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[Chronic gastritis and intestinal metaplasia].

Much has been written about gastric mucosae behavior and the occurrence of intestinal metaplasia. The aim of this paper is to learn something more about these matters in peruvian population. We selected 100 patients with endoscopically no localized lesions between 30 to 70 years of age. We took 8 samples of gastric mucosae in each patient which were carefully examined for the presence of inflammatory changes, settle the line type between antral and fundic mucosae and the frequency of intestinal metaplasia finding. The results showed disagreement between endoscopic and histological findings, so we conclude it is better to diagnose chronic gastritis on the basis of histological parameters. The line between antral and fundic mucosae was of the close type one found in 87% of all cases and it advanced proximally with increasing age. Intestinal metaplasia was present in 46% of the whole number of patients and the rate of occurrence increased in 50% over 50 years age. These findings will let us compare future investigations of gastric mucosae behavior with localized benign or malign lesions.

Adult↗

Thecal metaplasia in the adrenal gland of a man with acquired bilateral testicular atrophy.

Thecal metaplasia of the adrenal was observed as an incidental autopsy finding in a 77-year-old man with acquired bilateral testicular atrophy, probably secondary to previous bilateral inguinal herniorrhaphy. The metaplastic focus was composed of interlacing bundles of spindle cells attached to the adrenal capsule, strongly resembling ovarian theca. A related finding was hyperplasia of the anterior pituitary, involving particularly the basophils. We believe that the acquired gonadal failure of this man may have led to increased activity of the pituitary gonadotropes. Blastema cells outside of the testes with the ability to form gonadal stroma, such as cells of the adrenal capsule, were thereby stimulated to undergo metaplasia, giving rise to ovarian theca. Similar thecal metaplasia has been described previously in the adrenals of postmenopausal women. Whether the metaplastic foci are capable of hormone production is not known. Since this patient had an occult prostatic carcinoma at autopsy, potential hormone production by such metaplastic gonadal stroma is clinically relevant.

Adrenal Cortex↗

[Relationship between malignant transformation of ovarian mucinous cystadenoma and intestinal epithelial metaplasia].

Ninety cases of ovarian mucinous tumors were studied histologically and histochemically. Intestinal metaplasia was found in 48.2% (14/29) of benign. 73.6% (14/19) of borderline and 92.9% (39/42) of malignant mucinous cystadenomas. The differences between these three groups are statistically significant (P less than 0.01). Among 67 cases of intestinal metaplastic mucinous tumors, 43 contained argyrophil cells, and 36 contained argentaffin cells. The coexistence of intestinal metaplasic and uterocervical canal type epithelia was observed in 2/3 of borderline and 1/3 of malignant intestinal mucinous cystadenomas. In addition, there were 5 cases of borderline and 3 cases of malignant uterocervical canal type mucinous cystadenomas among the 90 cases. It is evident that the malignant transformation of ovarian mucinous cystadenoma was closely related to intestinal metaplasia. Anyhow, it seems not necessary for malignant transformation of all ovarian mucinous cystadenomas to pass through a stage of intestinal metaplasia: some of the malignant mucinous cystadenomas were considered probably originating from the uterocervical canal type epithelium.

Adenocarcinoma, Mucinous↗

A method of quantitating Paneth cell metaplasia of the stomach by image analysis.

Paneth cells are one of the histologic components of intestinal metaplasia of the stomach, as are mucin-producing goblet cells. With the aid of an image quantifier, the distribution of Paneth cells histochemically labeled with acid fuchsin was analyzed for a gastrectomy specimen containing an adenocarcinoma of the intestinal type; the topographic distribution of goblet cells histochemically labeled with Alcian blue (pH 2.5) was also analyzed. The specimen was cut into 63 blocks (0.5 X 4.0 cm) in four zones; antrum (zone I), intermediate region (zone II) and fundus (zones III and IV). Paneth cells were found only in sections containing mucin-producing goblet cells. Paneth cells were found in 12.5% of the 16 sections from the antral zone I containing Alcian blue-positive goblet cells. The rates were 44.4% for the intermediate zone II and 55.5% for the distal fundic zone III. The total area occupied by Paneth cells was significantly lower in the gastric mucosa as compared to the duodenal mucosa. The "Paneth cell index" (total Paneth cell area/total goblet cell area) was highest in the duodenum, followed by the distal fundic zone III. This method of quantitating Paneth cell metaplasia of the stomach will be used to investigate the topographic distribution of those cells in populations with low and high incidences of intestinal metaplasia.

Adenocarcinoma↗

Colonic metaplasia of ileostomies. Biological significance for ulcerative colitis patients following total colectomy.

