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Japanese Journal of Cancer Research : Gann logoLink to Japanese Journal of Cancer Research : Gann
. 1996 Jul;87(7):711–717. doi: 10.1111/j.1349-7006.1996.tb00282.x

Image Quantitation of Intestinal Metaplasia in Entire Gastrectomy Specimens from Swedish and Japanese Patients

Carlos A Rubio 1,✉, Marianne Matthies 1, Masayuki Itabashi 2, Teruyuki Hirota 3
PMCID: PMC5921154  PMID: 8698620

Abstract

The aim of this work was to investigate the extension of intestinal metaplasia (IM), as well as to quantitate various components of IM (namely sialomucins, sulfomucins and Paneth cells), in entire gastrectomy specimens from Swedish and Japanese patients. The length of the gastric mucosa was assessed by morphometry. The percent of sections with IM was regarded as the extension of IM in the specimens. Histochemically labeled sialomucins, sulfomucins and Paneth cells (the 3 main findings in gastric IM) were quantified in separate sections with the aid of an image analyzer. In total, 1,321 sections corresponding to 6 gastrectomy specimens were quantified. Sialomucins and sulfomucins were more extensively distributed in the 4 specimens with carcinoma than in the 2 without carcinoma (one having a peptic ulcer and the other, hereditary gastric cancer syndrome (HGCS) without carcinoma). On the other hand, quantitative analysis in Swedish specimens indicated that the highest values for sialomucins, sulfomucins and Paneth cells were present in HGCS. When Swedish and Japanese specimens with adenocarcinoma were compared, only sulfomucins (denoting Types II and III IM) were significantly higher in those carrying an intestinal‐type carcinoma (ITC) than in those with diffuse‐type carcinoma (DTC). The results substantiate those obtained with gastric biopsies by other authors. On the other hand, the mucosal extension and the amount of sulfomucins are not comparable parameters (since that mucin was not equally distributed, but “concentrated” in certain areas in the mucosa). One possible conclusion is that the focal distribution of acidic mucins and of Paneth cells in the gastric mucosa may strongly influence their detection rate in gastric biopsies. Thus, haphazard biopsy of the gastric mucosa may fail to sample areas with sulfomucins in population studies aiming to detect individuals at risk. Such sampling errors in gastric biopsies may explain the conflicting results on this subject appearing in the literature.

