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Takemoto H, Kotachi T, Teshima H, Tamari H, Tsuboi A, Tanaka H, Yamashita K, Urabe Y, Ishikawa A, Oka S. Verrucous gastritis-like lesion in intramucosal Helicobacter pylori-uninfected signet ring cell carcinoma with poorly differentiated adenocarcinoma. Clin J Gastroenterol 2024; 17:412-418. [PMID: 38520641 PMCID: PMC11127841 DOI: 10.1007/s12328-024-01952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
In Japan, accessible Helicobacter pylori (Hp) eradication therapy is associated with an increase in the prevalence of gastric cancers (GCs) in Hp uninfected stomachs. Signet ring cell carcinoma (SRCC) is the most common of these GCs. Intramucosal SRCC with poorly differentiated adenocarcinoma (PDA) occurring in Hp uninfected gastric mucosa is rare; furthermore, many Hp uninfected pure SRCCs exhibit discoloration and flat or slightly depressed lesions, and morphological elevation is relatively rare. We report a case of intramucosal SRCC with PDA with an elevated, verrucous gastritis-like lesion in a 57-year-old male patient. In the present case, the PDA area showed dense tumor cell growth and coexisting desmoplastic and fibrotic reactions. Histopathology and immunohistochemical staining identified extensive fibromuscular obliteration with smooth muscle bundles extending from the muscularis mucosa into the lamina propria. The patient underwent curative endoscopic submucosal dissection. The reporting and analysis of such rare cases may lead to a better understanding of the characteristics of advanced Hp uninfected GCs.
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Affiliation(s)
- Hiroki Takemoto
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Takahiro Kotachi
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan.
| | - Hajime Teshima
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Hirosato Tamari
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Akiyoshi Tsuboi
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Akira Ishikawa
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan
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Shiotsuki K, Takizawa K, Ono H. Indications of Endoscopic Submucosal Dissection for Undifferentiated Early Gastric Cancer: Current Status and Future Perspectives for Further Expansion. Digestion 2021; 103:76-82. [PMID: 34736250 DOI: 10.1159/000519650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a widely accepted and minimally invasive treatment for early gastric cancer (EGC) without the risk of lymph node metastasis (LNM). However, undifferentiated-type EGC (UD-EGC) is considered to have a relatively high risk of LNM. Recently, the Japan Clinical Oncology Group conducted a nonrandomized confirmatory trial (JCOG1009/1010) to evaluate the efficacy and safety of ESD for UD-EGC. Herein, we review the results of JCOG1009/1010 and the possibility of further expanding the indications for ESD. SUMMARY JCOG1009/1010 showed excellent technical results and 5-year overall survival in patients with UD-EGC. Based on the results, ESD for UD-EGC (cT1a) of ≤2 cm without ulceration was technically feasible and acceptable for standard treatment instead of gastrectomy with lymph node dissection. A review of the EGC of mixed histological type (mixed EGC) suggested that the mixed EGC might have worse biological behavior than the pure histological type. In cases of intramucosal EGC with pure signet-ring cell carcinoma or presenting a double-layer structure, the risk of LNM might be relatively low. Thus, there is a possibility of further expanding the indications or curative evaluations. In the case of UD-EGC after noncurative resection, the data suggest that the eCura system may be applicable to UD-EGC; however, due to the small number of cases, further study is warranted. Key Message: This review summarizes the present knowledge regarding indications for UD-EGC and the possibility of further expanding them.
