Histological criteria of differential diagnostics of pre-cancer changes in the gastric mucosa

Abstract

Objective: to analyze the immunohistochemical and morphometric features of intestinal metaplasia, intraepithelial neoplasia and undefined gastric intraepithelial neoplasia. Materials and methods. During video gastroscopy using the video endoscopic system EVIS EXERA III with an Olympus 190 gastroscope (Japan), biopsy specimens of 40 patients with chronic atrophic gastritis were obtained. Immunohistochemical studies allowed the formation of groups: intestinal metaplasia (cell proliferation exclusively in the intestinal metaplasia growth zone), indefinite intraepithelial neoplasia (single cells in a state of proliferation in the foveolar zone of glands) and intraepithelial neoplasia (pronounced activation of proliferation, decreased apoptotic activity in the intestinal metaplasia growth zone). Morphometric indicators such as the nuclear-cytoplasmic ratio and nuclear ellipticity coefficient were also calculated. Results. It was found that in intestinal metaplasia, the ratio of Caspase-3 positive cells to Ki-67 positive cells approaches 1 in all zones, while the nuclear-cytoplasmic ratio significantly increases, and the ellipticity coefficient of the nuclei decreases. In cases of undetermined intraepithelial neoplasia, the proliferation / apoptosis index increases significantly in the surface-foveolar zone and the adjacent glands, but decreases in the growth zone of intestinal metaplasia, which indicates the activation of protective mechanisms outside the metaplastic zones. Similar changes, but more pronounced, took place with intraepithelial neoplasia. Nuclei pleomorphism, which is a sign of more severe structural changes in the gastric mucosa, was characterized by a reduced number of goblet cells in the foci of intestinal metaplasia, noticeable fluctuations in the average deviation of the diameter and area of the nuclei of epithelial cells. Mononuclear infiltration of the lamina propria was least likely to accompany intestinal metaplasia and, most often, vague intraepithelial neoplasia. Conclusions. The combined use of immunohistochemical and morphometric methods of research allowed us to develop histological criteria for the differential diagnosis of precancerous changes in the gastric mucosa, which will contribute to adequate monitoring of patients with atrophic gastritis. Key words: differential diagnosis, intestinal metaplasia, undefined intraepithelial neoplasia of the gastric mucosa, immunohistochemistry, morphometry, nuclear-cytoplasmic ratio, nuclear ellipticity coefficient.