Histopathological and histogenetic study of carcinoma stomach in a high risk area

Seventy gastrectomy specimens of carcinoma-stomach received at the Department of Pathology, Medical College, Calicut were prospectively studied. The carcinomas were classified according to Lauren (1965) and adjacent mucosa was studied for evidence of atrophic gastritis and intestinal metaplasia (IM). The scoring system of Lauren was applied in all cases to analyses histogenesis. In cases with histological evidence of intestinal carcinoma, the adjacent mucosa showed IM, suggesting that "intestinal carcinomas" arise from areas of intestinal metaplasia. However, nine of the histollogically "diffuse mucous cell" carcinomas also showed intestinal metaplasia, and four of them were "intestinal" and others "gastric" when Lauren's scoring was applied. In this study type I and type II metaplasia were seen with a total absence of type III colonic metaplasia, raising the question, whether complete small intestinal type metaplasia also has to be viewed as a pre-malignant condition, in high risk areas.