Pathological disorders of the gastric mucosa surrounding carcinomas and primary lymphomas

OBJECTIVE: Gastritis, intestinal metaplasia, atrophy, and dysplasia are dis orders that frequently precede the full development of gastric adenocarcino ma. On the other hand, primary gastric lymphomas seem to arise from mucosa- associated lymphoid tissue. It is well accepted that these histological cha nges are caused by Helicobacter pylori infection. The objective of this stu dy is to determine the frequency and characteristics of epithelial and lymp hoid tissue disorders of the gastric mucosa surrounding primary carcinomas and lymphomas. METHODS: We studied 111 gastrectomies from patients harboring primary adeno carcinomas (30 intestinal and 30 diffuse type) and 51 gastric lymphomas. Fo r comparative purposes, we analized 86 stomachs from patients who died of d iseases other than gastric malignancies. Histopathological disorders of the gastric mucosa adjacent to primary neoplasms such as atrophy, intestinal m etaplasia, and dysplasia were recorded. Lymphoid follicles were classified in two groups, with or without expansion. Expansion was characterized by in creased size, irregular borders, enlarged marginal zone, and expanded germi nal centers. Differences were statistically evaluated with chi (2) and Fish er exact tests, odds ratio, and relative risk, with 95% CI. p values <0.05 were considered statistically significant. RESULTS: Most intestinal-type adenocarcinomas showed atrophy (76.6%) and in testinal metaplasia (86.6%) and less frequently, dysplasia (23.3%), in the surrounding gastric mucosa. Expansive lymphoid follicles were more frequent among lymphomas than in adenocarcinomas (56.8% vs 25%); however, a high pe rcentage of lymphomas were also associated with atrophy (50.9%), intestinal metaplasia (62.7%), and rarely dysplasia (11.8%). On the contrary, diffuse -type adenocarcinoma displayed less frequently atrophy (33%), intestinal me taplasia (50%), and dysplasia (3%). Gastric mucosa from patients without an y gastric neoplasia was almost normal (84%), whereas the remaining 16% show ed, both or alone, atrophy and intestinal metaplasia. CONCLUSION: Histopathological disorders of the gastric mucosa are not speci fic for any neoplasm, but intestinal-type adenocarcinomas frequently showed atrophy, intestinal metaplasia, and not uncommonly, dysplasia of the surro unding non-neoplastic gastric mucosa. Diffuse-type adenocarcinomas did not frequently show such lesions. Primary lymphomas displayed expansive lymphoi d follicles and also a high percentage of atrophy and intestinal metaplasia of the surrounding gastric mucosa. The presence of intestinal metaplasia, atrophy, and lymphoid follicles with expansion in endoscopic biopsies could suggest a higher suceptibility for the development of gastric intestinal-t ype adenocarcinoma or gastric lymphoma. Patients harboring such histopathol ogical changes must receive eradication therapy against H. pylori and proba bly closer follow-up. (C) 2001 by Am. Cell. of Gastroenterology.