Gastric Type Research Articles

Local type 2 immunity in eosinophilic gastritis

Eosinophilic gastritis (EoG) associates with type 2 immunity. However, the type 2 cytokine cellular source, gastric T-cell composition, and gastric T-cell relationship (or relationships) with disease pathology remain understudied. We defined gastric T-cell populations and their association with histologic and endoscopic EoG pathology. Gastric biopsy samples (n= 6 EoG, n= 7 control) were subjected to histologic, endoscopic, and flow cytometry analyses. In a complementary cohort (n= 83 EoG), IL4, IL5, and IL13 mRNA levels were correlated with EoG pathologic parameters. Gastric biopsy samples contained CD3+ T cells that were mainly CD8+; the CD8/CD4 ratio was comparable in EoG and control biopsy samples (5.7± 3.0 and 4.3± 0.6, respectively; P= .28). Gastric regulatory T (CD3+CD4+FOXP3+) and TH2 (CD3+CD4+GATA3+) cell levels were increased in EoG versus controls (2-fold, P< .05 and 10-fold, P< .001, respectively) and correlated with gastric eosinophil levels (r= 0.63, P< .05 and r=0.85, P< .001, respectively), endoscopic pathology (r= 0.56, P< .01; r= 0.84, P< .001, respectively), and histopathology (r= 0.72,P< .01; r= 0.82, P< .01, respectively). Cytokine-positive, most notably IL-4+, TH2 cell levels strongly correlated with histologic and endoscopic scores (r= 0.82, P< .0001 and r=0.78, P< .0001, respectively). In an independent EoG cohort (n= 83), bulk gastric IL4, IL5, and IL13 mRNA levels correlated with histologic score (r= 0.22, P< .005; r= 0.54, P< .0001; and r= 0.36, P< .0001, respectively) and endoscopic score (r= 0.27, P< .001; r= 0.40, P< .0001; and r= 0.35, P< .0001, respectively). EoG is a TH2 cell-associated disease featuring increased gastric type 2 cytokine-producing CD3+CD4+GATA3+TH2 cells that strongly correlate with disease pathologies.

Gastric Neuroendocrine Tumor Type 1: A Case Report

33-year-old patient who is referred to Endocrinology Outpatient Consultation in March 2021 due to the finding in gastric polyp biopsy 9 mm sessile located in greater curvature, of low-grade neuroendocrine tumor (ki-67 &lt; 3%) without infiltration of the muscularis layer own. It is followed jointly with the Digestive Service, performing mucosectomy in April 2021 on carcinoid in major curvature of the stomach, where there is no evidence of residual tumor in the anatomo-pathological study (A-P). After completing the study with other complementary tests, gastric neuroendocrine tumor type 1 is diagnosed against the background of chronic atrophic gastritis. At present, the patient continues with periodic gastroscopic check-ups scheduled by the Digestive Service.

Dissection of gastric homeostasis in vivo facilitates permanent capture of isthmus-like stem cells in vitro.

The glandular stomach is composed of two regenerative compartments termed corpus and antrum, and our understanding of the transcriptional networks that maintain these tissues is incomplete. Here we show that cell types with equivalent functional roles in the corpus and antrum share similar transcriptional states including the poorly characterized stem cells of the isthmus region. To further study the isthmus, we developed a monolayer two-dimensional (2D) culture system that is continually maintained by Wnt-responsive isthmus-like cells capable of differentiating into several gastric cell types. Importantly, 2D cultures can be converted into conventional three-dimensional organoids, modelling the plasticity of gastric epithelial cells in vivo. Finally, we utilized the 2D culture system to show that Sox2 is both necessary and sufficient to generate enterochromaffin cells. Together, our data provide important insights into gastric homeostasis, establish a tractable culture system to capture isthmus cells and uncover a role for Sox2 in enterochromaffin cells.

