The American Journal of Surgical Pathology - Fulltext: Volume 24(2 ::
1,2 We classified three types of lesions that were related to each other: typical adenoma malignum lesion, gastric metaplasia, and overt adenocarcinoma.
http://www.ajsp.com/pt/re/ajsp/fulltext.00000478-200002000-00043.htmHOME |
My stomach biopsy says I have a prominent gastric metaplasia. What does that mean and does that mean I'm a good candidate for stomach cancer?
Gastric metaplasia of esophagus: Esophageal segment lined with columnar metaplastic epithelium which is flat or villiform. Barrett's epithelium is characterized by two different types of cells: goblet cells and columnar cells. The symptomatology of Barrett's esophagus is that of gastro-esophageal reflux. It is the precursor of most esophageal adenocarcinomas. (WHO, 2000) -- 2003
Source: Diseases Database
Read about Barrett's Esophagus on Web MD it discusses gastric metaplasia
http://www.webmd.com/heartburn-gerd/bare...
I would also speak with your doctor he/she will be able to answer your questions more in depth.
Hello,
I would like to add a few words to the previous answer.
The notion of 'gastric metaplasia' is a bit counter-intuitive. You would think that since 'metaplasia' means, a change of one cell-type to another, that 'gastric metaplasia' would mean a change of the normal 'columnar'-cell inner lining of the stomach, into a different type of cell. But it doesn't.
The normal inside lining of the stomach, is made of up of 'columnar' cells. These look like this, under the microscope, ...http://io.uwinnipeg.ca/~simmons/1115coll... ... the characteristic feature of a 'columnar' cell is that it is tall and thin, - or at least 4 times higher than it is wide.
The normal inside lining of the food-pipe or 'esophagus,' is made of 'squamous' cells. These are long flat cells, occurring in sheets, like this, ... http://webanatomy.net/histology/epitheli... .... pretty much the exact opposite to columnar cells.
Clinical Medicine №2 2008 p 43::
This site may harm your computer.The prognostic value of gastric metaplasia in the duodenal mucosa in patients Regions of gastric metaplasia of the duodenum were confirmed by periodic
http://interstitial?url=www.medlit.ru/medeng/klm/klm08e0243.htmHOME |
The normal 'columnar' epithelium, lining the stomach, is built to withstand acid. The stomach contents are normally very acid, as part of the digestion process. The normal 'squamous' epithelium which lines the food-pipe, is not made to withstand acid, because normally the food-pipe does not hold any acid.
There is a change-point or 'transition point,' where at the lowermost end of the food-pipe, the inside lining type changes from squamous to columnar cells. This is called, in the joined-up technical words, so beloved of doctors, the 'squamo-columnar junction,' more easily also called the 'Z line.' The actual changeover point is about an inch above the stomach, please see this picture... http://www.uptodate.com/patients/content...
There is a valve at the join between the food-pipe and the upper end of the stomach, to prevent food and drink you've just swallowed into the stomach, from going back up the food-pipe, - - going back where it came from. This valve normally also prevents acid in the stomach, from going back up the food-pipe in the wrong direction.
Gastric metaplasia::
UpToDate, electronic clinical resource tool for physicians and patients that provides information on Adult Primary Care and Internal Medicine,
http://www.uptodate.com/patients/content/search.do;jsessionid=5E0FCFC7D576427891EB5F5F1C61B41F.1002?search=Gastric metaplasia&source=RELATED_SEARCHHOME |
However, if either there is an awful lot of acid, or the valve is a bit weakened, then acid *can* leak back up into the lower end of the food-pipe. This picture shows that happening,... the acid stomach contents are shown as a yellow color,... http://www.laparoscopy.com/pleatman/imag...
If this happens on a regular basis, the lower squamous epithelium of the food-pipe tries to protect itself by changing into a columnar cell type, like is normal inside the stomach. This is what is called 'gastric metaplasia,' even though it is not happening inside the stomach, but in the lower end of the food-pipe. The lower esophageal inner lining is turning INTO a gastric lining type.
This results in the Z-line, the transition line, moving upwards towards the mouth, and getting fragmented.
This is an inside-view of a lower food-pipe showing the Z-line, where squamous (white) epithelium changes to columnar (deep pink) epithelium... http://www.nature.com/gimo/contents/pt1/...
Here is a good graphic showing the change as the Z-line moves up... leave it on-screen and watch it...
http://i201.photobucket.com/albums/aa276...
I hope you've followed this!! The other possibility is that the normal inside lining, just beyond the outlet valve of the stomach, (at the bottom end of the stomach), - - can also change into the 'stomach' or 'gastric' cell type,... this is called "gastric metaplasia of the duodenum." Where the duodenum is, is shown here, ... http://www.mydr.com.au/content/images/ca...
You don't say whether your gastric metaplasia is inside your food-pipe, or inside your duodenum? It will not be inside your stomach, I hope I have explained why.
It's probably of the food-pipe? This condition is also known as "Barrett's esophagus" after the guy who described it.
This abnormally-located stomach-lining (inside the lower esophagus) can definitely be pre-cancerous. The cancer risk is described as low in most patients, see here... http://www.barrettsinfo.com/
The complications (including cancerous change), are well described at this UK Charity Site, of the "Barrett's Foundation," ... http://www.barrettsfoundation.org.uk/pro...
I think your doctor is trying to reassure you, and I think he is right when he says that a lot of people don't know they've got it. However, I do think it needs taking seriously and I think you should be under the care of a Specialist (if you are not... I am not sure how things work where you are).
The UK Barretts Foundation gives the risk of cancer as 1 in 100 per year, - - 1% a year. They do make the point that the metaplasia usually becomes more serious, (and is then called 'dysplasia'), before actual cancer develops.
I quote their article, << "Once Barrett's oesophagus has been diagnosed and regular acid lowering tablets have been started, a repeat endoscopy and tissue sampling is performed at regular intervals to monitor this condition. This is usually repeated every one to three years, but the exact timing of these checkups depends on each individual case." >> This would be the UK practice.
I hope this is of some help.
Best wishes,
Belliger (retired uk gp)
PS. Interesting, I have done some more research and found that two types of metaplasia *are* cancer precursors in the stomach, - - but they are still named differently (not as "gastric metaplasia"), and according to the same naming convention as above: so the first is called "intestinal metaplasia," - - and is the (metaplastic) appearance of intestinal cell tissue in the stomach; and the second is called "antralization of the fundus," and is the (metaplastic) appearance of specialized enzyme tissue in the top end of the stomach. Neither of these will apply to you!
PPS. Gastric metaplasia in the duodenal bulb, is more often referred to as "heterotopic gastric mucosa" or HGM. It does not appear to have a high malignancy potential, - - indeed some authors consider it protective against duodenal ulcer.
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