Evolution of precancerous changes in the gastric mucosa. A case report

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Abstract

To present the experience of long-term observation of a patient with atrophic and dysplastic measurements of the gastric mucosa, to try to analyze the correctness of treatment, dynamic observation.

The analysis included the period from 2008 to 2022. 19 esophagogastroduodenoscopies were performed. A histological study was conducted according to the Operative Link for Gastritis Assessment. Neoplastic changes were evaluated according to the World Health Organization classification of gastrointestinal tumors of 2019. The evolution of changes was observed under conditions of limited possibility of eradication of Helicobacter pylori due to intolerance to antibacterial drugs.

During 14 years of follow-up, the endoscopic picture did not demonstrate significant changes. In each study, atrophy of the gastric mucosa was noted; in most cases no intestinal metaplasia and hyperplasia, erosion, ulcers, and neoplasms of the examined segments were detected. According to the histology, atrophy, intestinal metaplasia and hyperplastic changes in the gastric mucosa, Helicobacter pylori were constantly present from 2008 to 2013. Unsuccessful attempts of eradication were made. In 2013 low-grade intraepithelial neoplasia was detected, and in 2014 — local high-grade intraepithelial neoplasia. Due to the small-scale nature of the changes, the observation tactics were continued. In 2015, against the background of persistent intraepithelial neoplasia of an indeterminate nature, an attempt was made to eradicate Helicobacter pylori. In 2016, a regression of neoplastic changes to low-grade intraepithelial neoplasia was recorded. From 2016 to 2022, there was a stabilization of inflammatory and atrophic changes. Intraepiteal neoplasia of the gastric mucosa and Helicobacter pylori did not recur.

The observation is notable for the fact that for 7 years it was impossible to carry out Helicobacter pylori eradication therapy. There was no negative dynamics for 5 years. In the period from 2013 to 2015, high-grade intraepithelial neoplasia of gastric mucosa was formed. The situation changed with the introduction of antibacterial therapy, after which neoplastic changes regressed and a stable picture was observed over the next 6 years. Despite the observations of various specialists, the availability of objective and reliable information, and the decisions made on its basis allowed to prevent the development of stomach cancer.

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About the authors

Alexander V. Tryapitsin

Saint Petersburg State University

Email: tryapitsin@gmail.com
SPIN-code: 3773-2304

MD, Cand. Sci. (Med.)