An unusual association of folic acid deficiency with gastric neuroendocrine tumor type I

The association of gastric neuroendocrine tumour type I with macrocytic anaemia due to vitamin B12 deficiency is commonly encountered. The etiological cause of macrocytic anaemia must always be precisely established for the subsequent treatment guidance. We present the case of a 63-year-old patient admitted for marked physical asthenia, palpitations, abdominal pain, flatulence, paresthesia in the upper and lower limbs and concentration difficulties. Clinical examination revealed pale, dry skin, Hunter's glossitis, and tachycardic heart sounds. Bloodwork showed pancytopenia with macrocytic normochromic anaemia, vitamin B12 within normal limits, but with low folic acid levels. The reticulocyte crisis was documented on day three after initiating folic acid treatment. Exploration by upper digestive endoscopy and colonoscopy described multiple polypoid tumours in the greater curvature of the stomach. The histopathological and immunohistochemical examination lead to the diagnosis of gastric neuroendocrine tumours (NET) type G1. To our knowledge, there are no reports about an association of this type of tumour with folate deficiency-induced anaemia.

Gastric neuroendocrine hyperplasia and dysplasia in a patient with Lynch syndrome

Lynch syndrome (LS) is a common hereditary syndrome caused by mutations in deoxyribonucleic acid mismatch repair genes, with a high probability of gastrointestinal, gynaecological and other cancers. The most common LS-associated gastric cancer is adenocarcinoma of the intestinal type. Neuroendocrine neoplasia has not been well understood in LS-associated gastric cancer. Herein, we report a case of a 68-year-old female, with a history of Lynch syndrome and ascending colon adenocarcinoma seven years ago, now presenting as synchronous gastric mixed type adenocarcinoma as well as mucinous adenocarcinoma in transverse colon tumour. On histological examination of the resection specimen, we observe additional diffuse neuroendocrine hyperplasia and dysplasia in the background gastric mucosa. As high grade gastric neuroendocrine carcinoma has been reported in Lynch syndrome, our case may indicate the early stage tumourigenesis of the neuroendocrine tumour in Lynch syndrome.

Endoscopic ultrasound-guided coiling and glue is safe and superior to endoscopic glue injection in gastric varices with severe liver disease: a retrospective case control study

Gastric varices (GV) are present in 25% of cirrhotic patients with high rates of rebleeding and mortality. Data on endoscopic ultrasound (EUS)-guided treatment in severe liver disease (model for end stage liver disease sodium [MELD-Na] >18 and Child-Turcotte-Pugh [CTP] C with GV) are scarce. Thus, we performed a retrospective comparison of endoscopic glue injection with EUS-guided therapy in cirrhotic patients with large GV. A retrospective study was performed in the tertiary hospitals of India. A total of 80 patients were recruited. The inclusion criteria were gastroesophageal varices type 2, isolated gastric varices type 1, bleeding within 6 weeks, size of GV >10 mm, and a MELD-Na >18. Treatment outcomes and complications of endoscopic glue injection and EUS-guided GV therapy were compared. In this study, the patients' age, sex, liver disease severity (CTP, MELD-Na) and clinical parameters were comparable. The median number of procedures, injected glue volume, complications, and GV obturation were better in the EUS group, respectively. On subgroup analysis of the EUS method (e.g., direct gastric fundus vs. paragastric collateral [PGC] coil placement), PGC coil placement showed decreased coil requirement, less injected glue volume, decreased luminal coil extrusion, and increased successful GV obturation. EUS-guided treatment is more efficient and safer, and requires a smaller number of treatment sessions, as compared to endoscopic treatment in severe liver disease patients with large GV. Furthermore, PGC coil placement increases the complete obliteration of GV.