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Affiliation(s)
- Kazuo Shiotsuki
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Department of Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, Hokkaido, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Togasaki K, Sugimoto S, Ohta Y, Nanki K, Matano M, Takahashi S, Fujii M, Kanai T, Sato T. Wnt Signaling Shapes the Histologic Variation in Diffuse Gastric Cancer. Gastroenterology 2021; 160:823-830. [PMID: 33217450 DOI: 10.1053/j.gastro.2020.10.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Diffuse-type gastric cancer (GC) is currently subdivided into signet-ring cell carcinoma (SRCC) and non-SRCC, referred to as poorly cohesive carcinoma not otherwise specified (PCC-NOS). Although these subtypes are considered to be independent, they often coexist in the same tumors, raising a question of whether they clonally differ or not. To tackle this question, we established an experimental platform for human diffuse GC that enables accurate modeling of histologic subtypes. METHODS Seven patient-derived diffuse GC organoid lines were established, characterized by histopathologic analysis, in situ hybridization, and gene expression analysis. For genetic modeling of diffuse GC, we knocked out CDH1 and/or TP53 in human normal gastric organoids. Green fluorescent protein-labeled GC organoids were xenotransplanted into immune-deficient mice for in vivo assessment. RESULTS PCC-NOS organoids transformed into SRCC-like structures on removal of Wnt and R-spondin from the culture medium. This morphologic change paralleled downregulation of Wnt-target and gastric stem cell genes, including LGR5, and elevation of differentiation markers, such as KRT20 and MUCs. The association between Wnt target gene expression and histologic subtypes was confirmed in 3 patient-derived GC tissues. In vivo, single clone-derived organoids formed tumors that comprised 2 distinct histologic compartments, each corresponding to SRCC and PCC-NOS. The transition from PCC-NOS to SRCC histology reflected the abundance of surrounding R-spondin-expressing fibroblasts. CONCLUSIONS SRCC and PCC-NOS were clonally identical, and their morphology was regulated by extracellular Wnt and R-spondin expression. Our results decoded how genetic mutations and the tumor environment shape pathohistologic and biologic phenotypes in human diffuse GCs.
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Affiliation(s)
- Kazuhiro Togasaki
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan
| | - Shinya Sugimoto
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Ohta
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kosaku Nanki
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan
| | - Mami Matano
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Sirirat Takahashi
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Fujii
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan.
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Murai K, Takizawa K, Shimoda T, Fujii S, Sugino T, Yoshida M, Kawata N, Tanaka M, Kakushima N, Terashima M, Ono H. Effect of double-layer structure in intramucosal gastric signet-ring cell carcinoma on lymph node metastasis: a retrospective, single-center study. Gastric Cancer 2019; 22:751-758. [PMID: 30523555 DOI: 10.1007/s10120-018-00905-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among all types of gastric cancer (GC), signet-ring cell carcinoma (sig-GC) accounts for 4-17% of cases. The prognosis of early sig-GC is relatively good, with the 5-year survival rate at 99.7%. However, the correlation between histological features and lymph node metastasis (LNM) among pT1a (M) sig-GC remains unclear. Sig-GC often exhibits a double-layer structure (DLS) in the intramucosal layer, demonstrating functional differentiation into the normal gastric gland. Assumedly, the loss of the differentiation makes the DLS deranged, accounting for the occurrence of submucosal invasion and LNM. This study aimed to assess the proportion of DLS, to elucidate the correlation between histological features (including DLS) and LNM status, and to determine the LNM-negative condition in pT1a (M) sig-GC. METHODS We reviewed the pathological data of 310 patients with 310 intramucosal sig-GCs who received gastrectomy with lymph node dissection. Immunohistochemistry was performed on all specimens to evaluate the presence of DLS. Furthermore, we review the clinicopathological features, including tumor size, lymphovascular invasion (LVI), ulceration (UL), and DLS results, and then statistically analyze the correlation between these features and LNM status. RESULTS Overall, 129 pT1a (M) sig-GCs (42%) were DLS present. The univariate analysis revealed that "Tumor size > 20 mm", "UL present", and "DLS absent" were significant risk factors of LNM. The multivariate logistic regression analysis revealed only "DLS absent" as statistically significant. CONCLUSIONS "DLS absent" is a risk factor of LNM detected by the multivariate analysis. In pT1a (M), LVI absent, UL absent, tumor size > 20 mm, sig-GC, no LNM occurred in "DLS present" cases.
