Table 2 Clinicopathological features of glandular atrophy of lamina propria in 896 cases
Type | Histopathological features (deep area of the gastric fovea, the isthmus of the gastric gland and the proliferating area of the glandular neck) | Immunophenotype | Clinically relevant | |||
|---|---|---|---|---|---|---|
Structure | Morphology | Mitotic pattern | Cell nucleus | |||
Lamellar gland simple atrophy | Generally normal Glands number ↓ Gland volume ↓ Glandular nterval ↑ | No significant change The number of basal glands of the gastric gland is reduced by 1/3 of the original glands | 0 ~ 2 /10HPF | Generally normal | MUC6 positive cells ↓; MUC5AC positive cells ↓ (possible). The positive number of ki67 in the proliferating zone 5% ~ 15% | Mainly occur in the elderly; Caused by the slow down of normal physiological migration of the proliferative zone. |
Lamina propria simple heavy atrophy | Generally normal Glands number ↓ Gland volume ↓ Glandular nterval ↑↑ Collagen fibers ↑ Lymphocytes ↑ Plasma cells ↑ Smooth muscle fiber bundles (+) | No significant change The number of basal glands of the gastric gland is reduced by more than 1/3 of the original glands. | 0 ~ 3 /10HPF | Generally normal | MUC6 positive cells ↓↓ MUC5AC positive cells ↓. The positive number of ki67 in the proliferating zone 2% ~ 10% | Degenerative changes in the elderly; Can be seen in the influence of chemical stimulation, autoimmune diseases and genetic factors. |
Glandular atrophy, proliferation and transformation | Cells proliferated significantly | The adenomatous proliferation: single to multi-glandular tubules; Lumpy distribution; Gradually enlargement | 1 ~ 3 /HPF | Volume increased (1 ~ 2 times of normal nucleus) nucleoli: small | CK20 (+/-) CK7 (+/-) The positive number of ki67 20–30% | Atrophy of the pyloric/fundus/cardia glands; Mainly seen in gastric mucosa affected by H.pylori infection and other factors. |
Glandular atrophy low grade intraepithelial neoplasia | Atypical epithelial cell hyperplasia: light to moderate | Low grade internal neoplasia occupies part or whole layer of gastric mucosa | 2 ~ 4 /HPF | The nuclei: elongated and polar; The nucleoli: small to medium size | CDX2 (+/-) Villin (+/-) CK20 (+/-). The positive number of ki67 30–40%. | Requires follow-up or endoscopic treatment |
Glandular atrophy high-grade intraepithelial neoplasia | Atypical epithelial cell hyperplasia: medium to severe | High-grade internal neoplasia occupy part or all of the gastric mucosa; Cells changed from columnar to cube-shaped | 2 ~ 6 /HPF | The nuclei: large; The nucleolar ratio: increased; The nucleoli: obvious. | CDX2 (+) villin (+) p53 (+) The number of ki67 positive 30–50% | Requires endoscopic ESD resection |
Gastric intramucosal carcinoma | Evolve into cancer cells | Cancer cells confined to the mucosa, part of the mucosa or the whole mucosa; Do not invade the submucos. |  | The nuclei: large or irregularity; The nucleoli: obvious or irregularity. | CDX2 (+) villin (+) p53 (+) The number of ki67 positive 30–80% | Histopathological papillary, glandular, sig-ring cells and undifferentiated carcinoma |