[Clinical and endoscopic findings and magnitude of gastric and duodenal reflux in patients with cardial intestinal metaplasia, short Barrett esophagus, compared with controls]

BACKGROUND

The diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years.

AIM

To assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia.

PATIENTS AND METHODS

A prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short Barret esophagus with intestinal metaplasia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content.

RESULTS

Control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. In patients with intestinal metaplasia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only seen in the presence of intestinal metaplasia. Gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia.

CONCLUSIONS

These findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of Barret esophagus and eventual dysplasia.

Metaplastic (infarcted) Warthin's tumour of the parotid gland: a possible consequence of fine needle aspiration biopsy

AIMS

The metaplastic (or infarcted) variant of Warthin's tumour is characterized by replacement of much of the original oncocytic epithelium by metaplastic squamous cells, along with areas of extensive necrosis, fibrosis and inflammatory change. The pathogenesis is unknown, but it is most likely to be vascular in origin. An association with a previous fine needle aspiration (FNA) has been suggested, and this is explored further.

METHODS AND RESULTS

Nine metaplastic Warthin's tumours were collected from several centres: all arose in the parotid gland, and all showed the characteristic histological features. Eight had previously undergone FNA some 1-4 months before surgery; the other case had had an incisional biopsy.

CONCLUSIONS

It is important to recognize metaplastic Warthin's tumour, because the differential diagnoses of this benign neoplasm include mucoepidermoid and squamous carcinoma, both primary and metastatic. The tumours in this study followed FNA or biopsy, and we believe this association is unlikely to be coincidental. Although many metaplastic Warthin's tumours clearly arise spontaneously, we conclude that the balance of probabilities favours the view that FNA is capable of causing metaplastic change in a Warthin's tumour, and may have done so in these cases. If so, this previously unusual subtype will become increasingly common, as FNA becomes more widely used (and its value appreciated) in the investigation of patients with a mass in the neck.

Mature bone metaplasia in abdominal wall scar

A 58-year-old man who had had three laparotomies for gastric surgery, developed a painful mass in the abdominal wall scar. Radiology confirmed bone formation in the scar. The bone was excised and the wound repaired. Histology confirmed metaplastic mature bone formation. This case draws the attention to the clinical condition of bone formation in midline scars. Clinically, it should be differentiated from scar recurrence following surgery for abdominal malignancy.

Stress: metaplastic effects in the hippocampus

Memory impairments, which occur regularly across species as a result of aging, disease and psychological insults (for example, stress), constitute a useful area for investigation into the neurobiological basis of learning and memory. Memory researchers have identified the hippocampus as a crucial brain structure involved in key aspects of memory formation. The most widely accepted putative mechanisms of memory storage in this structure are LTP and LTD. The hippocampus is enriched with receptors for corticosterone (a glucocorticoid hormone released in response to stress) and it plays a role in glucocorticoid negative feedback and, therefore, some hippocampal functioning might be particularly susceptible to stress. In support of this view, stress-induced modifications in learning, synaptic plasticity and endangerment of neurons have been seen in the hippocampus. Stress and glucocorticoids appear to exert a metaplastic effect through the modulation of Ca2+ levels. We propose a synaptic model that provides a conceptual scaffold to structure our understanding of the manifold actions of stress on the hippocampus. Accordingly, we suggest that stress-induced metaplasticity could disrupt Ca2+ homeostasis and thus endanger hippocampal neurons.

Nephrogenic adenoma in renal transplant recipients: a truly benign lesion?

OBJECTIVES

Nephrogenic adenoma is a benign metaplastic lesion of the urinary bladder, reported to occur as a response to inflammation, trauma, intravesical therapies, and after renal transplantation. The aim of this study was to evaluate on the basis of chromosomal analysis whether nephrogenic adenoma really is benign.

METHODS

Twelve renal transplant recipients with histologically verified nephrogenic adenoma were analyzed for numerical aberrations of chromosomes 7, 9, and 17. Results were related to total DNA content, p53 and Ki-67 positivity, and clinical outcome. Ten patients with superficial bladder cancer and 10 healthy renal transplant recipients formed the control groups.