Excurve and Emit Lobular Endocervical Glandular Hyperplasia

Lobular endocervical glandular hyperplasia of uterine cervix is a benign, exceptional lesion with a characteristic proliferation of miniature, spherical glands accompanied by gastric type differentiation. The discrete lobules incriminate upper endocervical canal of predominantly premenopausal women. Lobular endocervical glandular hyperplasia and gastric subtypes of cervical glandular lesions appear non concurrent to persistent infection with high risk variants of human papilloma virus (HPV). Cytological examination depicts mono-layered sheets of tall, columnar, mucinous cells demonstrating smooth nuclear outline with absent cellular or nuclear atypia or mitotic figures. Papanicolaou stained smears exemplify extracellular or intracellular, golden yellow mucin, indicative of gastric subtype of cellular differentiation. The well-defined lobular or acinar lesion is comprised of a centric crypt with circumscribing glandular articulations and miniature, spherical cysts which configure a floret-like pattern. Centric and peripheral glands are layered with columnar epithelial cells pervaded with pale, eosinophilic cytoplasm, bland, miniature, basal nuclei with mild nuclear atypia. Atypical cytological and architectural features may progress into the malignant ‘atypical lobular endocervical glandular hyperplasia’, currently contemplated as a category of gastric type adenocarcinoma in situ (GAIS). The lesion is immune reactive to pyloric gland mucin (HIK1083), MUC6, PAX2 or chromogranin A. Lobular endocervical glandular hyperplasia of uterine cervix requires segregation from neoplasms such as human papilloma virus (HPV) independent endocervical adenocarcinoma, gastric type, pyloric type metaplasia, gastric type adenocarcinoma in situ, type A tunnel clusters, micro glandular hyperplasia and mesonephric remnants or mesonephric hyperplasia of uterine cervix. Lesions detected upon surgical tissue sampling, cervical loop electrosurgical excision procedure (LEEP) or conisation may be optimally managed with total abdominal hysterectomy

The Token Transition-Minimal Deviation AdenocarcinomaUterine Cervix

Gastric type adenocarcinoma is a high grade, frequently discerned mucinous adenocarcinoma with gastric differentiation incriminating the endocervical canal. Of obscure aetiology, neoplasm depicts STK11 genetic mutations with chromosome 3q gain and chromosome 1p loss. Tumefaction exhibits cytological and histological features of gastric differentiation as tumour cells incorporated with voluminous, clear or pale, foamy, eosinophilic cytoplasm, tall, abundant, apical mucin, miniature, spherical, elliptical or enlarged, basal nuclei, irregular, vesicular chromatin and prominent nucleoli. The well differentiated neoplasm is comprised of well defined glandular articulations and minimal to absent stromal desmoplastic reaction. Neoplastic glands of variable outline, magnitude and irregular or claw-like glandular contour are observed. Tumour cells appear immune reactive to HIK1083, MUC6, p53, carcinoembryonic antigen (CEA) or mCEA, CK7, PAX8, CAIX or HNF-1B. Minimal deviation adenocarcinoma requires segregation from neoplasms such as human papillomavirus (HPV) associated endocervical adenocarcinoma, human papillomavirus (HPV) associated endocervical adenocarcinomas intestinal(goblet cell) type, clear cell adenocarcinoma, invasive stratified mucin producing adenocarcinoma, metastatic gastric or pancreaticobiliary carcinoma, lobular endocervical glandular hyperplasia, atypical lobular endocervical glandular hyperplasia, diffuse laminar endocervical glandular hyperplasia, tunnel clusters, florid deep glands, microglandular hyperplasia, pseudo-infiltrative tubal metaplasia, endocervicosis, endosalpingosis or endocervical type adenomyoma. Minimal deviation adenocarcinoma can be adequately categorized upon histological examination of tissue obtained with surgical sampling. Stage I tumours may be managed with surgical procedures as trachelectomy or radical hysterectomy and regional lymphadenectomy upon initial disease representation

Association between INDELs in MicroRNAs and Susceptibility to Gastric Cancer in Amazonian Population.

