The pathological sequence in the development of gastric cancer .2.

Studies of gastric microcarcinomas (size: 5 mm or less in diameter) have highlighted the importance of intestinal metaplasia in the development of gastric cancer. In this study, a consecutive selection of 57 microcarcinomas were examined and classified: 16 were gastric-phenotype tumours and 41 were predominantly intestinal-phenotype tumours. Intestinal metaplasia was severe within the surrounding mucosa of 31 of these intestinal-type carcinomas, moderate in 7 and mild in 3. Residual (pseudo) pyloric glands were found below the centre of 22 of the 41 intestinal-type tumours, but the centre of the remaining 19 tumours occupied the full thickness of the mucosa. It is suggested that intestinal-type microcarcinomas develop in the intestinalized mucosa or in the double-phenotypic mucosa (i.e. with intestinal type in the upper part and gastric type in the lower part). Understanding the relationship between intestinal metaplasia and gastric cancer may help to clarify the involvement of Helicobacter pylori in gastric cancer.