Displasia gastrica: su incidencia en condiciones preneoplascicas, cancer avanzado y cancer temprano

ABSTRACT

Dysplasia cancer sequence has not been determined in gastric cancer yet. Dysplastic changes are not frequent. Gastric cancer generally develops in areas of chronic atrophic gastritis. This chronic atrophic gastritis (CAG) is often associated with intestinal metaplasia (IM). IM has been classified in three types, according to morphologic patterns, differentiation and mucins production. We reviewed 55 gastrectomy specimes and 278 endoscopic biopsies. In order to determine an histological hight-risk group, we chose cases with preneoplastic conditions (60 CAG, 10 biopsies of gastric remmantes, 3 flat adenomas and 55 gastrectomies by cancer or ulcer). We also included 12 hyperplastic polyps because polyps because they may contain foci of intestinal metaplasia. Mucin techniques (PAS-ALCIAN BLUE Ph 2,5 and HID - A.B) were used in all cases that showed extensive intestinal metaplasia. In addition, we used immunohistochemistry teachniques to detect CEA. Dysplasia was found only in flat adenomas (3 cases), early gastric cancer (1 case) and advanced cancer (3 cases). We considered a preneoplastic lession only to moderate or severe dysplasia. Hyperplastic regenerative pathology is considered a reversible condition. Therefore, it should be defferentiated from dysplasia. We found that IM type III (sulfomucin predominance) is the most related to carcinoma, particulary to the intestinal type. CEA atingen is poorly specific in detecting high-risk lessions because it was seen in regenerative patology and in gastric cancer too. Relationship o f dysplasia and carcinoma, and/or neoplastic polyps was similar to other series