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KMID : 0390320140240010063
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Chungbuk Medical Journal
2014 Volume.24 No. 1 p.63 ~ p.73
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Diffuse-type adenocarcinoma arising in tubule neck dysplasia of the stomach
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Son Seung-Myoung
Lee Yong-Moon
Sung Ro-Hyun
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Abstract
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Purpose: Lauren classified gastric adenocarcinoma into intestinal and diffuse types. Intestinal-type epithelial dysplasia is a precursor to intestinal-type adenocarcinoma and the biological behavior of the former is relatively well-delineated. But the precursor lesion of diffuse-type adenocarcinoma is still ill-defined. Ghandur Mnaymneh, et al. reported tubule neck dysplasia of the stomach as a precursor to diffuse-type adenocarcinoma, though follow-up studies supporting their report are rare. We characterized three cases of diffuse-type adenocarcinoma arising in tubule neck dysplasia histologically and immunohistochemically.
Materials and Methods: Three cases of gastric resection specimens showing transition of tubule neck dysplasia into diffuse-type adenocarcinoma are studied for correlations between dysplasia and adenocarcinoma histologically and immunohistochemically using antibodies for tumor suppressor p53, adhesion molecule E-cadherin, intestinal mucin Muc-2 and gastric mucin Muc-5AC on paraffin-embedded formalin-fixed tissue.
Results: Tubule neck dysplasia shows atypical neck cells which occupy the gland-neck region and are confined within the basement membrane. The mucosal surface and the deeper glands are commonly spared. With increase in cellular atypism, the tumor infiltrates the lamina propria as a single cell or small cluster of tumor cells forming diffuse-type adenocarcinoma. The contiguous mucosa shows nonmetaplastic gastritis with elongated gland neck region without histologic and immunohistochemical evidence of intestinal metaplasia. Overexpression of p53 is not detected in both dysplasia and adenocarcinoma. Epithelial E-cadherin expression is decreased in dysplasia than in contiguous mucosa and markedly decreased in diffuse-type adenocarcinoma.
Conclusion: Down regulation of CDH1 gene rather than abnormal p53 plays a critical role in the pathogenesis of diffuse-type adenocarcinoma of the stomach. The mucosa contiguous to tubule neck dysplasia shows Helicobacter-associated chronic gastritis with elongation of the neck of the gastric crypt resulting in nodular hypertrophy of the antrum or hypertrophic rugae of the oxyntic mucosa. Tubule neck dysplasia is usually too small in size to be detected grossly or even microscopically. Follow-up of Helicobacter-associated chronic gastritis with nodular hyperplasia of the antrum or hypertrophic rugae of the oxyntic mucosa is recommended for prevention or early detection of diffuse-type adenocarcinoma.
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KEYWORD
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Gastric cancer, Diffuse-type, Adenocarcinoma, Tubule neck dysplasia, E-cadherin
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