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Affiliation(s)
- Katsuyuki Murai
- Division of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tadakazu Shimoda
- Division of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan.
| | - Shougo Fujii
- Division of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masaki Tanaka
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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RHOA mutations and CLDN18-ARHGAP fusions in intestinal-type adenocarcinoma with anastomosing glands of the stomach. Mod Pathol 2019; 32:568-575. [PMID: 30425335 DOI: 10.1038/s41379-018-0181-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022]
Abstract
A subtype of intestinal-type adenocarcinoma of the stomach, characterized by low-grade cytological atypia and anastomosing glands, has been described in several reports under different names. One of the remarkable features of these lesions, herein referred to as intestinal-type adenocarcinoma with anastomosing glands, is the frequent association of poorly differentiated adenocarcinoma components. Here we analyzed 44 intestinal-type adenocarcinomas with anastomosing glands focusing on the molecular abnormalities that are common in diffuse-type gastric cancers. Next-generation sequencing identified RHOA and CDH1 mutations in 22 (50%) and one lesion (2%), respectively. Reverse transcription-PCR detected CLDN18-ARHGAP fusions in three lesions (7%). Immunohistochemically, none of the lesions showed abnormal p53 expression patterns whereas focal and diffuse loss of ARID1A was observed in four and one lesion, respectively. Examination of 37 lesions of dysplasia and 26 usual-type intramucosal adenocarcinomas identified one RHOA mutation in adenocarcinoma and no CLDN18-ARHGAP fusions, indicating that these genetic alterations are highly specific to intestinal-type adenocarcinomas with anastomosing glands among differentiated-type intramucosal neoplasms. The present study showed that intestinal-type adenocarcinoma with anastomosing glands represents a genetically distinct group of tumors with the frequent presence of RHOA mutations and CLDN18-ARHGAP fusions, which are thought to be specific to diffuse-type gastric cancers.
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Vo DTN, Nakayama T, Yamamoto H, Mukaisho KI, Hattori T, Sugihara H. Progression risk assessments of individual non-invasive gastric neoplasms by genomic copy-number profile and mucin phenotype. BMC Med Genomics 2015; 8:6. [PMID: 25881098 PMCID: PMC4346124 DOI: 10.1186/s12920-015-0080-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 02/03/2015] [Indexed: 12/18/2022] Open
Abstract
Background Early detection and treatment of non-invasive neoplasms can effectively reduce the incidence of advanced gastric carcinoma (GC), but only when the lineage is continuous between non-invasive and advanced tumours. Although a fraction of non-invasive neoplasms progress to invasive GC, it is difficult to identify individual progression-prone non-invasive neoplasms. To classify non-invasive gland-forming gastric neoplasms into clusters of different levels of progression risk, we applied mucin phenotyping and genomic DNA microarray analyses to intramucosal gland-forming gastric neoplasms. Methods Formalin-fixed, paraffin-embedded tissues from 19 non-invasive and 24 invasive gland-forming neoplasms were obtained via endoscopic submucosal dissection or surgical excision. According to the Vienna classification, intramucosal neoplasms were classified as low-grade or high-grade non-invasive neoplasms (LGNs [category 3] and HGNs [category 4], respectively) or invasive carcinomas (intramucosal GCs and mucosal parts of submucosal or deeper GCs [category 5]). Neoplastic lesions were characterized by mucin phenotypes determined using monoclonal antibodies against MUC2, MUC5AC, MUC6, and CD10. Genomic DNA samples from mucosal neoplasms were subjected to array-based comparative genomic hybridization and subsequent unsupervised, hierarchical clustering with selected large-sized genes. Results There was no significant difference in mucin phenotype between HGNs/LGNs and invasive carcinomas. The clustering classified samples into stable, unstable, and intermediate. The histological tumour grade or mucin phenotype of non-invasive neoplasms did not correlate with the clustering results. Each cluster may represent an independent lineage of different outcome because the size distribution of non-invasive tumours among the 3 clusters almost overlapped. In contrast, the unstable cluster alone included invasive carcinomas. Conclusions These findings suggest that the outcome of individual tumours is not stochastically determined but can be predicted from the genomic copy-number profile even at the non-invasive stage. Non-invasive neoplasms of the unstable clusters, which accounted for 21% of non-invasive neoplasms, may progress to invasive carcinomas, whereas those of stable cluster may not. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0080-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diem Thi-Ngoc Vo
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
| | - Takahisa Nakayama
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
| | - Hiroto Yamamoto
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
| | - Ken-ichi Mukaisho
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
| | - Takanori Hattori
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
| | - Hiroyuki Sugihara
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, 520-2192, Japan.
