Summary
A total of 217 cases of gastric intestinal metaplasia (IM), out of 491 cases of consecutive multiple gastric biopsies, were examined using various histochemical methods. Three classifications were adopted (1) Jass and Filipe's (1979), (2) Segura and Montero's (1983), and (3) our own distinguishing two types of small intestine IM (incomplete and complete) and two types of colonic IM (incomplete and complete). Our classification revealed (1) a group of ‘pure’ IM cases (44%), (2) a group of ‘combined’ IM cases (15%), either small intestinal or colonic, expressing a maturating line, and (3) a conspicuous group of mixed ‘mosaic’ IM cases (41%) consisting of all possible combinations between the basic IM types. No significant correlations were found between each IM type and associated diseases (i.e. gastritis, stump gastritis, ulcer, adenoma and adenocarcinoma). However, a suggestive association between colonic IM and malignancy was observed. Our results confirmed the heterogeneity of IM and indicated two differentiation cell lines (ileal and colonic), thus providing additional evidence of impaired maturation and aberrant differentiation along various cell lines, supporting Leblond's (1976) unifying theory on the origin of intestinal epithelial cells.
Similar content being viewed by others
References
Bara, J., Paul-Gardais, A., Loisillier, F. &Burtin, P. (1978) Isolation of a sulphated glycopeptide antigen from human gastric tumours: its localization in normal and cancerous gastrointestinal tissues.Int. J. Cancer. 21, 133–9.
Bara, J., Hamelin, L., Martin, E. &Burtin, P. (1981) Intestinal M3 antigen, a marker for the intestinal type differentiation of gastric carcinomas.Int. J. Cancer. 19, 634–41.
Correa, P. (1985–86) The nomenclature of gastric cancer precursors. A guided tour to the tower of Babel.GIPC Newsletter.Fall-Winter, 15–18.
Culling, C. F. A., Reid, P. E. &Dunn, W. L. (1971) The effect of saponification on certain histochemical reactions of the epithelial mucins of the gastrointestinal tract.J. Histochem. Cytochem. 19, 654–62.
Culling, C. F. A., Reid, P. E., Burton, J. D. &Dunn, W. L. (1975) A histochemical method of differentiating lower gastrointestinal tract mucin from other mucins in primary or metastatic tumours.J. Clin. Pathol. 28, 656–8.
Ectors, N. &Dixon, M. F. (1986) The prognostic value of sulphomucin positive intestinal metaplasia in the development of gastric cancer.Histopathology 10, 1271–7.
Filipe, M. I. &Lake, B. D. (1983)Histochemistry in Pathology. App. 3, pp. 310–3. Edinburgh, London, New York: Churchill Livingstone.
Filipe, M. I. &Jass, J. R. (1986) Intestinal metaplasia subtypes and cancer risk. InGastric Carcinoma. (edited byFilipe, M. I. &Jass, J. R.) pp. 87–115. Edinburgh, London, New York: Churchill Livingstone.
Filipe, M. I., Potet, F., Bogomoletz, W. V., Dawson, P. A., Fabiani, B., Chauveinc, P., Fenzy, A., Gazzard, B., Goldfain, D. &Zeegen, R. (1985) Incomplete sulphomucin-secreting intestinal metaplasia for gastric cancer. Preliminary data from a prospective study from three centres.Gut 26, 1319–26.
Huang, C. B., Xu, J., Huang, J. F. &Meng, X. Y. (1986) Sulphomucin colonic type intestinal metaplasia and carcinoma in the stomach. A histochemical study of 115 cases obtained by biopsy.Cancer 57, 1370–5.
Jass, J. R. (1987) Intestinal metaplasia and gastric cancer. (letter)Histopathology 11, 881.
Jass, J. R. &Filipe, M. I. (1979) A variant of intestinal metaplasia associated with gastric carcinoma: a histochemical study.Histopathology 3, 191–9.
Jass, J. R. &Filipe, M. I. (1980) Sulphomucins and precancerous lesions of the human stomach.Histopathology 4, 271–9.
Jass, J. R. &Filipe, M. I. (1981) The mucin profiles of normal gastric mucosa, intestinal metaplasia and its variants and gastric carcinoma.Histochem. J. 13, 931–9.
Lapertosa, G., Baracchini, P., Catalano, M., Fulcheri, E., Tanzi, R. &Ungari, S. (1986a) Significance of O-acetylated sialic acid variants in the classification of intestinal metaplasia in gastric mucosa. (abstract)Basic Appl. Histochem 30, 113–4.
Lapertosa, G., Baracchini, P., Fulcheri, E., Tanzi, R. & Ungari, S. (1986b) A new histochemical approach to the classification of gastric intestinal metaplasia. (abstract)Proceed. of XVI Int. Congr. I.A.P., Wien. 91.