Gastric cancer (GC) is a multifactorial, complex, and aggressive disease with a prevalence of one million new cases and high global mortality. Factors such as genetic, epigenetic, and environmental changes contribute to the onset and progression of the disease. Identification of INDELs in miRNA and its target sites in current studies showed an important role in the development of cancer. In GC, miRNAs act as oncogenes or tumor suppressors, favoring important cancer pathways, such as cell proliferation and migration. This work aims to investigate INDELs in the coding region of miRNAs (hsa-miR-302c, hsa-miR-548AJ-2, hsa-miR-4274, hsa-miR-630, hsa-miR-516B-2, hsa-miR-4463, hsa-miR-3945, hsa-miR-548H_4, hsa-miR-920, has-mir-3171, and hsa-miR-3652) that may be associated with susceptibility and clinical variants of gastric cancer. For this study, 301 patients with GC and 145 individuals from the control group were selected from an admixed population in the Brazilian Amazon. The results showed the hsa-miR-4463, hsa-miR-3945, hsa-miR-548H_4, hsa-miR-920 and hsa-miR-3652 variants were associated with gastric cancer susceptibility. The hsa-miR-4463 was significantly associated with clinical features of GC such as diffuse gastric tumor histological type, "non-cardia" localization region, and early onset. Our findings indicated that INDELs could be potentially functional genetic variants for gastric cancer risk.

MRI characteristics for predicting histological subtypes in patients with uterine cervical adenocarcinoma

PurposeTo evaluate the magnetic resonance imaging (MRI) findings of uterine cervical adenocarcinoma for predicting different histological subtypes. Materials and methodsWe retrospectively analyzed MRI findings of 76 consecutive patients with histopathologically-confirmed uterine cervical adenocarcinoma undergoing preoperative MRI examination. An experienced pathologist classified the histological subtypes based on World Health Organization’s 2020 classification and into human papillomavirus (HPV)-associated adenocarcinomas (HPVAs, n = 54) (usual type and variants) and HPV-independent adenocarcinomas (HPVIs, n = 22) (gastric type adenocarcinoma (GAS), clear cell type, and other types). Different MRI variables were compared quantitatively and qualitatively between HPVA and HPVI and between GAS and non-GAS tumor types. ResultsThe maximum tumor diameter was significantly greater in HPVIs than HPVAs (41.9 ± 18.6 vs 32.7 ± 15.6 mm; p < 0.05). Heterogeneous enhancement on fat-suppressed gadolinium-enhanced T1-weighted images was more frequently seen in HPVIs than HPVAs (62 % vs 15 %; p < 0.01) and in GASs than non-GASs (78 % vs 16 %; p < 0.01). Also, infiltrative growth pattern (58 % vs 20 %; p < 0.05) and intratumoral cyst formation (83 % vs 47 %) (p < 0.05) were more frequent in GASs than non-GASs. ConclusionsCompared with HPVAs, HPVIs tend to have a larger tumor size with heterogeneous enhancement, of which GASs frequently show infiltrative growth patterns with intratumoral cyst formation and heterogeneous enhancement.

Gastric SWI/SNF complex deletion-associated undifferentiated carcinoma with rhabdoid phenotype: a clinicopathological and molecular analysis

