Early gastric carcinoma diagnosed on endobiopsic and surgical specimens

Early gastric carcinoma (EGC) is difficult to diagnose without a screening program.

In this study, we reveal the importance of endobiopsy in EGC diagnosis.

We examined multiple gastric endobiopsies from 1,201 patients with or without symptoms and endoscopical aspect for gastric carcinoma. All specimens were fixed in 15% buffered neutral pH formaldehyde and paraffin embedded. Histological sections were stained using current techniques: Hematoxylin-Eosin, trichromic van Gieson, Giemsa (for Helicobacter pylori) and Alcian blue, pH 1 and 2.5 (for acid and sulfated mucins). We used Laurén histological classification with two main types of gastric carcinoma: intestinal and diffuse.

From 1,201 gastric endobiopsies, we diagnosed gastric carcinoma in 257 patients (21.3%) and only four of them were EGCs, although their endoscopical examination was negative for gastric tumor. Among these malignant proliferations, three cases showed intestinal type EGC and one case was diffuse type EGC. The additional endobiopsies fragments presented chronic atrophic gastritis with H. pylori infection, intestinal metaplasia and dysplasia.

EGC had an incidence of 0.34%, which is very low because the lack of an endoscopical screening program favors the diagnosis of gastric cancer in advanced stages. Both histological types--intestinal and diffuse, were present in EGC, associated with H. pylori chronic gastritis, intestinal metaplasia and dysplasia. The presence of dysplasia recommends the endoscopical surveillance of these patients.