Lapertosa, G., Fulcheri, E. &Baracchini, P. (1988) Duodenitis and secretion of O-acetylated sialomucin variants. (letter)Histopathology.13, 122–3.
Lauren, P. (1965) The two main histological types of gastric carcinoma: diffuse and so-called intestinal type carcinoma. An attempt at a histoclinical classification.Acta Pathol. Microbiol. Scand. 64, 31–49.
Leblond, C. P. &Cheng, H. (1976) Identification of stem cells in the small intestine of the mouse. InStem Cells of Renewing Cell Populations. (edited byCarnie, A. B., Lala, P. K. &Osmond, G. G.) pp. 123–45. New York: Academic Press.
Matsukura, N., Susuki, K., Kawashi, T., Aoyagi, M., Sugimura, T., Kitaoka, H., Numajiri, H., Shirota, A., Itabashi, T. &Hirota, T. (1980) Distribution of marker enzymes in intestinal metaplasia in human stomach and relation of complete and incomplete types of intestinal metaplasia to minute gastric carcinoma.J. Natl. Cancer Inst. 65, 231–40.
Ming, S. C. (1984) Intestinal metaplasia: its heterogeneous nature and significance. InPrecursors of Gastric Cancer. (edited byMing, S. C.) pp. 141–53. New York: Praeger.
Nardelli, J., Bara, J., Rosa, B. &Burtin, P. (1983) Intestinal metaplasia and carcinomas of the human stomach: an immunological study.J. Histochem. Cytochem. 31, 366–375.
Pearse, A. G. E. (1985)Histochemistry: Theoretical and Applied. Vol. 2, 4th edn. pp. 675–753. Edinburgh, London, New York: Churchill Livingstone.
Ramesar, K. C., Sanders, D. S. &Hopwood, D. (1987) Limited value of type III intestinal metaplasia in predicting risk of gastric carcinoma.J. Clin. Pathol. 40, 1287–90.
Reid, P. E., Dunn, W. L., Ramey, C. W., Coret, E., Trueman, L. &Clay, M. G. (1984) Histochemical identification of side-chain substituted O-acylated sialic acids: The PAT-KOH-Bh-PAS and the PAPT-KOH-Bh-PAS procedures.Histochem J. 16, 623–39.
Rothery, G. A. &Day, D. W. (1985) Intestinal metaplasia in endoscopic biopsy specimens of gastric mucosa.J. Clin. Pathol. 36, 613–621.
Rubio, C., Kato, Y., Kitagawa, T. &Sugano, H. (1986) A pitfall in the interpretation of intestinal metaplasia of the stomach.Acta Pathol. Microbiol. Immunol. Scand. (A) 94, 165–6.
Segura, D. I. &Montero, C. (1983) Histochemical characterization of different types of intestinal metaplasia in gastric mucosa.Cancer 52, 498–503.
Siegel, S. (1956)Nonparametric Statistics for the Behavioral Sciences. International Student Edition. pp. 196–202. Tokyo: McGraw-Hill Kogakusha Ltd.
Silva, S. &Filipe, M. I. (1986) Intestinal metaplasia and its variants in the gastric mucosa of Portuguese subjects: a comparative analysis of biopsy and gastrectomy material.Hum. Pathol. 17, 988–95.
Sipponen, P., Seppala, K., Varis, E., Hjelt, L., Ihamaki, T., Kekki, M. &Siurala, M. (1980) Intestinal metaplasia with colonic type sulphomucins in the gastric mucosa: its association with gastric carcinoma.Acta Pathol. Microbiol. Scand. (A) 88, 217–24.
Spicer, S. S. (1965) Diamine methods for differentiating mucosubstances histochemically.J. Histochem. Cytochem. 13, 211–34.
Teglbjaerg, P. &Nielsen, H. O. (1978) Small intestine type and colonic type intestinal metaplasia of the human stomach.Acta Pathol. Microbiol. Scand. 86, 351–5.
Turani, H., Lurie, B., Chaimoff, C. &Kessler, E. (1986) The diagnostic significance of sulphated acid mucin content in gastric intestinal metaplasia with early gastric cancer.Am. J. Gastroenterol. 81, 343–5.
Veh, R. W., Meessen, D., Kuntz, H. D. &May, B. (1982) Histochemical demonstration of side-chain substituted sialic acids. InColonic Carcinogenesis (edited byMalt, R. A. &Williamson, R. C. N.) Falk Symposium31, pp. 355–65. Lancaster: MTP Press Ltd.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Baracchini, P., Fulcheri, E. & Lapertosa, G. Patterns of intestinal metaplasia in gastric biopsies. A comparison of different histochemical classifications. Histochem J 23, 1–9 (1991). https://doi.org/10.1007/BF01886501
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF01886501