Objective: To investigate the clinicopathological features and molecular genetic characteristics of gastric SWI/SNF complex deletion-associated undifferentiated carcinoma with rhabdoid phenotype. Methods: Six cases of gastric SWI/SNF complex deletion-associated undifferentiated carcinoma with rhabdoid phenotype diagnosed at the Henan Cancer Hospital, Zhengzhou, China from January 2019 to December 2021 were collected. Histological observation, immunohistochemical staining, next-generation sequencing, and detection of mismatch repair (MMR), EBER, and HER2 were performed. The clinicopathological and molecular characteristics were summarized and relevant literatures were reviewed. Results: The 6 patients were all male, aged 48-75 years. Their initial symptoms mainly included abdominal pain, melena, and dysphagia. Endoscopic examinations showed gastric ulcer type masses, and the morphology of H&E were similar: the tumor cells showed diffuse infiltrating growth, no specific structural characteristics, obvious cell atypia, obvious mitoses, and rhabdomyoid cells with unequal proportions of eosinophilic cytoplasm. The immunohistochemistry for CKpan was negative in 3 of the 6 cases, while focal expression of other epithelial markers was found, including EMA (6/6), CK8/18 (4/6), and CK7 (1/6). P53 was diffusely strong positive in 4 cases (4/6), and negative in 1 case (1/6). Ki-67 was highly expressed (positive rate range, 60%-90%). Other related markers such as mesenchymal tumors, lymphoma, melanoma and germ cell tumors were all negative. Detection of the SWI/SNF complex subunit, namely INI1 (SMARCB1), BRG1 (SMARCA4), ARID1A protein detection, was detected in 5 cases with no SMARCA4 expression (5/6), 1 case with no ARID1A expression (1/6), and all cases with SMARCB1 expression (6/6). MMR proteins were examined, and dMMR was found in 1 of the 6 cases. HER2 expression was 0 in 3 cases, 1+ in 1 case, and 2+ in 2 cases, while no amplifications of HER2 gene were detected using FISH. EBER was negative in all 6 cases. Among the 4 cases of surgical radical treatment that were subject to next-generation sequencing, 3 cases showed TP53 mutations; 1 case showed ARID1A gene frame shift mutation, and there were also mutations of ATM, PTEN and other genes. There was 1 case with detected SMARCA4 gene copy number variant, and other gene mutations such as ALK, BRAF, CDKN1B, BRCA2, etc. Conclusions: Gastric SWI/SNF complex deletion-associated undifferentiated carcinoma with rhabdoid phenotype is a poorly differentiated and rare tumor. Detection of SWI/SNF complex related proteins is helpful for its diagnosis. Moreover, gene mutations associated with SWI/SNF complex will become a new indicator for its diagnosis and prognostication, and a potential new target for molecular therapy, which deserves more attention and warrants more research.

Gastrointestinal: Multiple metastases of laterally spreading non-ampullary duodenal adenocarcinoma with gastric phenotype.

Non-ampullary duodenal adenocarcinoma could be divided into two major types: gastric and intestinal types with mucin immunohistochemistry. Ushiku et al. reported that the gastric type has a worse prognosis than the intestinal type in patients with duodenal adenocarcinoma. However, few studies have examined the malignant potential of gastric-type duodenal adenocarcinomas. A 76-year-old woman with respiratory symptoms underwent computed tomography, which showed bilateral cavitary pulmonary lesions. Esophagogastroduodenoscopy detected a duodenal tumor spreading from the superior duodenal angle to the prepylorus (Fig. 1a–c). Biopsy showed well-differentiated adenocarcinoma, which was immunohistochemically positive for the MUC5AC (gastric foveolar mucin) and focally positive for the MUC6 (pyloric and Brunner's gland mucin), but negative for MUC2 (major intestinal goblet cell mucin), CDX2 (intestinal transcription factor), and CD10 (intestinal epithelial cells) (Fig. 2a–g). The tumor was soft and flat without any findings suggesting muscle invasion. But positron emission tomography/computed tomography revealed increased uptake in the duodenal bulb, multiple lung lesions, para-aortic lymph nodes, sternum, and ninth thoracic spine (Fig. 1d–f). Histology and immunohistochemistry of lung lesion showed mucinous adenocarcinoma with gastric-type mucin expression, which was similar to the finding of duodenal carcinoma (Fig. 2h–n). Therefore, we diagnosed the patient with multiple metastases from gastric-type duodenal adenocarcinoma. The patient underwent palliative chemotherapy with S-1 plus oxaliplatin, but she died from progressive disease 7 months after diagnosis.

Adenocarcinoma of the uterine cervix, gastric-type (GAS): a review of the literature focused on pathology and multimodality imaging.

Adenocarcinoma of the uterine cervix, gastric-type (GAS) is a rare, well-differentiated subtype of HPV-independent endocervical adenocarcinoma. It classically arises in middle-aged women with symptoms, including profuse watery vaginal discharge and abnormal uterine bleeding. Given the rarity of this disease, misdiagnosis is common and prognosis remains poorly defined. Distinct pathology and imaging findings can aid in diagnosis. A literature review was performed to ascertain recurring pathologic and radiologic characteristics of GAS. Key pathologic features of GAS include cytologically benign appearing mucinous glands that infiltrate into the deep stroma and may demonstrate lymphovascular or perineural invasion. Multiple imaging modalities including transvaginal ultrasound, CT, and MRI may aid in diagnosis of GAS, which characteristically is seen as a multicystic mass with solid components. MRI in particular is the preferred imaging study because it offers the best chance of identifying a potential solid component, which is key to making the diagnosis of GAS and distinguishing it from other endocervical diseases processes. Careful attention to histopathologic and radiologic details, in conjunction with clinical correlation, is necessary to distinguish GAS from other multicystic cervical lesions.