Two patients who had undergone proctocolectomy for ulcerative colitis developed lesions in their ileal stoma that appeared to be inflammatory polyps morphologically similar to those encountered in the large intestine of ulcerative colitis patients. One of these patients eventually developed mucinous adenocarcinoma in the ileal stoma. The ileal mucosa adjacent to the neoplasm had morphologic features of large-bowel mucosa and was richly populated by sulfomucin-containing goblet cells, which are characteristic of large-bowel mucosa. Sulfomucin-containing goblet cells were also found in the inflammatory lesions biopsied from the ileal stomas of both patients, as well as from the adenocarcinoma found in one patient. These findings support the hypothesis that colonic metaplasia can occur in ileal stomas of ulcerative colitis patients. Furthermore, the metaplastic colonic tissue is the site of origin of lesions typically found in ulcerative colitis. Colonic metaplasia occurring in ileal stoma should be recognized by pathologists as a clinical entity. When colonic metaplasia is identified in the ileal stoma of an ulcerative colitis patient, biopsy surveillance of stomal mucosa is recommended.

Adenocarcinoma↗

The respiratory epithelium. VII. Epidermoid metaplasia of hamster tracheal epithelium during regeneration following mechanical injury.

Regeneration was studied in female Syrian golden hamster tracheal epithelium. The epithelium was focally removed in vivo by scraping it with a blunt probe. At 2 hours, virtually all cells had sloughed from the injured area leaving a bare basal lamina. At 6 and 12 hours, flattened cells that migrated from adjacent uninjured epithelium partially covered the denuded basal lamina. Increased cell division did not occur at these times. Many of the simple squamous cells contained well-developed endoplasmic reticulum, Golgi apparatus, and mucous granules. Other cells resembled basal cells. At 24 hours the defect was covered by one or two layers of simple squamous cells. At that time, many of those cells were in division, and cell division was also greatly increased in mucous cells and basal cells in the uninjured epithelium distant from the defect. At 48 hours the epithelium was stratified, composed of four or five layers of polygonal to flattened cells, typical of nonkeratinizing epidermoid metaplasia. The cells contained many tonofilament bundles, a large Golgi apparatus, and many tiny mucous granules. Mitoses were seen in all cell layers. At 72 hours, the surface layer of cells was undifferentiated (indifferent cells) overlying an epithelium that otherwise retained its epidermoid character. Indifferent cells were characterized by an electron-lucent cytoplasm and a lack of tonofilament bundles, mucous granules, or cilla. Cells similar in other respects to indifferent cells were seen that possessed mucous granules or early signs of cilla formation. Some cells showed mucous granules and cilla developing in the same cell. By 96 hours, the regenerated epithelium was fully differentiated and was indistinguishable from the normal epithelium. These observations show that mucous cells have a significant role in the regenerative response. Mucous cells have a dual potential; they can undergo epidermoid metaplasia and still retain the ability to secrete mucus. The study explains the universal occurrence of mucosubstances in areas of epidermoid metaplasia and makes more understandable the previously reported fact that many bronchogenic carcinomas are combined epidermoid and adenocarcinomas. In the presence of a carcinogen, the hypothesis has been forwarded that initiation of mucous cells and basal cells occurs, which leads to malignant transformation and produces tumors that show active secretory activity and keratinization, often in the same cell.

Animals↗

Intestinal metaplasia as a common option of oval cells in relation to cholangiofibrosis in liver of rats exposed to 2-acetylaminofluorene.

Oval cell proliferation in the liver was studied in rats exposed to dietary 2-acetylaminofluorene for 2 weeks with partial hepatectomy performed midway at 1 week. Using autoradiography after either continuous or pulse exposure to [3H]thymidine, histochemical staining for leucine aminopeptidase and gamma-glutamyltransferase, and transmission electron microscopy, we found that every animal showed islands of oval cells with small intestinal metaplasia at 3 weeks. Transitions from these islands of metaplasia to cholangiofibrosis were commonly seen. The importance of small intestinal metaplasia of oval cells in the genesis of cholangiofibrosis is presented and discussed.

2-Acetylaminofluorene↗

Improvement in bronchial squamous metaplasia in smokers treated with folate and vitamin B12. Report of a preliminary randomized, double-blind intervention trial.

To test whether changes in folate and vitamin B12 nutrition modify the severity of potentially premalignant lesions identified by cytology in sputum samples of smokers, we conducted a randomized, controlled prospective intervention trial in smokers with bronchial squamous metaplasia. Seventy-three men with a history of 20 or more pack-years of cigarette smoking who had metaplasia on one or more sputum samples were stratified according to smoking level and randomly assigned to four months' treatment with either placebo or 10 mg of folate plus 500 micrograms of hydroxocobalamin. Direct cytological comparison of the two groups after four months showed significantly greater reduction of atypia in the supplemented group. This provides preliminary evidence that atypical bronchial squamous metaplasia may be reduced by supplementation with folate and vitamin B12. However, the significance of these findings is tempered by substantial spontaneous variation in sputum cytologies, the small study population, the short duration of the trial, and the supraphysiological doses of folate and B12 used. The results should not be construed as pointing to a potential way of preventing lung cancer in individuals who continue to smoke or as supporting self-medication with large doses of folate or B12 by smokers.

