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Chromogranin immunostaining revealing a nodular proliferation of positive cells in the mucosa in the setting of extensive intestinal metaplasia and glandular atrophy (Â2).
Source publication
Rationale:
Gastric neuroendocrine neoplasms (g-NENs) represent a distinctive group of gastric tumors, stratified into different prognostic categories according to different histological characteristics, put forth in the 2018 World Health Organization classification system. The clinical presentations, as well as pathological features, represent imp...
Context in source publication
Context 1
... neuroendocrine features invading the mucosa, and with minimal extension in the submucosa. The uniform cells were arranged in nest and showed regular round nuclei, without significant pleomorphism, with only 1 mitoses/10 high-powered fields (HPF). The proliferative index Ki-67 was <2%. The cells were positive for chromogranin A and synaptophysin (Fig. 2). The base of the resected lesion was free of tumor cells. The fragments from the surrounding mucosa displayed histological features corresponding with an autoimmune atrophic gastritis (type A), limited to the corporeal region, with extensive intestinal and pseudopyloric metaplasia. The immunohistochemical examina- ...
Citations
... The median age of diagnosis was 58 years (range 34-71), and males represented 59.3% of the population. In 21 studies, the origin of the tumor site was predominantly the gastric corpus/fundus (83.3%) , and prevalent polypoid morphology from endoscopy was identified in 13 out of the 31 studies [15][16][17][20][21][22][23]25,26,[28][29][30][31]. A total of 17 out of the 31 studies included tumor depth invasion data, resulting in an invasion that included the submucosa in most cases [15,16,[19][20][21][22][23][24][25]28,30,32,[34][35][36][37][38]. ...
... A total of 17 out of the 31 studies included tumor depth invasion data, resulting in an invasion that included the submucosa in most cases [15,16,[19][20][21][22][23][24][25]28,30,32,[34][35][36][37][38]. A total of 26 out of the 31 papers reported dimensional data, and the median size was 16.5 mm (8-62.5 mm) [14][15][16][17][18][19][20][21]23,24,26,28,31,32,34,[36][37][38][39][40][41][42][43][44][45]. Six out of thirty-one authors reported a cutoff size of >10 mm for low tumor-related death [16][17][18][19]21,39], while 7 out of the 31 papers reported a larger cut-off size of >20 mm for an increased risk of gastric wall infiltration, metastasis at diagnosis, and relapse (p < 0.001) [14,[22][23][24]26,43,44]. A total of 3 out of the 31 authors showed a higher risk of gastric wall infiltration (and then lymph node and distant metastasis at diagnosis) with a cut-off of >17 and >19 mm [30,37,38], while two authors shared a stricter cut-off of <5 mm for sharing an indication of endoscopic management [37,39]. ...
... A total of 26 out of the 31 papers reported dimensional data, and the median size was 16.5 mm (8-62.5 mm) [14][15][16][17][18][19][20][21]23,24,26,28,31,32,34,[36][37][38][39][40][41][42][43][44][45]. Six out of thirty-one authors reported a cutoff size of >10 mm for low tumor-related death [16][17][18][19]21,39], while 7 out of the 31 papers reported a larger cut-off size of >20 mm for an increased risk of gastric wall infiltration, metastasis at diagnosis, and relapse (p < 0.001) [14,[22][23][24]26,43,44]. A total of 3 out of the 31 authors showed a higher risk of gastric wall infiltration (and then lymph node and distant metastasis at diagnosis) with a cut-off of >17 and >19 mm [30,37,38], while two authors shared a stricter cut-off of <5 mm for sharing an indication of endoscopic management [37,39]. The data on lymphatic and vascular invasion were available in less than 50% of the selected articles. ...
Purpose:
to collect data from real-life experiences of the management of type 3 g-NETs and identify possible prognostic factors that may impact the decision-making process.
Methods:
We performed a systematic review of the literature on type 3 g-NET management using the PubMed, MEDLINE, and Embase databases. We included cohort studies, case series, and case reports written in the English language.
Results:
We selected 31 out of 556 articles from between 2001 and 2022. In 2 out of the 31 studies, a 10 mm and 20 mm cut-off size were respectively associated with a higher risk of gastric wall infiltration and/or lymph node and distant metastasis at diagnosis. The selected studies reported a higher risk of lymph node or distant metastasis at diagnosis in the case of muscularis propria infiltration or beyond, irrespective of the dimensions or grading. From these findings, size, grading, and gastric wall infiltration seem to be the most relevant factors in management staff making choices and prognoses of type 3 g-NET patients. We produced a hypothetical flowchart for a standardized approach to these rare diseases.
Conclusion:
Further prospective analyses are needed to validate the prognostic impact of the use of size, grading, and gastric wall infiltration as prognostic factors in the management of type 3 g-NETs.
... A significant reduction in the gastric glands results in vitamin B12 and iron malabsorption, leading to pernicious anemia and iron deficiency anemia. Neoplasms, including neuroendocrine tumors and gastric cancers, can occur in the stomach because of hypergastrinemia, chronic, persistent inflammation, and damage to the mucosa [8,9]. It is also known that patients with autoimmune gastritis often have other autoimmune disorders, most commonly an autoimmune thyroid disease [10]. ...
Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8+/CD3+ and CD4+/CD3+ ratios differed between the samples. Body CD4+/antrum CD4+, which is calculated by dividing the CD4+/CD3+ ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 ± 3.13) than in active (1.47 ± 0.41) and inactive gastritis (1.42 ± 0.77). Antrum CD8+/CD4+ in autoimmune gastritis (7.86 ± 7.23) was also higher than that in active (1.49 ± 0.58) and inactive gastritis (2.84 ± 2.17). The area under the receiver operating characteristic curve of antrum CD8+/CD4+ was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8+/CD4+ ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis.