Endoscopic findings of gastric neoplasms in familial adenomatous polyposis are associated with the phenotypic variations and grades of dysplasia.

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric neoplasms. However, endoscopic findings have not been sufficiently investigated. We investigated the phenotypic expression of gastric adenoma (low-grade dysplasia) and gastric cancer (high-grade dysplasia or carcinoma) in patients with FAP and clarified their relationships to endoscopic findings. Of 29 patients with FAP who underwent esophagogastroduodenoscopy between 2005 and 2020, 11 (38%) had histologically confirmed gastric neoplasms, including 23 lesions of gastric adenoma and 9 lesions of gastric cancer. The gastric neoplasms were classified into 3 phenotypes (gastric, mixed, or intestinal type) according to the immunostaining results and evaluated for location (U or M region: upper or middle third of the stomach or L region: lower third of the stomach), color (same as the background mucosa, whitish, or reddish), macroscopic type (elevated, flat, or depressed), background mucosal atrophy (present or absent), fundic gland polyps in the surrounding mucosa (present or absent), and morphologic changes in tumor size. Elevated whitish gastric adenomas were further subdivided by macroscopic type (flat elevated, protruded, or elevated with a central depression) and color (milky- or pinkish-white). The gastric adenomas included gastric (11/23, 48%), mixed (4/23, 17%), and intestinal (8/23, 35%) phenotypes. In contrast, no lesions of gastric cancers showed a gastric phenotype (0/9, 0%), while 5 (56%) and 4 (44%) lesions were intestinal and mixed phenotypes, respectively. Gastric cancers were significantly more likely than gastric adenomas to present as reddish depressed lesions with gastric atrophy. All gastric-type adenomas occurred in non-atrophic mucosa, in mucosa with fundic gland polyps in the periphery, in the U or M region, and as flat elevated or protruded lesions with a milky-white color. Half of the lesions increased in size. Meanwhile, the typical endoscopic features of intestinal-type adenomas included occurrence in the L region and elevated pinkish-white lesions with central depression. None of the intestinal-type adenomas increased in size during the observation period. We believe that these endoscopic features will be useful for the prompt diagnosis and appropriate management of gastric neoplasms in patients with FAP.

Carcinoembryonic antigen levels in pancreatic juice are associated with histological subtypes of intraductal papillary mucinous neoplasm of the pancreas.

BackgroundThe present study aimed to examine the correlation between preoperative carcinoembryonic antigen levels in pancreatic juice (PJ‐CEA) and the histological subtype of intraductal papillary mucinous neoplasm (IPMN).MethodsWe enrolled IPMN patients who underwent endoscopic retrograde pancreatography between March 2002 and March 2018. Clinical factors associated with IPMN histological subtypes of 67 patients who underwent surgery were analyzed. Furthermore, the relationship between CEA immunohistochemistry findings and histological subtypes was investigated.ResultsMedian PJ‐CEA were 15 ng/ml in the gastric type, 150 ng/ml in the intestinal type, and 175 ng/ml in the pancreatobiliary type. Both intestinal and pancreatobiliary types had significantly higher PJ‐CEA than the gastric type (p = 0.001). In the analysis of histological subtype predictors, high PJ‐CEA (≥63 ng/ml) only showed a significant difference in multivariate analyses (95% confidence interval 4.8–70.2; p < 0.001). Immunohistochemistry findings revealed significantly higher CEA expression in the non‐gastric type than in the gastric type (p < 0.001). The non‐gastric type showed a significantly worse prognosis than the gastric type (p = 0.017).ConclusionPJ‐CEA was an independent predictor of IPMN histological subtypes in a preoperative setting. High PJ‐CEA predict the non‐gastric type, while low PJ‐CEA predict the gastric type.