RESULTS

All 12 patients with nephrogenic adenoma had monosomy 9 in a mean of 24.3% (range 20% to 30%) of the evaluated cells; 3 patients had an additional trisomy 7 in a mean of 8% (range 6% to 10%) of the counted cells. Chromosome 1 7 was disomic in all patients. DNA histograms were diploid in 11 of the 12 patients and aneuploid in 1 patient. No p53 and Ki-67 positivity was present in this group. All patients with superficial bladder cancer had monosomy 9 in a mean of 79.8% (range 75% to 85%) of the counted cells. Two patients were found to have an additional trisomy 7 in 50% and 65% of the cells, respectively. The latter had an aneuploid histogram; the others had haploid/diploid histograms. p53 was negative in all specimens. Ki-67 positivity was present in 70% of these patients. All healthy transplant recipients had disomic chromosomal patterns according to diploid DNA histograms and negative immunocytochemical results.

CONCLUSIONS

Even if in a lower percentage of cells, aberrations of chromosome 7 and 9 were detected in nephrogenic adenoma. It therefore cannot be excluded that nephrogenic adenomas in immunosuppressed renal transplant recipients may develop into malignant lesions.

Dietary vitamin A and prevalence of bronchial metaplasia in asbestos-exposed workers

The purpose of this investigation was to examine the association between dietary intake of vitamin A in the form of retinol and provitamin A carotenoids and the prevalence of bronchial squamous metaplasia in a sample of asbestos workers from an industrial clinic. Bronchial biopsies were obtained from 49 asbestos workers. Pulmonary function testing was done and in-person interviews were conducted to estimate dietary intake of retinol and provitamin A carotenoids, tobacco exposure, and asbestos exposure. Results indicated that workers with metaplasia reported consuming a significantly lower intake of total vitamin A [2000 retinol equivalents (RE)/d] than did subjects without metaplasia (2710 RE/d, P = 0.02). Logistic regression analyses showed that higher intakes of retinol [odds ratio (OR): 0.31; 95% CI: 0.04, 2.44], provitamin A carotenoids (OR: 0.31; 95% CI: 0.03, 2.84), and total vitamin A (OR: 0.29; 95% CI: 0.03, 2.49) were associated with a nonsignificant reduction in the OR for metaplasia (highest quartile compared with lowest quartile, adjusted ORs). Current smoking (OR: 5.25; 95% CI: 0.50, 55.1) and former smoking (OR: 2.95; 95% CI: 0.31, 28.1) were associated with a nonsignificant increase in the OR for bronchial metaplasia compared with never smoking. Greater airway obstruction [decreased forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)] was associated with an increased OR for metaplasia (OR: 2.86; 95% CI: 1.09, 7.69). These results suggest that a higher (ie, above the median) intake of vitamin A from foods decreases the risk of bronchial metaplasia in workers occupationally exposed to asbestos.

Osseous metaplasia in caecal adenocarcinoma

Images

Intestinal metaplasia at the gastro-oesophageal junction: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?

BACKGROUND

Intestinal metaplasia, whether in the cardia or the distal oesophagus, has been uniformly defined as specialised columnar epithelium, suggesting a relation with Barrett's oesophagus. It is, however, not clear whether the risk factors associated with intestinal metaplasia are identical at both sites.

AIMS

To investigate biopsy specimens obtained below the squamocolumnar junction (SCJ) in relation to endoscopic aspect, gastric histology, and clinical presentation.

PATIENTS AND METHODS

In 423 patients investigated the endoscopic aspect of the SCJ was classified as unremarkable (group I, n = 315) or suggestive of Barrett's oesophagus (group II, n = 108). Standardised biopsy specimens from the antrum, corpus, and directly below the SCJ were investigated.

