with those of 213 subjects who underwent both EGD and colonoscopy during the same period at the author’s Health Promotion Center as a control group. H pylori infection was evaluated in both the gastric dysplasia and control groups.RESULTS: The mean age of all 346 study subjects was 54.1 ± 10.5 years, and there were 258 (73%) men and 87 (27%) women. No signif icant difference was found between the H pylori positive and negative subjects in terms of the prevalence of colorectal adenoma and advanced colorectal adenoma (P = 0.261). Patients with gastric dysplasia showed no elevated risk of colorectal adenoma (OR = 0.910, 95% CI: 0.587-1.411, P = 0.738), but had a signif icantly higher risk of having advanced colorectal adenoma (OR = 3.382, 95% CI: 1.700-6.342, P = 0.000).CONCLUSION: The study emphasizes the need for colon surveillance in patients with gastric dysplasia, regardless of H pylori infection.

Probe-based confocal endomicroscopy is accurate for differentiating gastric lesions in patients in a Western center

Objective： Probe-based confoeal laser endomicroscopy （pCLE） technique may improve the diagnosis of gastric mucosal lesions allowing acquisition of high-resolution in vivo images at the cellular and mierovaseular levels. This study aims to evaluate the accuracy of pCLE for the differential diagnosis of non-neoplastic and neoplastic gastric lesions.Methods： Twenty gastric mucosal lesions from 10 patients were evaluated during endoscopic procedure and were examined by pCLE. Diagnostic pCLE was followed by biopsies or endoscopic resection of suspected lesions. A senior pathologist evaluated the specimens and was blinded to the pCLE results.Results： Patients＇ mean age was 68.3 （range, 42-83） years and six were men. Thirteen suspicious flat or elevated lesions （classified as 0-Is, 0-IIa or 0-IIa ＋ IIc） and seven pre-malignant lesions （atrophy and intestinal metaplasia） were evaluated. One patient was studied during his long-term follow-up after partial gastrectomy and presented severe atrophy, intestinal metaplasia, and xanthomas at the stump mucosa. The location of gastric lesions was in the body （n=10 lesions）, the antrum （n=9） and the incisura angularis （n=1）. All neoplastic lesions and all but one benign lesion were properly diagnosed by pCLE. pCLE incorrectly diagnosed one small antrum lesion as adenoma, however the final diagnosis was intestinal metaplasia. The final histological diagnosis was neoplastic in 9 and benign lesions in 11. In this small case series, pCLE accuracy was 95% （19/20 lesions）.Conclusions： pCLE is accurate for real time histology of gastric lesions, pCLE may change the management of patients with gastric mucosal lesions, guiding biopsies and endoscopic resection, and avoiding further diagnostic workup or unnecessary therapy.

Endoscopic excision of a prolapsing malignant polyp which caused intermittent gastric outlet obstruction

A 69-year-old male with chronic lymphocytic leukemia presented with iron deficiency anemia and post-prandial abdominal fullness. Endoscopy showed a large polyp on a stalk, protruding through the pylorus into the duodenum causing intermittent gastric outlet obstruction. While prolapsing gastric antral polyps are usually benign and hyperplastic, inflammatory or regenerative in type, excisional snare polypectomy here led to complete resolution of his symptoms, but showed a malignant polyp.

Gastric Polyps in a Digestive Endoscopy Center in Dakar

Introduction: The gastric polyp is a tumor protruding into the gastric lumen. It is asymptomatic most often with a risk of malignant degeneration closely related to its histological nature. These data are very rare in Africa. Objectives: Reporting the frequency and endoscopic and histological characteristics of gastric polyps in the digestive endoscopy center of Aristide Le Dantec hospital in Dakar. Patients and methods: This was a retrospective study carried out in the digestive endoscopy center of Aristide Le Dantec Hospital in Dakar from January 2012 to December 2016. We have included all patients with one or more gastric polyps coupled with histological findings available. Results: There were 60 patients with gastric polyps, hence a prevalence of 0.8%. We included 37 patients. Their mean age was 46 years [21 years - 75 years]. The sex-ratio was 0.48. Epigastralgia was the most frequent endoscopic indication (51.3%). The polyp was unique in 26 patients (70.3%) with an average size of 6.87 mm [2 - 15 mm]. Polyps were sessile in 31 cases (83.8%) and pediculate in 6 cases (16.2%). They were most often in the antrum (51.4%). Antral erosions (13.5%) and fundic atrophy (13.5%) were the main associated endoscopic lesions. These were hyperplastic polyps in 27% of cases and adenoma in 16.2% of cases. Chronic atrophic gastritis (10.8%) and intestinal metaplasia (10.8%) were the main histological lesions associated with polyps. Helicobacter pylori (Hp) were present in 17 patients (45.9%). Conclusion: The prevalence of gastric polyps is 0.8% in the endoscopy center of Aristide Le Dantec hospital. They are usually hyperplastic or adenomatous.

