The pathologists’ eyes on foregut: histopathological relations in the experimental and routine diagnostics

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SUMMARY I. The study aimed to investigate the incidence of duodeno-gastroesophageal reflux-induced malignoma formation in a series of duodeno-esophageal anastomosis operations in rats. This surgical method provided a model for the reflux-induced esophageal pathologies, without carcinogen administration. 30 weeks of duodeno-gastroesophageal reflux disease significantly increased the risk of the development of BE, and reflux-induced EAC formation was evident in 4 animals. In one of these particular cases, a superficial squamous cell cancer was noted in close vicinity to the adenocarcinoma formation. The results of the applied rat model afford evidence of the simultaneous activation of more than one possible carcinogenetic pathway in experimental GERD. Synchronous neoplasm formation with different growth pattern characteristics is a rarity in humans, and this phenomenon suggests that the presented model is a suitable means of mimicking the whole spectrum of human GERD pathology. II/1. The study aimed to carry out standardized histopathological analysis focusing not only on SIM but also on the presence of additional glands in the metaplastic process at 826 consecutive patients. According to standardized histopathological dataset the cases were classified and recorded by computerized method. The obtained data proved that 1) pure SIM is very rare in the Hungarian population, 2) cardiac and superficial mucous glands are good predictors for SIM, 3) pancreatic acinar and fundic metaplasias carry less severe metaplastic process, and 4) superficial mucous glands can be responsible for creating foregut-derived tissues and thus can be the origin of BE. II/2. The study aimed to assess the value of forceps biopsy sampling in establishing the correct diagnosis revealed by EMR as well as to evaluate the efficacy of this method. Fifty-six subjects with sessile gastric polyps of epithelial origin, at least 0.5 cm in diameter, and not associated with polyposis syndromes, were included. The obtained data showed that forceps biopsy is not fully representative of the entire lesion, and a simple biopsy may therefore lead to a faulty differentiation between the neoplastic and non-neoplastic lesions. EMR proposes diagnostic and staging advantage in assessing patients with EGC as compared to forceps biopsy, because it provides more intact mucosa and submucosa for histological analysis. Sessile gastric polyps should be fully resected by EMR for a final diagnosis and (depending on the lesion size and type) possibly definitive treatment.

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