Hyperplasia of enterochromaffin-like (ECL) cells as a precursor of neuroendocrine gastric tumors in autoimmune gastritis

The purpose of this publication is to update knowledge about chronic autoimmune gastritis and about cases of hyperplasia of enterochromaffin-like (ECL) cells as precursors of the development of neuroendocrine gastric tumor type 1 due to clinical example’s demonstration. Discussion: the types and main characteristics of neuroendocrine tumors of the stomach were discussed, in particular tumors type 1 associated with autoimmune gastritis. The mechanisms of formation of neuroendocrine tumors in the stomach against the background of an autoimmune process were presented, two clinical examples presenting the algorithm of diagnosis of autoimmune gastritis and associated neuroendocrine tumors were presented. Both clinical examples demonstrated the presence of subepithelial formations of the stomach body according to FGDS, which have not been morphologically identified. Timely repeated FGDS with sampling of biopsies according to the OLGA standard made it possible to verify the formations, and the serological markers helped in clarifying the diagnosis and morphological nature of tumors. Conclusion: analysis of clinical data, anamnesis and esophagoduodenoscopy with morphological evaluation of the gastric mucosa biopsy may help to find out the cause and nature of chronic inflammation in the gastric mucosa. Atrophy of the glands in the stomach body, pseudopiloric metaplasia, hyperplasia of enterochromaffin (ECL) cells are sufficient morphological criteria for autoimmune gastritis. The study of the level of chromogranin A in blood serum can be considered as a marker of the development of type 1 neuroendocrine gastric tumor in patients with autoimmune gastritis and the presence of polyps in the stomach body.

Difference in the effects of three nutritional pathways on postoperative rehabilitation in patients with gastric cancer and type 2 diabetes mellitus*

Abstract Objective To explore the difference in the effects of three nutritional pathways on the rehabilitation of patients with gastric cancer and diabetes mellitus after operation. Methods Overall, 120 patients were randomly divided into the partial parenteral nutrition (PPN), early enteral nutrition (EEN), and diabetes mellitus special enteral nutritional emulsion (DEN) groups. The differences in the effects of three nutritional modes were compared. Results (1) On postoperative day four, the total protein level in the EEN and DEN groups was significantly higher than that in the PPN group (P &lt; 0.05). On postoperative day ten, body mass index, lymphocyte count, total protein level, and pre-albumin level in the DEN group were significantly higher than those in the PPN group (P &lt; 0.05). (2) On postoperative day four, there was no significant difference in the fasting blood glucose level between the EEN and DEN groups (P &gt; 0.05), but this level was significantly lower than that in the PPN group (P &lt; 0.05). On postoperative day ten, fasting and postprandial blood glucose levels in the DEN group were significantly lower than those in the PPN group. (3) On postoperative day four, the C-reactive protein level in the DEN group was significantly lower than that in the other groups (P &lt; 0.05). (4) The incidence rates of complications in the PPN, EEN, and DEN groups were 25.0%, 10.0%, and 5.0%, respectively. The incidence of complications in the PPN group was significantly higher than that in the other groups. However, there was no significant difference in perioperative indexes among the three groups (P &gt; 0.05). Conclusion Enteral nutrition is more conducive to the recovery of patients with gastric cancer and type 2 diabetes mellitus after operation; the special enteral nutrition emulsion for diabetes mellitus is more effective than the conventional nutrition solution in stabilizing blood sugar levels and reducing the degree of inflammation.

Biology and management of lobular endocervical glandular hyperplasia.