Russian Federation, 154 Fontanka river Emb., Saint Petersburg, 190103

Vladimir A. Malkov

Saint Petersburg State University

Email: wladimir.malkow@gmail.com
SPIN-code: 5350-2074

MD

Russian Federation, 154 Fontanka river Emb., Saint Petersburg, 190103

Emil M. Gasanov

Saint Petersburg State University

Email: gasanov-emil15@mail.ru
SPIN-code: 2537-7071

MD

Russian Federation, 154 Fontanka river Emb., Saint Petersburg, 190103

Ilya A. Belyakov

National Center for Clinical Morphological Diagnostics

Author for correspondence.
Email: zavpao@ncmd.ru
SPIN-code: 3239-3584

MD

Russian Federation, Saint Petersburg

References

  1. Kaprin AD, Starinskii VV, Shakhzadova AO, et al. Zlokachestvennye novoobrazovaniya v Rossii v 2020 godu (zabolevaemost’ i smertnost’). Moscow: MNIOI im. P.A. Gertsena; 2021. 252 p. (In Russ.)
  2. Bakulin IG, Pirogov SS, Bakulina NV, et al. Prophylaxis and early diagnosis of stomach cancer. Russian Journal of Evidence-Based Gastroenterology. 2018;7(2):44–58. (In Russ.) doi: 10.17116/dokgastro201872244
  3. Maev IV, Samsonov AA, Andreev DN. Infektsiya Helicobacter pylori. Moscow: GEHOTAR-Media; 2016. (In Russ.)
  4. Lee YC, Chen TH, Chiu HM, et al. The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention. Gut. 2013;62:676–682. doi: 10.1136/gutjnl-2012-302240
  5. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71:1724–1762. doi: 10.1136/gutjnl-2022-327745
  6. Nagtegaal ID, Odze RD, Klimstra D. The 2019 WHO classification of tumors of the digestive system. Histopathology. 2020;76(2):182–188. doi: 10.1111/his.13975
  7. German SV, Zykova IYe, Modestova AV, Yermakov NV. Prevalence of infection H. pylori in Moscow population The Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2010;20(2):25–30. (In Russ.)
  8. Zakharova NV, Simanenkov VI, Bakulin IG, et al. Prevalence of Helicobacter pylori infection in gastroenterological patients in Saint Petersburg. Farmateka. 2016;(S5):33–39. (In Russ.)
  9. Tryapitsyn AV, Malkov VA, Gasanov EM, Belyakov I. Chronic gastritis and precancerous diseases of the stomach: Is there a chance of a correct diagnosis? Herald of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):85–102. (In Russ.) doi: 10.17816/mechnikov60431
  10. Baranskaya EK, Ivashkin VT. Klinicheskii spektr predrakovoi patologii zheludka. The Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2002;(3):7–14. (In Russ.)
  11. Di Gregorio C, Morandi P, Fante R, De Gaetani C. Gastric dysplasia. A follow-up study. Am J Gastroenterol. 1993;88(10):1714–1719.
  12. Farinati F, Rugge M, Di Mario F, et al. Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients. A prospective study. I.G.G.E.D. — Interdisciplinary Group on Gastric Epithelial Dysplasia. Endoscopy. 1993;25(4):261–264. doi: 10.1055/s-2007-1010310
  13. Fertitta AM, Comin U, Terruzzi V, et al. Clinical significance of gastric dysplasia: a multicenter follow-up study. Gastrointestinal Endoscopic Pathology Study Group. Endoscopy. 1993;25(4):265–268. doi: 10.1055/s-2007-1010311
  14. Pathology and genetics of tumours of the digestive system. S.R. Hamilton, L.A. Aaltonen (editors). Lyon: ARC Press; 2000. doi: 10.1046/j.1365-2559.2001.01219.x
  15. Rugge M, Farinati F, Di Mario F, et al. Gastric epithelial dysplasia: a prospective multicenter follow-up study from the Interdisciplinary Group on Gastric Epithelial Dysplasia. Hum Pathol. 1991;22(10):1002–1008. doi: 10.1016/0046-8177(91)90008-d
  16. Rugge M, de Boni M, Pennelli G, et al. Gastritis OLGA staging and gastric cancer risk: a twelve-year clinico-pathological follow-up study. Aliment Pharmacol Ther. 2010;31(10):1104–1111. doi: 10.1111/j.1365-2036.2010.04277.x
  17. Rugge M, Correa P, Dixon M, et al. Gastric Dysplasia: The Padova International Classification. Am J Surg Pathol. 2000;24(2):167–176. doi: 10.1097/00000478-200002000-00001
  18. de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology. 2008;134(4):945–952. doi: 10.1053/j.gastro.2008.01.071
  19. Tryapitsyn AV, Mal’kov VA. The role and diagnostic value of the most common methods for diagnosing Helicobacter pylori infection. Herald of North-Western State Medical University named after I.I. Mechnikov. 2019;11(4):59–66. (In Russ.) doi: 10.17816/mechnikov201911459-66

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2. Fig. 1. Gastric body mucosa with moderate lymphoplasmocytic infiltration of its own plate, moderate atrophic component, pseudopiloric epithelial metaplasia, focal complete intestinal metaplasia. The arrows indicate the glands with goblet cells and intestinal epithelium. 100× magnification. Hematoxylin-eosin staining

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3. Fig. 2. The mucous membrane of the antrum of the stomach with weak lymphoplasmocytic infiltration of its own plate, a weak atrophic component. 100× magnification. Hematoxylin-eosin staining

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4. Fig. 3. 2021. The mucous membrane of the antrum of the stomach with weak lymphoplasmocytic infiltration of its own plate, focal complete intestinal metaplasia. The arrows indicate the gland with goblet cells and intestinal epithelium. 100× magnification. Hematoxylin-eosin staining

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5. Fig. 4. 2022. The mucous membrane of the stomach body with weak lymphoplasmocytic infiltration of its own plate, moderate atrophic component, pseudopiloric metaplasia of the epithelium, focal complete intestinal metaplasia. The arrows indicate the glands with goblet cells and intestinal epithelium. 100× magnification. Hematoxylin-eosin staining

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6. Fig. 5. 2022. The mucous membrane of the antrum of the stomach with weak lymphoplasmocytic infiltration of its own plate. Positive dynamics in the form of disappearance of the glands with complete intestinal metaplasia. 100× magnification. Hematoxylin-eosin staining

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