RESULTS

Intestinal metaplasia was detected at the SCJ in 13.4% of group I patients, where it was significantly associated with gastric intestinal metaplasia (odds ratio (OR) 6.96; confidence interval (CI) 2.48 to 19.54) and H pylori (OR 7.85; CI 2.82 to 21.85), and in 34.3% of group II patients where it was significantly associated with reflux symptoms (OR 19.98; CI 6.12 to 65.19), erosive oesophagitis (OR 12.16; CI 3.86 to 38.24), and male sex (OR 6.25, CI 2.16 to 18.14), but not with H pylori or gastric intestinal metaplasia.

CONCLUSION

This study suggests that the pathogenesis of intestinal metaplasia at the SCJ is not uniform: at an endoscopically unremarkable SCJ it is a sequela of H pylori gastritis, but coexisting with endoscopic features of Barrett's oesophagus it is associated with male sex and gastro-oesophageal reflux disease.

Effects of azoxymethane on X-ray induced intestinal metaplasia in Donryu rats

The present study was undertaken to determine the effect of azoxymethane (AOM) administration on intestinal metaplasia induced by X-irradiation in male Donryu rats. Five-week-old animals were X-irradiated with two doses of 10 Gy each at a 3-day interval or three X-ray doses of 10 Gy at a 2-day interval and then received AOM injections i.m. at a dose of 15 mg/kg body weight once weekly for 3 weeks, 6 months after irradiation. Alkaline phosphatase positive foci were decreased after AOM treatments, but aberrant crypt like-foci appeared within areas of intestinal metaplasia. In contrast no induction was observed in normal-appearing gastric mucosa.

Tumour-simulating squamous cell metaplasia (SCM) in necrotic areas of salivary gland tumours

Squamous cell metaplasia (SCM) adjacent to necrotic areas of salivary gland tumours must be distinguished from other types of SCM (focal SCM in the excretory ducts of salivary glands; necrotizing sialometaplasia; focal SCM within salivary gland tumours) in respect to the tissue structure. Based on the high cellular proliferation, arcade- or cord-like pseudoneoplastic SCM develops with stellate extension in the surrounding tissue and focal inclusion of goblet cell metaplasia. This proliferative SCM resembles the cellular demarcation of radicular dental cysts. In the Salivary Gland Register 8 cases of tumor-simulating SCM could be analysed which clinically and morphologically were suspect of squamous cell or mucoepidermoid carcinoma. Five cases were localized in the parotid gland, 2 cases in the submandibular gland and 1 case in the palatinal glands. Tumour-simulating SCM was developed in pleomorphic adenomas (5 cases) and in multifocal adenomatous oncocytic hyperplasia (3 cases).

Eccrine squamous syringometaplasia in the skin of children after burns

We report 3 cases of severe burns in children in which eccrine squamous syringometaplasia (ESS) was found in skin biopsies taken 10 days after the trauma occurred. Microscopic examination showed partial or total necrosis of the epidermis, focal dermal necrosis and squamous metaplasia in eccrine ducts. These cases appear to be the first reported instances of ESS as an early consequence of severe burns.

Helicobacter pylori infection accelerates gene expression of glicentin in the gastric mucosa. Its association with intestinal metaplasia of the stomach

BACKGROUND

Glicentin is an intestinal polypeptide hormone which seems to promote intestinal metaplasia (IM) in the gastric mucosa. The aim of this study was to clarify whether Helicobacter pylori infection accelerates glicentin gene expression.

METHOD

Glicentin mRNA was investigated by reverse-transcription polymerase chain reaction using gastric biopsies from 47 patients examined endoscopically and denying IM.

RESULTS

IM was observed in 18 (38.3%) cases histologically, but not in the other 29 (62.7%). Glicentin mRNA was significantly correlated with histological IM (P < 0.01) and was positively correlated with H. pylori infection (P < 0.05).

CONCLUSION

Our results indicate that H. pylori infection is associated with the induction of glicentin in the gastric mucosa, thus supporting the hypothesis that H. pylori infection accelerates IM of the stomach.