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Nishimura R, Mukaisho KI, Yamamoto H, Sonoda A, Andoh A, Fujiyama Y, Hattori T, Sugihara H. Precursor-derived versus de-novo carcinogenesis depends on lineage-specific mucin phenotypes of intramucosal gland-forming gastric neoplasms. Histopathology 2013; 63:616-29. [PMID: 24033890 DOI: 10.1111/his.12208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 06/15/2013] [Indexed: 11/29/2022]
Abstract
AIMS To clarify the lineage-specific carcinogenesis of gland-forming gastric neoplasms, by characterizing mucin phenotypes and proliferation patterns immunohistochemically using monoclonal antibodies against MUC2, MUC5AC, MUC6, CD10 and Ki67. METHODS AND RESULTS We analysed 49 gland-forming intramucosal neoplasms, including 15 non-invasive low-grade neoplasms (group A), 10 non-invasive high-grade neoplasms (group B) and 24 intramucosal adenocarcinomas (group C). The mode of gland-forming gastric carcinoma development was different between the intestinal and gastric lineages. The pure intestinal-type accounted for 93% of group A, 50% of group B and 4.2% of group C tumours. A zonal pattern of cell proliferation was well retained in group A tumours and was lost size-dependently in group B tumours. These findings suggest that non-invasive low-grade neoplasms of the intestinal lineage progress to non-invasive high-grade neoplasms, but rarely to intramucosal adenocarcinomas. In tumours of the gastric lineage, which exhibited pure gastric or mixed phenotypes, the polarity of cell proliferation and differentiation was well retained in small (≦5 mm) tumours but was lost in larger tumours in groups B and C. CONCLUSIONS Intramucosal adenocarcinomas of the gastric lineage may often arise de novo, develop in the proper gastric mucosa, and are partially derived from non-invasive high-grade neoplasms.
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Affiliation(s)
- Rie Nishimura
- Department of Pathology, Division of Molecular Diagnostic Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan; Department of Internal Medicine, Division of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Sonoda A, Mukaisho KI, Nakayama T, Diem VTN, Hattori T, Andoh A, Fujiyama Y, Sugihara H. Genetic lineages of undifferentiated-type gastric carcinomas analysed by unsupervised clustering of genomic DNA microarray data. BMC Med Genomics 2013; 6:25. [PMID: 23866769 PMCID: PMC3728264 DOI: 10.1186/1755-8794-6-25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 07/11/2013] [Indexed: 12/13/2022] Open
Abstract
Background It is suspected that early gastric carcinoma (GC) is a dormant variant that rarely progresses to advanced GC. We demonstrated that the dormant and aggressive variants of tubular adenocarcinomas (TUBs) of the stomach are characterized by loss of MYC and gain of TP53 and gain of MYC and/or loss of TP53, respectively. The aim of this study is to determine whether this is also the case in undifferentiated-type GCs (UGCs) of different genetic lineages: one with a layered structure (LS+), derived from early signet ring cell carcinomas (SIGs), and the other, mostly poorly differentiated adenocarcinomas, without LS but with a minor tubular component (TC), dedifferentiated from TUBs (LS−/TC+). Methods Using 29 surgically resected stomachs with 9 intramucosal and 20 invasive UGCs (11 LS+ and 9 LS−/TC+), 63 genomic DNA samples of mucosal and invasive parts and corresponding reference DNAs were prepared from formalin-fixed, paraffin-embedded tissues with laser microdissection, and were subjected to array-based comparative genomic hybridization (aCGH), using 60K microarrays, and subsequent unsupervised, hierarchical clustering. Of 979 cancer-related genes assessed, we selected genes with mean copy numbers significantly different between the two major clusters. Results Based on similarity in genomic copy-number profile, the 63 samples were classified into two major clusters. Clusters A and B, which were rich in LS+ UGC and LS−/TC+ UGC, respectively, were discriminated on the basis of 40 genes. The aggressive pattern was more frequently detected in LS−/TC+ UGCs, (20/26; 77%), than in LS+UGCs (17/37; 46%; P = 0.0195), whereas no dormant pattern was detected in any of the UGC samples. Conclusions In contrast to TUBs, copy number alterations of MYC and TP53 exhibited an aggressive pattern in LS+ SIG at early and advanced stages, indicating that early LS+ UGCs inevitably progress to an advanced GC. Cluster B (enriched in LS−/TC+) exhibited more frequent gain of driver genes and a more frequent aggressive pattern than cluster A, suggesting potentially worse prognosis in UGCs of cluster B.