Lobular endocervical glandular hyperplasia (LEGH) is a multicystic proliferative disorder of the uterine cervix. The aim of this review was to clarify the current understanding of this unique tumor. This article reviews the chronological progress of research regarding clinico-pathological and genetic aspects of LEGH and related cervical cystic diseases such as Nabothian cyst and adenocarcinoma of gastric type (GAS), using the literature and data from our institute. We also describe clinical management including preoperative diagnosis and adequate surgical/expectant treatment based on the biological features. Recent studies revealed several unique aspects of LEGH, that is, (i) production of gastric mucin, (ii) symptomatic and histological similarity with minimal deviation adenocarcinoma (MDA), and (iii) frequent association with GAS, including MDA. These findings indicated that LEGH is a gastric metaplasia, as well as pre-cancerous neoplasia. For the preoperative diagnosis of LEGH, the combination of "cosmos" sign on magnetic resonance imaging, detection of gastric mucin, and lack of nuclear atypia on cytology is important. Cone biopsy is effective for pathological diagnosis. Simple hysterectomy is indicated as surgical treatment for LEGH; however, meticulous follow-up is also an option, especially for young patients, because the rate of malignant transformation was reported to be 1%-2%. For LEGH patients who selected follow-up, a worsening cytology and increase in lesion size were important signs of malignant change of LEGH for safe follow-up. Proper understanding of the characteristics of LEGH is important for adequate management.

Validation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity Questionnaire for the Latin American Population.

Background Chemotherapy-induced peripheral neuropathy is a common adverse effect of chemotherapeutic treatment and is associated with decreased quality of life. The aim of this study was to evaluate the validity and reliability of the neurotoxicity subscale of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) for the Chilean population. Methods A cross-sectional study in which 101 participants with haematologic, colorectal, breast, gastric, gynaecological, and other types of cancer completed the FACT/GOG-Ntx. Content validity (n = 14 health professionals evaluated the subscale in four categories: test-retest reliability (n = 20 patients), dimensionality, internal consistency, and concurrent validity and discriminant validity. In all analyses, p < 0.05 was considered significant. Results There was an agreement among the evaluators for all categories of the subscale (Kendall's coefficient, W = 0.4, p < 0.01) and moderate to high intrarater reliability (intraclass correlation coefficient = 0.7–0.9). Of the 11 original items that make up the subscale, none was eliminated. The factor analysis generated four factors that represented 72.2% of the total variance. Cronbach's α was 0.8 for the 11 items. Women showed greater compromise in emotional well-being and neurotoxicity symptoms compared with men, and age was directly correlated with the questions ‘I have difficulty hearing' (r = 0.2, p = 0.019) and ‘I feel a noise or buzzing in my ears' (r = 0.2, p = 0.03). Conclusion The Chilean version of the FACT/GOG-Ntx neurotoxicity subscale is a valid and reliable scale for evaluating neurotoxicity symptoms in adult cancer survivors in Latin America. The scales also adequately distinguish between sex-based well-being among the afflicted population.

Prediction of antidiabetic effect after gastrectomy with Roux-en-Y reconstruction in patients with gastric cancer and type 2 diabetes.

This study investigated the antidiabetic outcomes after gastrectomy with long-limb RY reconstruction (LRYR) and the prognostic factors for remission after 1 year in patients with type 2 diabetes (T2DM) and gastric cancer. In 25 Koreans with T2DM and gastric cancer, plasma glucose and insulin levels were measured during a 75 g oral glucose tolerance test, before and 1 week after gastrectomy with LRYR. Patients were examined after 1 year and we defined glycemic control as "remission" when the HbA1c level after 1 year was <6.0% without medication. One year after surgery, 12 patients achieved HbA1c < 6.0% without medication. Among the preoperative indices, the duration of diabetes was shorter in the remission group than that in the non-remission group (median 2.0 [0-6.5] years vs 7.0 [4.5-10.0] years, P = .023). At 1 week after surgery, significant improvements in fasting, 30 minutes, 60 minutes, 90 minutes stimulated glucose levels and insulin resistance (HOMA-IR and Matsuda index) were found only in the remission group. The multivariable logistic regression analysis results showed that higher 30 minutes stimulated glucose level and HOMA-IR index at 1 week after surgery were independent factors for lower odds of 1-year diabetes remission. Shorter duration of diabetes and early postoperative improvements in 30 minutes stimulated glucose level and HOMA-IR were important determinants of long-term antidiabetic outcomes after gastrectomy with LRYR in patients with T2DM and gastric cancer.