Clinical significance of white gastric crypt openings observed via magnifying endoscopy

AIM:To evaluate the relationship between Helicobacter pylori(H.pylori)-induced gastritis and white gastric mucosal crypt openings(COs)in the gastric corpus.METHODS:A total of 175 consecutive patients(including 69 patients with gastric cancer)were enrolled in this study.We used magnifying endoscopy(ME)to observe the mucosa microsurface of the lesser and greater curvature of the gastric corpus(350 areas in all).We focused on areas with a round pit microstructure(primarily observed in non-atrophied areas)and evaluated the white openings of these gastric pits.We classified the whiteness of the COs as the"white-edged dark spot"type(consisting of a dark spot bordered by white);the"white"type(pure white with no dark spot);and the"dense white pit(DWP)"type(dense white,resembling a snowball).Gastritis was also histologically evaluated according to the updated Sydney System.RESULTS:We detected round COs using ME in 246 of the 350 areas examined.The histological examination showed significantly more mononuclear cells and neutrophil infiltration in the"white"and"DWP"types than the"white-edged dark spot"type(P<0.001).Furthermore,significantly high-grade inflammation and evidence of active H.pylori-induced gastritis was observed in the"DWP"type(P<0.001).Significant differences were observed in the whiteness of COs between H.pylori-positive(n=139)and negative(n=36)patients(P<0.001).The sensitivity and specificity of the"white"and"DWP"types for predicting H.pylori infection were78.5%and 81.7%,respectively.Of the patients with gastric cancer,22.5%(18/80)had"white-edged dark spots",51.3%(41/80)had"white"COs,and 26.3%(21/80)had"DWP"-type COs."DWPs"were frequently observed among patients with undifferentiated gastric cancer[45.7%(16/35)].CONCLUSION:CO whiteness detected via ME was associated with histological evidence of gastritis and helps to predict the severity of inflammation and H.pyloriinduced activity.

Bone formation in a rectal inflammatory polyp

Heterotopic bone formation(osseous metaplasia) is rarely detected in the gastrointestinal tract.Most of reported cases are associated with malignant lesions.We herein report a case of osseous metaplasia in a rectal inflammatory polyp and a review of the literature on suggested mechanisms for its aetiology.A 39-year-old man visited our hospital with a chief complaint of melena.Total colonoscopy revealed a slightly reddish subpedunculated polyp,about 12 mm in diameter,in the lower rectum.Endoscopic resection was performed.Histologically,several foci of heterotopic bone formation were found.From the review of the literature,all of the polyps described were larger than 10mm in diameter,55.6% showed inflammatory changes,and 62.5% were detected in the rectum.Osteogenic stimulation was considered to be a result of the inflammatory process.As our inflammatory polyp was located in the rectum,the pathogenesis could be a reactive change stimulated by the repeated local trauma,or be on a peculiar characteristic of the rectal mucosa itself.

Significance of EGFRGene Mutation in Fresh Cytological Specimens of Lung Adenocarcinoma

Objective:This paper aims to study the mutation of epidermal growth factor receptor(EGFR)gene in fresh cytological specimens from patients with lung adenocarcinoma,and to determine the prognosis of positive patients by tyrosine kinase inhibitor(TKI).Methods:A total of 313 specimens from needle aspiration and pleural effusion were collected in the Cancer Detection Center of the Fourth Hospital of Hebei Medical University.After HE and immunocytochemistry stainings,the specimens were diagnosed as lung adenocarcinoma by two cytology pathologists.The mutation of 18-21 exon was detectied using ARMS to observe mutations situation.Then,the objective response rate(ORR)and the progressionfree survival(PFS)between the targeted group and the chemotherapy group of patients were comparedith.Results:Among 313 cases,293 cases of lung adenocarcinoma were diagnosed,and DNA specimens were extracted from 288 cases.The success rate was about 98.3%.130 mutations were found and the rate was 45.1%.EGFR mutation of adenocarcinoma patients mainly occurred to females,nonsmokers,but had nothing to do with age.The ORR was statistically different between the targeted group with chemotherapy(P<0.01),and PFS curve of targeted group was on chemotherapy group.The efficacy and the survival time of targeted group and targeted and chemotherapy group were superior to that of chemotherapy group.The results of the EGFR mutation and the prognosis of the tested positive patients in the fresh cytology samples were consistent with that from previous literatures.Conclusion:The results of the test were accurate,and fresh cytological specimens can be used as a replacement for tumor tissue specimens.