RESUMO
Background: Crawling-type gastric adenocarcinoma is a rare subtype of gastric cancer, however, the understanding on this special entity of gastric cancer is still lacking. Aims: To investigate the clinical, endoscopic and pathological characteristics of crawling-type early gastric adenocarcinoma. Methods: Patients diagnosed as crawling-type early gastric adenocarcinoma in Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2021 were recruited consecutively in a retrospective study. The clinical data were reviewed, the pathological specimens were collected for immunohistochemical staining, and a telephone follow-up was conducted for prognosis analysis. Results: Fourteen patients with crawling-type early gastric adenocarcinoma and fulfilling the inclusion criteria were enrolled in the study, of them, 9 were male, 5 were female, and the mean age was 65.9 years old. No family history of gastric cancer was reported. The clinical manifestations were not specific. All patients were positive for Helicobacter pylori (Hp) infection. Tumors were more likely to occur in the middle and lower thirds of the stomach, with marked atrophic background mucosa. Macroscopically, 11 lesions were superficial-depressed (0-IIc) and 3 were superficial-flat type (0-IIb+ IIc). The color of the lesions was red. Lesions with indistinct border were observed endoscopically in 10 cases. Complete resection was achieved in all 14 patients after endoscopic submucosal dissection n=10 or surgical treatment n=4. Three submucosal and 11 intramucosal infiltration were observed pathologically. Immunohistochemical results of gastric (MUC5AC and MUC6) and intestinal (MUC2, CD10 and CDX-2) markers showed that most of the patients were mixed immunophenotype; the Ki-67 index ranged mostly between 30% and 70%. In a mean follow-up time of 38 months, all 14 patients were survived. Two patients with heterochronous early gastric cancer were found by follow-up endoscopy. Conclusions: When a superficial-depressed or superficial-flat type tumor with reddish color change and atrophic background mucosa is observed endoscopically in an Hp-positive patient, the possibility of crawling-type early gastric adenocarcinoma should be considered. Adequate preoperative evaluation should be carried out to judge the extent and depth of tumor invasion, which may guide the decision of treatment strategy. Postoperative endoscopic surveillance is recommended.
RESUMO
BACKGROUND:Studies have shown that astrocytes participate not only in the passive metabolic and structural support, but also actively in the central nervous system information processing. OBJECTIVE:By observing the directionality and specificity of astrocyte fiber growth and synapse formation, to explore the possible mechanisms of astrocytes and neurons in the interaction. METHODS: Primary cels from the hippocampi of green fluorescent protein transgenic newborn mice were isolated and cultured, glial fibrilary acidic protein was used as specific marker for astrocytes in immunofluorescence staining, and then the results were observed and scanned by confocal microscope. RESULTS AND CONCLUSION:The elongation of astrocyte fibers was directional and specific, and terminated to the pyramidal cels nearby. The end of astrocyte fibers and pyramidal cels contributed to the synapse formation. However, not al the projections were toward the adjacent cels, and synapse-like structure was not only formed nearby. The results implicated that both astrocytes fiber elongation and synapse formation have the directionality and specificity, providing evidence for further studies on signal transduction between astrocytes and pyramidal cels.