Bronchi↗

Regression of bronchial epidermoid metaplasia in heavy smokers with etretinate treatment.

Forty heavy-smoker (over 15 packets per year) volunteers were selected for and have completed a 6-month etretinate treatment on the basis of an index of metaplasia (IM) greater than 15% determined according to the following procedure: bronchoscopy with systematic biopsies in ten sites of the bronchial tree. Each biopsy was cut into ten sections and an IM was calculated: IM = number of sections with epidermoid metaplasia/number of sections examined X 100. Etretinate, a retinoid derivative, was given orally at the daily dose of 25 mg, at the end of which patients underwent a second fibroscopy protocol. A highly significant reduction of IM (P = 10(-5)) was observed after 6 months of treatment for those of the patients who maintained their smoking habits during treatment. Besides, the four patients who stopped smoking while under treatment and are excluded from the statistical analysis all had a complete regression of metaplasia at the second fibroscopy. No morbidity was due to etretinate or fibroscopy. Etretinate significantly reduces potentially precancerous bronchial epidermoid metaplasia in heavy smokers. Its association with smoking arrest may induce a rapid restoration of bronchial epithelium to normal.

Carcinoma, Squamous Cell↗

Correlation of bronchial epidermoid metaplasia with level of tobacco consumption in heavy smokers.

One hundred forty-four heavy-smoker (125 males, 19 females) volunteers with at least 15 packet-year of smoking experience (number of daily packets of cigarettes X number of years of smoking) underwent bronchoscopy with systematic biopsies in ten sites of the bronchial tree. No morbidity was related to the fibroscopy procedure. Each biopsy was cut into ten sections and an index of metaplasia (IM) was calculated: IM = number of sections with epidermoid metaplasia/number of sections examined X 100. A highly significant statistical correlation was observed (P = 10(-4)) between the IM and the amount of cigarettes smoked (slope of the curve: 0.23). Sex appeared to play an important role in the incidence of metaplasia, since 84% of the examined females had an IM less than 15% versus 48% of the males (P adjusted for individual tobacco consumption in packet-years less than 0.01). Early study of HLA phenotype (locus A) failed to detect a link between HLA and risk of tobacco-induced epidermoid metaplasia.

Epidermal Cells↗

Juvenile onset pernicious anemia, partial intestinal villous atrophy, ulcerative colitis, and squamous metaplasia of the stomach.

We report a case of a 13-yr-old white boy with juvenile onset pernicious anemia in association with IgG deficiency. He had marked gastric atrophy, intestinal metaplasia of the stomach, and an intractable antral ulcer that required surgery. In addition, his gastric mucosa showed evidence of a progressive squamous metaplasia. Diffuse squamous metaplasia of the stomach, a very rare gastric lesion, has not previously been described either in association with pernicious anemia, atrophic gastritis, or hypogammaglobulinemia. This patient also has ulcerative colitis involving the entire colon and partial villous atrophy noted on small intestinal biopsy.

Anemia, Pernicious↗

Regression of bronchial epidermoid metaplasia in heavy smokers with etretinate treatment.

40 voluntary heavy smokers (over 15 packets-years) were selected for and have completed a six months etretinate treatment on the basis of an index of metaplasia (IM) greater than 15% determined according to the following procedure: bronchoscopy with systematic biopsies in 10 sites of the bronchial tree. Each biopsy was cut into 10 sections and an IM was calculated: (Formula: see text). Etretinate, a retinoid derivative, was given orally at the daily dose of 25 mg, at the end of which they underwent a second fibroscopy protocol. A highly significant reduction of IM (p = 10(-5)) was observed after 6 months of treatment for those of the patients who maintained their smoking habits during treatment. Besides, the 4 patients who stopped smoking while under treatment and are excluded from the statistical analysis, all had a complete regression of metaplasia at the second fibroscopy. No morbidity was due to etretinate or fibroscopy. Etretinate significantly reduces potentially precancerous bronchial epidermoid metaplasia in heavy smokers. Its association with smoking arrest may induce a rapid restoration of bronchial epithelium to normal.

Carcinoma, Bronchogenic↗

Squamous metaplasia of the trigone in women with recurrent cystitis syndrome.

