2 articles
Despite worldwide decreasing trends in the incidence of gastric cancer, the disease remains a significant global health burden, one of the leading causes of cancer death worldwide, and its prevention is a priority for the health system. Intestinal-type gastric carcinoma originates in dysplastic epithelium, which, in turn, develops in the environment of chronic atrophic gastritis and gastric intestinal metaplasia.
Narrative literature review. A bibliographic search was conducted in the databases PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline. Articles published between 2000-2024 were selected based on the following keywords: "gastric intestinal metaplasia" and "gastric epithelial dysplasia", used in different combinations with the terms "epidemiology", "clinical picture", "risk factors", "classification", "diagnosis", and "management" to maximize the search yield. After processing the information from the databases according to the search criteria, 215 full articles were found. The final bibliography contains 34 relevant sources, considered representative of the materials published on the subject of this summary article.
Gastric intestinal metaplasia represents the replacement of the gastric epithelium with two types of intestinal-type epithelium (enteric or colonic) as an adaptive response to chronic injury, while gastric epithelial dysplasia is defined as unequivocal neoplastic change of the gastric epithelium (intraepithelial neoplasia) without evidence of stromal invasion. Gastric intestinal metaplasia and gastric epithelial dysplasia are preneoplastic lesions of gastric cancer. The estimated annual risk of gastric adenocarcinoma in patients with gastric intestinal metaplasia is 0.13-0.25%, and in patients with gastric epithelial dysplasia it is 1.36%, depending on the extent and type of the lesion.
Despite the lack of a specific treatment for gastric intestinal metaplasia, the management strategy, according to current clinical guidelines, includes eradication of Helicobacter pylori infection, screening for early detection of gastric cancer, and control of other risk factors. Appropriate management of high-grade gastric epithelial dysplasia requires endoscopic resection due to its potential for progression to carcinoma and the possibility of coexisting carcinoma. For low-grade gastric epithelial dysplasia, which has a lower risk of malignant transformation, scientists recommend annual endoscopic surveillance with biopsy and histological examination.
MALT lymphoma is the most common type of extranodal non-Hodgkin lymphoma. In two-thirds of cases, it originates in the stomach and is strongly associated with Helicobacter pylori infection. It presents a complex clinical picture, that can resemble multiple conditions, and typically follows a benign course.
Clinical case presentation
This report discusses an uncommon case of a 52-year-old female who presented to the oncologist with insignificant weight loss, episodes of melena and fatigue. The disease started in 2018 with upper gastrointestinal bleeding from a gastric ulcer caused by H. pylori, which was later eradicated. The patient underwent multiple upper endoscopies over the years, with no evidence of malignancy. During the most recent investigation, an ulcerated mass of about 20 mm with infiltration of the adjacent mucosa was found. The biochemical and serological examination was within normal values. Abdominal computed tomography revealed unexplained perigastric and intestinal lymphadenopathy. The patient underwent total gastrectomy and lymph node dissection due to suspected gastric cancer. Histological and immunohistochemical examinations confirmed advanced MALT lymphoma with tumour cells positive for cluster of differentiation 45, 20 (CD45, CD20) and B-cell lymphoma 2 (BCL2). Given the advanced stage of the disease, adjuvant polychemotherapy was also administered, and the patient's condition improved significantly.
MALT lymphoma is a rare condition that requires close attention and a high index of suspicion, even in unusual cases like the one presented. Endoscopic examination performed by an experienced specialist, accompanied by proper biopsy and a multidisciplinary team approach increases the survival rate of patients.