Effects of radiation on the normal prostate gland

Prostate cancer is one of the commonest tumours of adult males. It shows a range of biological behaviour: many tumours are discovered incidentally; others will kill by producing widespread metastatic disease. Despite the fact that radiation is frequently used in the treatment of a range of pelvic lesions, including adenocarcinoma of the prostate itself, studies on the morphological changes in the normal prostate gland after irradiation are limited. This seems particularly surprising following the increasing use of needle biopsy specimens to assess the prostate. Patients who receive pelvic irradiation often suffer from lower urinary tract symptoms such as frequency and dysuria and it is possible that these may be related to prostatic and/or periprostatic injury. We therefore investigated the prostate glands removed at cystoprostatectomy for transitional cell carcinomas of the bladder which had received radiotherapy pre-operatively. The changes were compared to control prostatic tissue from transurethral resection specimens for benign myoadenomatous hyperplasia. We found a range of inflammatory, fibrotic and reactive cytological features, including many of the changes seen in benign hyperplasia, but these were significantly more exaggerated in the post-radiation group. In addition intraprostatic vascular and neural changes were prominent. This study documents radiation-induced changes throughout the normal prostate gland and neighbouring soft tissue and has particular importance in current pathological practice with the increasing and widespread use of needle biopsies in the diagnosis and follow-up of prostate cancer.

Evaluation of the Palmaz stent in the trachea and mainstem bronchi of normal dogs

OBJECTIVE

This study evaluates the efficacy of the Palmaz balloon expandable intraluminal stent in the trachea and mainstem bronchi of normal dogs.

STUDY DESIGN

Effects of the stent were evaluated by physical examination, thoracic radiography, respiratory tract fluoroscopy and endoscopy, tracheal diameter measurement, postmortem examination, and airway histomorphometry.

ANIMALS OR SAMPLE POPULATION

Ten normal beagle dogs.

METHODS

Stent size was estimated from thoracic radiographs in awake dogs. Group I dogs (n = 4) had two stents placed: one in the thoracic trachea (TT) plus a randomly chosen mainstem bronchus (MB). Group II dogs (n = 3) had stents placed in the MB (one stent), TT (one stent), and mid- or proximal cervical trachea (CT) (one or two stents). Three dogs were used as sham-operated controls (group III). Temperature, pulse, respiration, and cough were measured twice daily. Dogs were evaluated at 21 and 49 to 56 days after stent placement, euthanatized, and tissues were collected for histomorphometric analysis of stent integration and epithelial pathology.

RESULTS

Mean tracheal diameters of awake (10.5 +/- 1.7 mm) and anesthetized dogs before stent implantation (13.9 +/- 2.0 mm) were significantly different (P < .01). Complications associated with stent placement included acute pulmonary edema (n = 2), stent migration (n = 7), stent collapse (n = 4 CT, 2 TT, and 1 MB), and positive tracheal culture (n = 10). Group II dogs coughed more at rest, exercise, and with tracheal palpation than dogs in other groups (P < .01). Group I dogs coughed more at rest than group III dogs (P < .01). Stent integration ranged from 0 to 91.3%. Squamous metaplasia and epithelial ulceration associated with stents ranged from 0 to 57.5% and 0 to 32.7%, respectively.

CONCLUSIONS

Determination of stent size should be based on measurements taken on anesthetized dogs because use of inappropriately sized stents may promote stent migration, squamous metaplasia, and/or ulceration. Epithelialization over stent struts may occur if the stent is closely associated with tracheal epithelium.

CLINICAL RELEVANCE

Palmaz stents do not appear to be appropriate for placement in the CT of dogs; however, with technical modifications, application in the TT and MB may be feasible.

Atypical cartilage in reactive osteocartilagenous metaplasia of the traumatized edentulous mandibular ridge

Eighteen cases of reactive osteocartilagenous metaplasia of the edentulous mandibular alveolar ridge forming clinical masses that mimic neoplasms are reported. Although most of these lesions appeared histologically benign, three exhibited atypical microscopic features suggestive of chondrosarcoma. Of those cases that were followed, none of the lesions recurred after simple surgical excision. Because many investigators consider all cartilagenous lesions of the jaws potentially malignant, the importance of recognizing this benign condition is stressed.

