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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (2): 292-298. doi: 10.19723/j.issn.1671-167X.2023.02.013

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Clinicopathological features of Helicobacter pylori-negative early gastric cancer

Wei-hua HOU1,Shu-jie SONG2,Zhong-yue SHI3,Mu-lan JIN3,*()   

  1. 1. Department of Pathology, Pingdingshan Medical District, 989 Hospital of PLA Joint Logistics Support Force, Pingdingshan 467099, Henan, China
    2. Department of Gastroenterology, Pingdingshan Medical District, 989 Hospital of PLA Joint Logistics Support Force, Pingdingshan 467099, Henan, China
    3. Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2022-09-13 Online:2023-04-18 Published:2023-04-12
  • Contact: Mu-lan JIN E-mail:kinmokuran@163.com

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Abstract:

Objective: To investigate the clinicopathological features of Helicobacter pylori (Hp)-negative early gastric cancer. Methods: The clinicopathological data of 30 cases of Hp-negative early gastric cancer were collected retrospectively at Pingdingshan Medical District, 989 Hospital of PLA Joint Logistics Support Force, and Beijing Chaoyang Hospital, Capital Medical University, from 2009 to 2021, and the histomorphological characteristics and immunophenotype were observed, and combined with the literature to explore. Results: The median age of 30 patients was 58.5 years (range: 21-80 years), including 13 males and 17 females. The upper part of the stomach was 13 cases, the middle part of the sto-mach was 9 cases, and the lower part of the stomach was 8 cases. The median diameter of the tumor was 11 mm (range: 1-30 mm). According to the Paris classification, 9 cases were 0-Ⅱa, 7 cases were 0-Ⅱb, and 14 cases were 0-Ⅱc. Endoscopic examination showed that 18 cases of lesions were red, 12 cases of lesions were faded or white, and microvascular structures and microsurface structures were abnormal. In all the cases, collecting venules were regularly arranged in the gastric body and corner mucosa. There were 18 cases of well differentiated adenocarcinoma in the mucosa. The tumor presented glandular tubular-like and papillary structure, with dense glands and disordered arrangement; the cells were cuboidal or columnar, with increased nuclear chromatin and loss of nuclear polarity, and most of them expressed gastric mucin. Signet-ring cell carcinoma was found in 7 cases, all the cancer tissues were composed of signet-ring cells, and the cancer cells were mainly distributed in the middle layer to the surface layer of mucosa. Gastric oxyntic gland adenoma (gastric adenocarcinoma of the fundic gland type confined to mucosa) in 2 cases, gastric adenocarcinoma of the fundic gland type in 2 cases, and gastric adenocarcinoma of fundic gland mucosa type in 1 case. The tumor tissue was composed of branching tubular glands, except 1 case of mucosal surface epithelium was partially neoplastic, the other 4 cases of mucosal surface epi-thelium were all non-neoplastic; the cells were arranged in a single layer, and the nucleus was close to the basal side, and the nucleus was only slightly atypical. Pepsinogen I and H+/K+ ATPase were positive in 5 cases of gastric fundus gland type tumors, and 1 case of foveolar-type tumor cells at the surface and depth of mucosa showed MUC5AC positive. The gastric mucosa adjacent to cancer was generally normal in all cases, without atrophy, intestinal metaplasia and Hp. Conclusion: Hp-negative early gastric cancer is a heterogeneous disease group with various histological types, and tubular adenocarcinoma and signet-ring cell carcinoma are common. Tubular adenocarcinoma mostly occurs in the elderly and the upper to middle part of the stomach, while signet-ring cell carcinoma mostly occurs in young and middle-aged people and the lower part of the stomach. Gastric neoplasm of the fundic gland type is relatively rare.

Key words: Stomach neoplasms, Helicobacter pylori-negative, Clinical pathology, Endoscopic submucosal dissection

CLC Number: 

  • R735.2

Table 1

Comparison of clinicopathological characteristics of patients with different histological types of Helicobacter pylori-negative early gastric cancer"

Parameter Well differentiated adenocarcinoma
(n=18)		 Signet ring cell carcinomas
(n=7)		 Gastric neoplasm of fundic gland type
(n=5)
Gender
   Male 8 2 3
   Female 10 5 2
Age
   <60 years 6 7 2
   ≥60 years 12 0 3
Location
   Upper part 9 1 3
   Middle part 7 1 1
   Lower part 2 5 1
Tumor diameter
   ≤20 mm 13 7 5
   >20 mm 5 0 0
Paris classification
   0-Ⅱa 5 0 4
   0-Ⅱb 4 3 0
   0-Ⅱc 9 4 1
Depth of invasion
   pT1a 18 7 2
   pT1b 0 0 3
Phenotypes
   Gastric 10 3 -
   Intestinal 0 2 -
   Gastrointestinal 8 2 -
Mutation expression of p53
   Yes 4 0 0
   No 14 7 5

Figure 1

Well differentiated tubular adenocarcinoma in gastric mucosa A, the mucosa is in the shape of superficial protuberance, and deep stained tumor glands can be seen in the center, and the thickness of the mucosa on both sides is almost normal (HE ×20); B, the tumor glands are densely arranged with clear boundaries (HE ×100); C, tumor cells are positive for MUC5AC (IHC ×40); D, tumor cells are positive for MUC6 (IHC ×100)."

Figure 2

Signet ring cell carcinoma in gastric mucosa A, the mucosal tissue was generally normal, and the superficial area was weakly stained (HE ×20); B, the number of glands in the superficial layer of the mucosa decreases, and the morphology and distribution of glands in the deep layer of the mucosa are normal (HE ×100); C, signet ring cells can be seen in the superficial layer of mucosa, and the neck and narrow part of some glands are destroyed (HE ×200); D, signet ring cells are positive for MUC2 (IHC ×200)."

Figure 3

Gastric adenocarcinoma of fundic gland mucosa type A, the tumor tissue in the deep stained area in the middle of the mucosa infiltrates the submucosa, and the thickness of the mucosa on both sides is approximately normal (HE ×20); B, the tumor is composed of dense branched tubular glands with clear tumor boundaries (HE ×40); C, tumor cells involve the mucosal surface (HE ×200); D, tumor cells involve the gastric foveolar (HE ×100); E, MUC5AC is positive in foveolar epithelial cells on the mucosal surface and below (IHC ×100); F, tumor cells are positive for MUC6 (IHC ×100); G, tumor cells are positive for pepsinogenⅠ(IHC ×100); H, tumor cells are positive for H+/K+-ATPase (IHC ×100)."

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