Gastric Foveolar Hyperplasia, Foveolar Dysplasia and Pit Dysplasia in 414 Gastric Cancers-Prevalence and Clinicopathological Significance
DY Park, HJ Kang, DH Shin, KU Choi, CH Lee, GY Huh, MY Sol, GY Lauwers. Pusan National University Hospital, Busan, Republic of Korea; Massachusetts General Hospital and Harvard Medical School, Boston, MA
Background: Despite wide acceptance of the gastritis-intestinal metaplasia-dysplasia-carcinoma sequence, especially in intestinal type gastric adenocarcinoma, the precise detailed nature of precursor lesions of gastric adenocarcinoma remains to be delineated. Gastric foveolar hyperplasia, fovoelar dysplasia and pit dysplasia are not well-defined and their prevalence and clinicopathological significances are unclear.
Design: On this background, we have evaluated gastric foveolar hyperplasia (thickening of mucosa as much as 1.5 times compared to adjacent gastric foveolar mucosa), foveolar dysplasia and pit dysplasia (dysplasia in pit with surface foveolar maturation) in 414 gastric cancers and investigated relationship between various clinicopathological features of gastric cancers and features of adjacent mucosa (extent of inflammation, atrophy, intestinal metaplasia).
Results: Of the 414 gastric cancers, 221 cases (53.4%), 105 cases (25.4%), 87 cases (21.0%) showed gastric foveolar hyperplasia, foveolar dysplasia and pit dysplasia in adjacent gastric mucosa, respectively. Gastric adenocarcinoma with foveolar hyperplasia were significantly associated with older age (p=0.000), male gender (p=0.000), body/fundic location (p=0.000), intestinal histologic type (p=0.000), advanced gastric cancer (p=0.008), lymphovascular tumor emboli (p=0.004), tendency of lymph node metastasis (p=0.062) and microsatellite instability (MSI-H) (p=0.042). Gastric adenocarcinoma with foveolar dysplasia and pit dysplasia were highly associated with older age (p=0.001, 0.002), male gender (p=0.028, 0.050), body/fundic location (p=0.000, 0.000), intestinal histologic type (p=0.000, 0.000). Interestingly, gastric mucin-containing intestinal metaplasia (incomplete IM) in adjacent mucosa was highly associated with gastric adenocarcinoma with gastric foveolar hyperplasia, pit dysplasia (p=0.000,0.000). Also muc6 expression of gastric adenocarcinoma has associated with association of pit dysplasia in adjacent mucosa phenotypes (p=0.036).
Conclusions: Taken together, we suggest that gastric fovolear hyperplasia, foveolar dysplasia and pit dysplasia are important candidate precursor of gastric adenocarcinoma, especially in intestinal type gastric adenocarcinoma and more detailed prospective studies are needed to determine precise clinical impact in clinical GI pathology routine practice.
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 59, Tuesday Afternoon