Keywords: Quantification, Gastric mucosa, Intestinal metaplasia, Cancer

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REFERENCE

  • 1.Muir , C. , Sasco , A. and Whelan , S.Geography of cancer. Patterns and distribution of cancer throughout the world . Cancer Mag ., 3 , 18 – 22 ( 1990. ). [Google Scholar]
  • 2.Kato , I. , Tominaga , S. , Ito , Y. , Kobayashi , S. , Yoshii , Y. , Matsuura , A. , Kameya , A. and Kano , T.Atrophic gastritis and stomach cancer risk: cross‐sectional analyses . Jpn. J. Cancer Res ., 83 , 1041 – 1046 ( 1992. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Ming , S.Dysplasia of gastric epithelium . Front. Gastrointest. Res ., 4 , 164 – 172 ( 1979. ). [DOI] [PubMed] [Google Scholar]
  • 4.Stemmermann , G.Intestinal metaplasia of the stomach. A status report . Cancer , 74 , 556 – 564 ( 1994. ). [DOI] [PubMed] [Google Scholar]
  • 5.Nakamura , T. and Nakano , G.Histopathological classification and malignant change in gastric polyps . J. Clin. Pathol ., 38 , 754 – 764 ( 1985. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Fujita , S.Biology of early gastric carcinoma . Pathol. Res. Pract ., 163 , 297 – 309 ( 1978. ). [DOI] [PubMed] [Google Scholar]
  • 7.Rubio , C. A. , Kato , Y. , Kitagawa , T. , Sugano , H. and Grimelius , L.Intramucosal cysts of the stomach, VIII. Histochemical studies . Acta Pathol. Microbiol. Immunol. Scand ., 96 , 627 – 634 ( 1988. ). [DOI] [PubMed] [Google Scholar]
  • 8.Sugimura , T. , Sugano , H. , Terada , M. , Stemmermann , G. , Yasui , W. and Tahara , E.Intestinal metaplasia and gastric cancer . Mol. Carcinog ., 11 , 1 – 7 ( 1994. ). [DOI] [PubMed] [Google Scholar]
  • 9.Rubio , C. A. , Kato , Y. and Kitagawa , T.Frequency of atypical mitosis in intestinal metaplasia of the gastric mucosa in Japanese patients . Jpn. J. Cancer Res ., 85 , 284 – 289 ( 1994. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Rubio , C. A. and Jessurun , J.Low frequency of intestinal metaplasia in gastric biopsies from Mexican patients: a comparison with Japanese and Swedish patients . Jpn. J. Cancer Res ., 83 , 491 – 494 ( 1992. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Imai , T. and Murayama , H.Time trend in the prevalence of intestinal metaplasia in Japan . Cancer , 52 , 353 – 361 ( 1983. ). [DOI] [PubMed] [Google Scholar]
  • 12.Rubio , C. A. , Pisano , R. , Llorens , P. and Duarte , I.A comparative study between the gastric mucosa of Chileans and other dwellers of the Pacific basin . Jpn. J. Cancer Res ., 87 , 117 – 121 ( 1996. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Hirota , T. , Okada , T. , Itabashi , M. , Yoshida , S. , Matsukura , N. , Kitaoka , H. and Hirayama , T.Significance of intestinal metaplasia as a precancerous condition of the stomach . In “Precursors of Gastric Cancer ,” ed. Ming S. , pp. 179 – 193 ( 1984. ). Praeger Publishers; , New York . [Google Scholar]
  • 14.Kato , Y. , Kitagawa , T. , Yanagisawa , A. , Kubo , K. , Utsude , T. , Hiratsuka , H. , Tamaki , M. and Sugano , H.Site‐dependent development of complete and incomplete intestinal metaplasia types in the human stomach . Jpn. J. Cancer Res ., 83 , 178 – 183 ( 1992. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Stemmermann , G. N. and Hayashi , T.Intestinal metaplasia of the gastric mucosa: a gross and microscopic study of its distribution in various disease states . J. Natl. Cancer Inst ., 41 , 627 – 634 ( 1968. ). [PubMed] [Google Scholar]
  • 16.Rubio , C. A. , Lindholm , J. and Rodensjö , M.Mapping intestinal metaplasia by histochemistry and morphometry . Pathol. Res. Pract ., 184 , 525 – 528 ( 1989. ). [DOI] [PubMed] [Google Scholar]
  • 17.Rubio , C. A. , Kato , Y. , Sugano , H. and Kitagawa , T.Intestinal metaplasia of the stomach. I: quantitative analysis in gastric peptic ulcer and in incipient adenocarcinoma in Japanese subjects . Anticancer Res ., 5 , 435 – 440 ( 1985. ). [PubMed] [Google Scholar]
  • 18.Rubio , C. A. , Jass , J. R. and King , A.Gastric cell phenotypes and intestinal metaplasia in Polynesian and non‐Polynesian residents of New Zealand . J. Environ. Pathol. Toxicol. Oncol ., 13 , 243 – 249 ( 1984. ). [PubMed] [Google Scholar]