Urocystic mucosal biopsies of the white patch on the trigone in 44 women complaining of dysuria and frequency with or without bacteriuria showed varying degrees of squamous metaplasia as well as submucosal fibrosis. The patients with more frequent episodes of such symptoms in the past had more severe squamous metaplasia with submucosal fibrosis. Introital bacteria were found in almost all patients with mild or moderate development of squamous metaplasia, but not in those with severe lesions. These facts suggest that introital bacteria may be one of the causative factors for the initiation and early development of these abnormal mucosal changes. However, the further progression to severe mucosal alteration seems to be independent of any bacteria and this severe mucosal alteration may result in recurrence of such symptoms.

Adolescent↗

Squamous metaplasia of the opening of bronchial glands.

The major bronchi of swine, a dog and rabbits were examined with a scanning electron microscope and the fine structure of the openings of bronchial glands were studied three-dimensionally. The smallest areas of squamous metaplasia involved the duct openings. By examining serial sections with the light and transmission electron microscopes these early lesions were found localized at the opening of the bronchial gland duct. Cells intermediate to goblet and squamous cells were present in these lesions. Squamous metaplasia starting at this particular location is probably common and metaplasia can be an intracellular process.

Animals↗

Induction of intestinal metaplasia and carcinoma in the glandular stomach of rats by N-alkyl-N'-nitro-N-nitrosoguanidines.

Induction of intestinal metaplasia and carcinoma of the stomach in Wistar rats by four homologs of N-alkyl-N'-nitro-N-nitrosoguanidine (N-alkyl-NNG) was investigated. N-Propyl-, N-butyl, N-isobutyl, and N-pentyl-NNG's were administered to rats as 0.34mM solutions in the drinking water for 12 months and the rats were killed about 6 months later. Intestinal metaplasia was found in the glandular stomach of 100%, 50%, 44%, and 17% of the rats treated with N-propyl-, N-butyl-, N-isobutyl-, and N-pentyl-NNG's, respectively. Adenocarcinoma of the glandular stomach was found in 29% of the rats treated with N-propyl-NNG, but not in those treated with other N-alkyl-NNG's. In the control group, 11% of the rats had intestinal metaplasia but none had tumors.

Adenocarcinoma↗

Endocrine cells in the intestinal metaplasia of gastric mucosa.

Sections of gastric mucosa removed during surgery for cancer or peptic ulcer and containing regions of intestinal metaplasia were studied by the immunofluorescence technique using several antiserums against intestinal hormones. Endocrine cells such as cells containing somatostatin, glicentin (gut GLI-I), motilin, and probably cholecystokinin were found within metaplastic intestinal epithelium while secretin and neurotensin, which are present in the normal intestinal mucosa, were not detected in metaplastic epithelium. The endocrine-cell population present in the intestinal metaplasia resembles that found in the cryptal region of the normal small intestine, a finding in accordance with the fact that intestinal metaplasia of gastric mucosa usually reproduces structural and histochemical characteristics of small intestinal crypts.

Adult↗

[Histochemical differential diagnosis of intestinal metaplasia of the stomach--new sialic acid stains].

tients with precancerous lesions of the stomach should be followed regularly, since the prognosis of gastric carcinoma is still rather bad. A histochemical method implaying the use of sialic acid is described, which allows differentiation of two forms of intestinal metaplasia of the gastric mucosa, exhibiting possibly different degrees of premalignancy . The two types of metaplastic areas produce, respectively, duodenum-like or colon-like goblet cell mucus. Probably only the latter type is to be classified as a premalignant lesion. This hypothesis is being supported by the fact, that during histochemical work-up of routine biopsy material of gastric mucosa intestinal metaplasia of the colon type was found only in two out of twenty cases of metaplasia.

Biopsy↗

Types of mucosal metaplasia in relation to the histogenesis of gastric carcinoma.

One hundred thirty-nine surgically resected stomachs and 16 stomachs obtained at necropsy in China were studied histochemically to evaluate the types and distribution of mucosal metaplasia in relation to benign and malignant disease. Three classes of mucin were distinguished: small-intestinal (N-acylated sialomucin); colonic (sulfated and O-acylated sialomucin); and gastric (neutral mucin). Small-intestinal type of metaplasia (SIM) occurred in 95% of instances of atrophic gastritis, 36% of cases of superficial gastritis, 60% of cases of gastric ulcers, and 39% of cases of duodenal ulcers. Colonic type of metaplasia (CIM) was less common and was found in only 11% of benign lesions. It was located in the antrum, particularly on the lesser curvature. Mucin was present in 66 of 84 carcinomas. The stomach tumors fell into three histochemical groups: colonic (acid mucin), 32; gastric (neutral mucin), 19; and mixed (acidic and neutral), 15. In 94% (30/32) of colonic type of gastric carcinoma, CIM was present. Thus, CIM is related to development of colonic type of gastric carcinoma, whereas SIM is a nonspecific reaction to mucosal damage.

Adolescent↗