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Affiliation(s)
- Ayano Sonoda
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu 520-2192, Japan
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Re-evaluation of phenotypic expression in undifferentiated-type early gastric adenocarcinomas using mucin core protein and CDX2. Gastric Cancer 2013; 16:208-19. [PMID: 22829163 DOI: 10.1007/s10120-012-0172-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undifferentiated-type early gastric adenocarcinomas are generally classified into two groups: pure undifferentiated-type adenocarcinomas, which naturally develop as undifferentiated-type without a glandular component; and mixed differentiated/undifferentiated-type adenocarcinomas, which are associated with some vestigial glandular component and presumably develop from differentiated-type adenocarcinoma. The differences in phenotypic expression between these two groups were examined using mucin core protein and CDX2. METHODS A total of 210 lesions of undifferentiated-type early gastric adenocarcinoma less than 25 mm in diameter were classified into four categories (gastric type, gastrointestinal type, intestinal type, and null type) based on their MUC5AC, MUC6, MUC2, and CDX2 immunoprofiles. RESULTS Gastric type was significantly (p < 0.01) decreased and gastrointestinal type was significantly (p < 0.01) increased both in pure undifferentiated-type adenocarcinomas and in mixed differentiated/undifferentiated-type adenocarcinomas when CDX2 was applied to mucin core protein. In the pure undifferentiated-type adenocarcinomas, gastric type decreased and gastrointestinal type increased as tumor size increased (p < 0.05). In contrast, in the mixed differentiated/undifferentiated-type adenocarcinomas, gastrointestinal type was most common even in small-sized (≤10 mm) carcinomas and was generally stable regardless of tumor size. In submucosal carcinomas, gastrointestinal type decreased and gastric type and intestinal type increased during carcinoma invasion from the intramucosal to submucosal parts (p < 0.05). The positivity rates for all phenotypic markers, especially gastric markers, tended to decrease during submucosal invasion. CONCLUSIONS CDX2 is a sensitive marker for assessing intestinal phenotypic expression, and it is likely that there are two different pathways of tumor progression in undifferentiated-type adenocarcinoma of the stomach, according to phenotypic expression.
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Zhou ZH, Zhang JD, Zhao HB, Zhao LN, Shan BZ. Cell origin and premalignant lesions of gastric signet-ring cell carcinoma: a histopathologic study. Shijie Huaren Xiaohua Zazhi 2010; 18:2001-2006. [DOI: 10.11569/wcjd.v18.i19.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the cell origin and premalignant lesions of gastric signet-ring cell carcinoma (SRCC).
METHODS: A total of 42 cases of early gastric SRCC were included in this study. The histological morphology of gastric SRCC was observed. Differentiation markers MUC5AC and MUC6 were labeled by immunohistochemical double-staining of gastric SRCC tissue. The expression of Ki-67 and gastrointestinal stem/progenitor cell marker musashi-1 in SRCC was detected by immunohistochemistry. Additionally, the immunophenotype of gastric glands adjacent to carcinoma was also detected.
RESULTS: Early gastric SRCC was characterized by a two-layered structure consisting of superficial layer and basal layer. The superficial layer contained typical large signet-ring cells that possessed abundant cytoplasm, whereas the basal layer was composed of small-sized primitive cancer cells with a high nucleus/cytoplasm ratio. Cells in the basal layer shared common morphologic features and a similar anatomic location with those in the proliferative zone of gastric glands. These cells were negative for both MUC5AC and MUC6, or merely exhibited a weak MUC5AC expression. Compared with the superficial layer, the percentages of Ki-67- and musashi-1-positive cells were significantly higher in the basal layer (t = 31.0 and 22.8, respectively, both P < 0.01). Cells in the basal layer could differentiate into typical signet-ring cells, which resembles the differentiation process of proliferitive zone cells into gastric pit cells. Dysplasia of the proliferative zone of gastric glands adjacent to SRCC was noted, and dysplastic cells in the proliferative zone were phenotypically consistent with cancer cells in the basal layer.
CONCLUSION: Gastric SRCC may originate from MUC5AC-/lowMUC6- pre-pit cells in the proliferative zone of gastric glands. Dysplasia of the proliferative zone may represent the premalignant lesions of gastric SRCC.
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