  • 19.Rivera , F. and Rubio , C. A.Quantitative studies of the extension of gastric intestinal metaplasia in gastrectomy specimens from Swedish patients . Eur. J. Gastroenterol. Hepatol ., 5 , 521 – 525 ( 1993. ). [Google Scholar]
  • 20.Jass , J. R. and Filipe , M. I.Sulphomucins and precancerous lesions of the human stomach . Histopathology , 4 , 271 – 279 ( 1980. ). [DOI] [PubMed] [Google Scholar]
  • 21.Craanen , M. E. , Blok , P. , Dekker , W. , Ferwerda , J. and Tytgat , G.Prevalence of subtypes of intestinal metaplasia in gastric antral mucosa . Dig. Dis. Sci ., 36 , 1529 – 1536 ( 1991. ). [DOI] [PubMed] [Google Scholar]
  • 22.Filipe , M. I. and Ramachandra , S.The histochemistry of intestinal mucins. Changes in disease . In “Gastrointestinal and Oesophageal Pathology ,” pp. 97 – 116 ( 1995. ). Churchill Livingstone; , Edinburgh . [Google Scholar]
  • 23.Filipe , M. I. and Jass , J. R.Intestinal metaplasia subtypes and cancer risk . In “Gastric Carcinoma ,” ed. Filipe M. I. and Jass J. R. , pp. 65 – 86 ( 1986. ). Churchill Livingstone; , Edinburgh . [Google Scholar]
  • 24.Rubio , C. A. , Uribe , U. , Svensson , A. and May , I.A method for the quantification of intestinal metaplasia of the stomach by morphometry . Anal. Quant. Cytol. Histol ., 10 , 115 – 119 ( 1988. ). [PubMed] [Google Scholar]
  • 25.Rubio , C. A. , Hirota , T. , Itabashi , M. , Hirohashi , S. and Kato , Y.Quantitation of gastric intestinal metaplasia by morphometry in Japanese patients . Jpn. J. Cancer Res ., 83 , 495 – 498 ( 1992. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Rubio , C. A. , Porwit , A. and Rodensjö , M.Method to quantitate intestinal metaplasia of stomach by image analysis . J. Clin. Pathol ., 47 , 799 – 801 ( 1988. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Rubio , C. A. , Porwit‐McDonald , A. , Rodensjö , M. and Duvander , A.A method of quantitating Paneth cell metaplasia of the stomach by image analysis . Anal. Quant. Cytol. Histol ., 11 , 115 – 118 ( 1988. ). [PubMed] [Google Scholar]
  • 28.Rubio , C. A. , Saraga , E. P. and Lindholm , J.Improved method for mapping gastric intestinal metaplasia using selective histochemical morphometry . Anal. Quant. Cytol. Histol ., 12 , 122 – 126 ( 1990. ). [PubMed] [Google Scholar]
  • 29.Matsukura , N. , Suzuki , K. , Kawahi , T. , Aoyagi , M. , Sugimura , T. , Kitaoka , H. , Numajiri , H. , Shirota , A. , Itabashi , M. and Hirota , T.Distribution of marker enzymes and mucin in intestinal metaplasia in human stomach and relation of complete and incomplete types of intestinal metaplasia to minute gastric carcinomas . J. Natl. Cancer Inst ., 65 , 231 – 240 ( 1980. ). [PubMed] [Google Scholar]
  • 30.Silva , S. , Filipe , M. I. and Pinho , A.Variant of intestinal metaplasia in the evolution of chronic atrophic gastritis and gastric ulcer. A follow up study . Gut , 31 , 1097 – 1104 ( 1990. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Turani , H. , Lurie , B. , Chaimoff , C. and Kessler , E.The diagnostic significance of sulfated acid mucin content in gastric intestinal metaplasia with early gastric cancer . Am. J. Gastroenterol ., 81 , 343 – 345 ( 1986. ). [PubMed] [Google Scholar]
  • 32.Ramesar , K. , Sanders , D. and Hopwood , D.Limited value of type III intestinal metaplasia in predicting risk of gastric carcinoma . J. Clin. Pathol ., 40 , 1287 – 1290 ( 1987. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Gad , A.Intestinal metaplasia and gastric carcinoma . In “Precursors of Gastric Cancer ,” ed. Ming S. C. , pp. 195 – 206 ( 1984. ). Praeger Publishers; , New York . [Google Scholar]
  • 34.Matsukuma , A. , Mori , M. and Enjoji , M.Sulphomucin‐secreting intestinal metaplasia in the human gastric mucosa. An association with intestinal‐type gastric carcinoma . Cancer , 66 , 689 – 694 ( 1990. ). [DOI] [PubMed] [Google Scholar]
  • 35.Baracchini , P. , Fulcheri , E. and Lapertosa , G.Patterns of intestinal metaplasia in gastric biopsies. A comparison of different histochemical classifications . Histochem. J ., 23 , 1 – 9 ( 1991. ). [DOI] [PubMed] [Google Scholar]

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