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

Treatment strategies,whether as follow-up or"total incisional biopsy"for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen,are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment.Based on the histological findings of the biopsy specimen,it is difficult to differentiate between reactive or regenerative changes,inflammation and neoplastic changes,intraepithelial and invasive tumors.Therefore,gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and highfrequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection(ESD),a therapeutic option for gastric intraepithelial neoplasia,including low-grade neoplasms.Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.

High expression of APC is an unfavorable prognostic biomarker in T4 gastric cancer patients

BACKGROUND Adenoma polyposis coli(APC)mutation is associated with tumorigenesis via the Wnt signaling pathway.AIM To investigate the clinical features and mechanism of APC expression in gastric cancer(GC).METHODS Based on APC expression profile,the related genome-wide mRNA expression,microRNA(miRNA)expression,and methylation profile in GC,the relationship between APC and GC,as well as the prognostic significance of APC were systematically analyzed by multi-dimensional methods.RESULTS We found that high expression of APC(APC^high)was significantly associated with adverse outcomes of T4 GC patients.Genome-wide gene expression analysis revealed that varying APC expression levels in GC were associated with some important oncogenes,and corresponding cellular functional pathways.Genomewide miRNA expression analysis indicated that most of miRNAs associated with high APC expression were downregulated.The mRNA-miRNA regulatory network analysis revealed that down-regulated miRNAs affected their inhibitory effect on tumor genes.Genome-wide methylation profiles associated with APC expression showed that there was differential methylation between the APC^high and APC^low groups.The number of hypermethylation sites was larger than that of hypomethylation sites,and most of hypermethylation sites were enriched in CpG islands.CONCLUSION Our research demonstrated that high APC expression is an unfavorable prognostic factor for T4 GC patients and may be used as a novel biomarker for pathogenesis research,diagnosis,and treatment of GC.

胃底腺型肿瘤的内镜与病理学分析

目的探讨胃底腺型肿瘤胃泌酸腺腺瘤(oxyutic gland adenoma,OGA)和胃底腺腺癌(gastric adenocarcinoma of fundic gland type,GA-FG)的临床病理特征。方法回顾性分析2020年8月至2023年2月福建省肿瘤医院收治的6例胃底腺型肿瘤患者,分析其临床资料、内镜学特征、病理特征、免疫组织化学结果,治疗及预后情况。结果6例患者中男性1例,女性5例,平均年龄57岁。主要发生部位为胃底、胃体,以浅表隆起型多见。病理形态特点为胃底腺型肿瘤大多位于胃黏膜深层,表现为腺体结构紊乱,主要由主细胞型细胞构成。其中OGA 3例,GA-FG 3例。免疫组织化学表达结果为胃蛋白酶原重组人抗体1(pepsinogen 1)阳性5例,MUC65例,突触素(synaptophysin,Syn)阳性6例,嗜铬蛋白(chromogranin,CgA)均为阴性,肿瘤增殖标记物(Ki-67)<10%。结论OGA与GA-FG发病率低,无明显的内镜学特异性,如内镜医师认识不足,易误诊漏诊;免疫组织化学有助于鉴别诊断,首选内镜下黏膜切除或者剥离术治疗。

胃泌酸腺肿瘤49例临床病理学分析

目的:分析胃泌酸腺肿瘤的临床病理学特征。方法:选取2016年1月—2020年12月于山东大学第二医院确诊的49例胃泌酸腺肿瘤包括泌酸腺腺瘤(OGA)和胃底腺型腺癌(GA-FG)为研究对象,回顾性分析其临床资料、内镜表现、组织学特征、免疫表型并进行随访。结果:胃泌酸腺肿瘤的患者年龄19~83岁,平均(57.3±2.4)岁,男女比例为24∶25。病变主要位于胃体(27/49)和胃底(15/49)。内镜下有4种表现:扁平隆起型、息肉样、扁平型和凹陷型。部分病变可见扩张的树枝状血管。48例为单发,病变最大径平均为(3.9±0.5)mm(1.0~7.0 mm)。7例表现为黏膜下浸润,浸润深度均小于500μm。该肿瘤由密集的腺体吻合呈条索状,镜下呈不规则分支状、迷路状。该类肿瘤细胞分化好,形态类似于泌酸腺细胞,以主细胞为主,细胞核轻度增大,有轻微异型性,核分裂像少见。免疫标志物MUC6(100%)和Pepsinogen-Ⅰ(83%)呈弥漫性阳性,H+/K+-ATPase不同程度阳性(58%)。结论:泌酸腺肿瘤是一种新的胃肿瘤组织学类型,具有独特的临床病理特征,该类肿瘤发病率较低,预后良好,但仍需长期随访。