[Study on the mutagenicity of salted pork from high risk area of stomach cancer and its relation to pathological changes of gastric mucosa]

To investigate the relations between salted pork (SP) from Zhuanghe (a high risk area of stomach cancer in northeast China) and stomach cancer three studies had been done, including the mutagenicity of SP, the effect of SP on the gastric mucosa of residents in Zhuanghe area who had consumed SP for 10-30 years and the mucosal lesions of dogs taking SP. The results showed that the extract of SP was a strong mutagen in strain TA98 and led to increased micro-nuclei rate (MNR) and micro-nuclei cell rate (MNCR) of V79 cell at a dose range of 20-80 mumol/ml. There were dose-effect relations between SP and MNR, MNCR. The results also indicated that pathological changes of gastric mucosa of residents who consumed SP had remarkable difference from those of the control group. In people who had consumed SP for 10 years, mucosal lesions including necrosis and erosion were seen; for those consumed SP for 10+(-)20 years, there were hyperplasia and dysplasia and those for 20+(-)30 years different degrees of dysplasia and even malignant change could be observed. The research also found that SP had damaging effect on gastric mucosa in dogs taking SP. The mucosal lesions became more severe with time of feeding SP. The conclusion is that SP is a strong mutagen, long-term exposure to SP may result in repeated gastric mucosal damage and repair, and finally in severe dysplasia and malignancy.

The reactions of euthyroid and hyperthyroid glands to radioactive iodine

BACKGROUND

Researchers generally assume that the thyroid gland reacts more or less comparably to external irradiation and radioactive iodine.

DESIGN

The thyroid glands from 20 euthyroid patients and 20 hyperthyroid patients, all of which had been treated with radioactive iodine, were studied.

RESULTS

The two groups manifested different reactions. Almost all the euthyroid glands displayed a fibrotic atrophic pattern, whereas the glands from the Graves' disease patients showed more adenomatous and Hashimoto lesions than atrophy.

CONCLUSION

Differences in the reactivity of normal and hyperplastic follicles may cause different reactions to treatment with radioactive iodine.

Gastric tumorigenicity of 1,2-dimethylhydrazine on the background of gastric intestinal metaplasia induced by X-irradiation in CD (SD) rats

Five-week-old male CD (SD) rats were X-irradiated with a total of 20 Gy in 2 equal fractions with a 3-day interval. After the second irradiation, rats were fed normal diet supplemented with 1% sodium chloride, which is known to increase intestinal metaplasia. 1,2-Dimethylhydrazine (DMH) solution was injected i.m. into the back musculature at a dose of 20 mg/kg body weight weekly for 10 weeks, beginning 20 weeks after the final irradiation. Twelve months after the initial carcinogen treatment, gastric tumors in the glandular stomach were observed in 2 (3 lesions) of 30 animals in the X-irradiated and DMH-treated group fed diet supplemented with 1% sodium chloride. No gastric tumors were observed in the group which excluded X-irradiation from the experimental protocol.

Gastric metaplasia of regenerating duodenal mucosa and deformity of duodenal bulb: a correlative study

The correlation between the presence and degree of gastric metaplasia of regenerating duodenal mucosa and the deformity of duodenal bulb was studied. Based on the endoscopically morphological patterns of bulb, the duodenal ulcers were divided into three types: type I, with a normal-shaped bulb; type II, with mildly deformed bulb; and type III, with a markedly deformed bulb. A total of 159 patients with active duodenal ulcers were scheduled to be treated with H2-receptor antagonists. Of these patients, 124 proved to have a healed duodenal ulcer 4 weeks after initial treatment upon follow-up endoscopic examinations. Two biopsies were taken from the centre of the ulcer scar when the ulcer was found to be healed for light microscopic study. Histologically, the degree of gastric metaplasia was divided into three grades: grades 0, 1 and 2. The results show that a healed duodenal ulcer with a normal-shaped bulb is not frequently accompanied by gastric metaplasia. However, a healed ulcer with a markedly deformed bulb has a high incidence and degree of gastric metaplasia, which may be easily colonized by Helicobacter pylori and thus develop an environment of easy recurrence. Therefore, a cycle of healing and recurrence may exist in patients with a duodenal ulcer and a markedly deformed bulb. Eradication of H. pylori may be the best way to break this cycle.

Nephrogenic metaplasia: long-term haemodialysis and anuria as potential risk factors and reversibility with renal transplantation

AIM

To determine the incidence of nephrogenic metaplasia in patients with defunctionalized bladders due to long-term end-stage renal failure on haemodialysis.

METHODS

From the dialysis registry of the Princess Alexandra Hospital 13 anuric patients who had been on haemodialysis for 10 or more years were identified. Of these, seven were currently awaiting renal transplantation and six had successful transplants. Endoscopic assessment of their lower urinary tracts was performed.

RESULTS

Three cases of nephrogenic metaplasia were identified. In one case this led to significant haematuria following transplantation. However, the changes of nephrogenic metaplasia disappeared over the subsequent 18 months without specific treatment.

CONCLUSIONS

It appears that a chronically defunctionalized bladder in the presence of end-stage renal failure is associated with an increased risk of nephrogenic metaplasia. These changes may spontaneously regress following transplantation and restoration of bladder function.

Intestinal metaplasia--its association with gastric cancer

Endoscopic gastric biopsies from 230 patients and post gastrectomy specimens of 18 patients were evaluated for the presence of intestinal metaplasia (IM) and its association with the gastric lesions. There were a total of 78 malignant and 170 benign lesions. IM was present in 53% of patients with gastric carcinoma (GC) and in 10.6% with benign lesions of the stomach. The IM in association with GC was of type 1 (Small Intestinal) in 58.8%; type II (mixed gastric and small intestinal) in 11.8% and type III (Colonic) in 29.4%. In patients with benign lesions the IM was predominantly of type I (94.5%) except in 1 patient who had type III metaplasia. Our findings indicate that type III IM was significantly more frequent in patient with GC than with benign lesions (29.4% Vs 5.5%; p < .005). Therefore we conclude that patients with type III IM should be kept on surveillance for GC.

Determinants for the development of chronic atrophic gastritis and intestinal metaplasia in the stomach

This study aimed to identify the factors associated with the development of gastric precancerous changes, in a prospective series of patients undergoing endoscopy. Risk factors and associated mucosal changes were evaluated in 134 endoscoped patients affected by chronic non-atrophic (n = 76) or atrophic gastritis (CAG) (n = 32), with or without intestinal metaplasia (IM), or lacking any major histological changes (n = 26). The following variables were taken into account: age, alcohol consumption, smoking habit, vitamin C intake (using a questionnaire), gastric juice vitamin C (HPLC on gastric juice samples obtained at endoscopy), H. pylori infection, gastric mucosa malondialdehyde (MDA; a measure of free radical production) and extent of CAG in gastric biopsies (only for IM). Tissue MDA levels were significantly higher, and vitamin C levels significantly lower in CAG and IM patients (P = 0.01). Multiple regression analysis showed significant correlations for: CAG vs age (P < 0.02), MDA (< 0.02) and gastric vitamin C (< 0.05); IM vs age (P < 0.0005), CAG (< 0.0005) and MDA (< 0.001). Using stepwise discrimination analysis, the independent variables included in the model were: for CAG, age (P < 0.003), MDA (< 0.05), gastric juice vitamin C (< 0.05); for IM, CAG (P < 0.0005), age (< 0.001), MDA (< 0.03) and vitamin C intake (< 0.05). H. pylori was not included. The major determinants for CAG and IM were age, free radical production (as measured by MDA), vitamin C (for CAG) and vitamin C intake and CAG (for IM).(ABSTRACT TRUNCATED AT 250 WORDS)