TFF3在胃癌、癌前病变及胃腺瘤中的表达及其与血管生成的关系

目的:分析三叶因子3(TFF3)在不同胃黏膜病变中的表达及其与间质微血管密度(MVD)值的关系,探讨其在胃癌、癌前病变及胃腺瘤发生、发展中的作用.方法:应用免疫组织化学PV6000法检测20例正常胃黏膜、20例胃腺瘤、20例萎缩性胃炎伴肠化生、20例不典型增生、40例胃癌组织中TFF3的表达,同时检测MVD值,以抗CD34标记.结果:TFF3在胃腺瘤、萎缩性胃炎伴肠化生、不典型增生和胃癌各组表达均高于正常组(50.0%,65.0%,70.0%,57.5% vs 5.0%,均P<0.01).胃癌MVD值高于正常胃黏膜、胃腺瘤、萎缩性胃炎伴肠化生和不典型增生(30.65±6.04 vs 14.87±3.06,22.33±3.78,23.16±3.20,25.22±4.66,均P<0.01),各组MVD值均高于正常胃黏膜组(均P<0.01).TFF3表达和MVD值与胃癌淋巴结转移和分期有关(均P<0.05),MVD值还与胃癌浸润深度有关(P<0.05).TFF3阳性表达组的MVD值明显高于TFF3阴性组(34.53±4.45 vs 25.39±3.25,P<0.01).结论:TFF3可能是胃黏膜癌变过程中的早期分子事件,在胃黏膜癌变和癌变后的恶性演进过程中起作用,对胃癌早期诊断和预测胃癌发生转移可能具有重要的提示作用.

HIF-1α基因转染人胃腺癌SGC7901细胞对裸鼠移植瘤的影响及机制

目的探讨低氧诱导因子(HIF)-1α基因转染人胃腺癌SGC7901对裸鼠移植瘤血管生成及Eph A2表达的影响及其可能机制。方法采用HIF-1α基因重组质粒p GCsish HIF-1α,转染胃腺癌SGC7901细胞并接种裸鼠(SGC7901/shRNA,实验组),建立裸鼠皮下人胃腺癌移植瘤模型,动态观测裸鼠肿瘤体积和质量;设SGC7901(未转染组)、转染空质粒的SGC7901(SGC7901/Neo,空载体组)为对照。观察移植瘤生长情况,8周后,获取移植瘤模型瘤组织,称取湿重,免疫组化SP法检测移植瘤组织的微血管密度,Western blot检测上皮细胞激酶A2(Eph A2)表达。结果与未转染组比较,空载体组瘤体积、质量改变不明显,HIF-1α转染的实验组的瘤体积、质量明显降低;HIF-1α转染的实验组诱导血管增生、形成血管生成拟态和Eph A2蛋白表达较未转染组组、空载体组明显降低(P<0.05,P<0.01)。结论 HIF-1α基因转染可明显抑制裸鼠人胃腺癌移植瘤的生长,该作用可能与其抑制肿瘤血管新生、形成血管拟态及Eph A2蛋白表达有关。

β-连环蛋白和APC蛋白在胃腺瘤和胃癌中的表达及意义

目的观察β-连环蛋白和家族性腺瘤样息肉病蛋白(adenomatous polyposis coli protein,APC蛋白)在正常胃黏膜、胃腺瘤和胃癌组织中的表达,探讨其在胃癌发生、发展中的作用。方法经胃镜活检病理检查证实的126例不同胃组织标本,包括40例正常胃黏膜、38例胃腺瘤性息肉(胃腺瘤)和48例胃腺癌组织,以免疫组化ABC法检测标本中中β-连环蛋白和APC蛋白的表达。结果正常胃黏膜、胃腺瘤、胃癌组织β-连环蛋白和APC蛋白异常表达率呈递增趋势,经两两比较,差异均有统计学意义(P<0.05)。胃癌组织中β-连环蛋白和APC蛋白具有显著相关性(r=1.0,P<0.05),胃腺瘤中两者无明显相关性(r=0.169,P=0.430)。结论β-连环蛋白和APC蛋白在胃癌的发生、发展中起重要作用,但两者在胃腺瘤中的相互作用及具体机制有待进一步研究。

抗胃腺癌免疫核糖核酸有效成分构象分析

本研究将NRNA、ATIRNA和ATIRNAⅠ～Ⅴ组份进行了抑癌活性对比分析,证实以ATIRNAⅠ、Ⅱ组份活性最强。继而用园二色谱仪对ATIRNAⅠ、Ⅱ组份进行了CD谱分析,参照SRNA、NRNA、ATIRNA和ATIRNAⅢ、Ⅳ、Ⅴ组份的CD谱分析。结果发现,ATIRNAⅠ、ⅡCD谱明显不同于其它各种RNA的CD谱;ATIRNAⅠ、Ⅱ的构象在低盐浓度条件下,兼有A、Z和其它型构象,具有较大分子柔顺性;在高盐浓度条件下会发生Z→A型构象转变;而其它各种RNA只呈单纯A型构象,分子刚性较强,在高盐浓度条件下有A→Z型构象转变趋势。

APC基因在胃癌、癌前病变及胃腺瘤中表达意义的研究

目的探讨APC基因在胃癌及胃腺瘤发生、发展中的重要作用以及在胃癌早期诊断中的意义。方法运用免疫组化技术检测APC基因蛋白在30例胃癌,30例不典型增生,30例肠上皮化生(肠化)和10例胃腺瘤,20例正常胃黏膜组织中的表达。结果①APC基因蛋白阳性表达率在胃腺瘤(50%),肠化(53.3%),不典型增生胃黏膜组织(40%)及胃癌(53.3%)中比正常胃黏膜(90%)明显降低(P<0.05)。中重度不典型增生APC表达率(47.1%)比轻度不典型增生(61.5%)低(P<0.05)。②APC表达率与胃癌是否有淋巴结转移有关(P<0.05)。结论APC基因的失活在胃癌的发生、发展中及胃腺瘤的发生中起重要作用。

APC基因在胃癌、癌前病变及胃腺瘤中表达意义的研究

目的探讨APC基因在胃癌、癌前病变及胃腺瘤发生、发展中的重要作用及其在胃癌早期诊断中的意义。方法运用免疫组织化学技术检测APC基因在30例胃癌、30例不典型增生、30例肠上皮化生、10例胃腺瘤和20例正常胃黏膜组织中的表达。结果APC基因阳性表达率，胃腺瘤为50．0％，肠上皮化生为66．7％，不典型增生为53．3％及胃癌为53．3％，均比正常胃黏膜的90．0％低（P均〈0．05）。中重度不典型增生APC基因阳性表达率为47．1％，比轻度不典型增生（61．5％）低（P〈0．05）。APC基因阳性表达率与胃癌是否有淋巴结转移有关（P〈0．05）。结论APC基因在胃癌的发生、发展中及胃腺瘤的发生中起重要作用。APC基因表达检测有助于早期胃癌的诊断。

西藏自治区藏族人群胃息肉样病变的临床、内镜及病理学特征分析

目的探讨西藏自治区藏族人群胃息肉样病变的临床、内镜及病理学特征。方法收集2016年1月至2018年12月在拉萨市人民医院经胃镜检查诊断的胃息肉样病变的病例,回顾性分析其性别,年龄,息肉的部位、数目、大小、山田分型、病理组织学分型,幽门螺杆菌(H.pylori)检测结果(13 C呼气试验)。结果拉萨市人民医院消化内科在2016年1月至2018年12月3年内共完成5312例胃镜检查,检出胃息肉患者119例(2.2%),其中藏族108例(纳入本次研究),汉族11例。藏族患者中男51例,女57例。胃息肉于胃窦、胃体、贲门胃底部最常见,分别为58.3%、22.2%、15.7%。96例(88.9%)患者为单发息肉,余12例(11.1%)为多发息肉。胃息肉的内镜下形态以山田Ⅰ型及Ⅱ型最多见,分别为47.2%和42.6%。息肉直径<0.5 cm者64例(59.3%),≥0.5 cm者44例(40.7%)。108例患者中的69例同时行13 C呼气试验,其中42例呈阳性(60.9%)。病变的组织学类型依次为增生性息肉(52.8%,57/108)、炎性息肉(34.3%,37/108)、腺瘤性息肉(10.2%,11/108)、胃底腺息肉(2.8%,3/108)。胃息肉的不同病理类型与息肉的部位(χ^(2)=23.180,P=0.001)、患者H.pylori感染情况(χ^(2)=8.062,P=0.029)具有相关性。结论西藏自治区藏族人群胃息肉好发于胃窦、胃体部,以单发为主,内镜下形态以山田Ⅰ型及Ⅱ型最常见,病理类型以增生性息肉及炎性息肉最常见,且胃息肉的病理类型与息肉的部位及患者H.pylori的感染状态相关。