Elsevier

Human Pathology

Volume 33, Issue 4, April 2002, Pages 415-420
Human Pathology

Original Contributions
Epstein-Barr virus, p53 protein, and microsatellite instability in the adenoma-carcinoma sequence of the stomach*,**

https://doi.org/10.1053/hupa.2002.124718Get rights and content

Abstract

To elucidate the adenoma-carcinoma sequence in the stomach, we investigated Epstein-Barr virus (EBV) incorporation, p53 overexpression, and microsatellite instability (MSI) in gastric adenomas and carcinomas. The study involved 66 cases of gastric carcinomas within or adjacent to adenomas (adenoma-carcinoma cases), 81 cases of simple adenomas (without carcinoma), and 306 de novo carcinomas (without adenoma focus). EBV incorporation was revealed in 1 (1.5%) of the adenoma-carcinomas, in none of the adenomas, and in 17 (5.6%) of the de novo carcinomas. p53 overexpression was observed in 24.2% (16 of 66) of the adenomas in the adenoma-carcinoma cases and in 36.5% (23 of 63) of corresponding carcinomas (κ = 0.63, P = 0.00). MSI was positive in 12.3% (8 of 65) of the adenomas in the adenoma-carcinoma cases and in 18.8% (12 of 64) of the corresponding carcinomas (κ = 0.77, P = 0.00). In conclusion, EBV incorporation is not possibly associated with the gastric adenoma-carcinoma sequence, whereas the gastric adenoma-carcinoma sequence seems to be supported in terms of p53 overexpression or MSI. The transcriptional activation of EBV may occur relatively late (after the adenoma stage) in the gastric adenoma-carcinoma sequence. HUM PATHOL 33:415-420. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Specimens

Sixty-six surgically resected stomachs with a gastric adenoma focus adjacent to or within gastric carcinoma (Fig 1), 81 cases of simple gastric adenomas (without carcinoma), and 306 cases of de novo gastric carcinoma (without adenoma focus) were retrospectively identified from the surgical pathology files of Seoul National University Hospital.

. A case of gastric adenoma coexisting with gastric carcinoma. Note the adenoma focus in the right upper part, the well-differentiated adenocarcinoma in the

Clinicopathologic comparison between adenoma-carcinoma cases, simple adenomas, and de novo carcinomas

Clinicopathologic features are summarized in Table 1.

. Clinicopathologic features of the cases of gastric adenoma-carcinoma sequence, simple adenomas, and de novo carcinomas

Empty CellAdenoma-Carcinoma Sequence (n = 66)Empty CellEmpty CellEmpty Cell
Empty CellAdenomasCarcinomasSimple Adenomas (n = 81)De Novo Carcinomas (n = 306)P Value
Patients
 Age
  Mean61.44 years60.22 years54.49 years
  Range42–86 year28–82 years18–80 years
  Male:Female ratio50:1666:15208:98
Adenomas
 Histology
  Tubular4969Not significant
  Villotubular1010
  Villous72
 Grade
  High30230.03
  Low3658

Discussion

The present study is the first to demonstrate that EBV incorporation is not possibly associated with the gastric adenoma-carcinoma sequence and to suggest that transcriptional activation of EBV probably occurs relatively late (after the adenoma stage) in the gastric adenoma-carcinoma sequence, although it still remains unknown in case of gastric cancer unrelated to the adenoma-carcinoma sequence. In the present study, the cases of gastric carcinomas within or adjacent to adenomas (ie,

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    *

    Supported by the Seoul Municipal Boramae Hospital (grant 2000-01) affiliated with Seoul National University Hospital. Hee Sung Kim is funded by the BK21 Project for Medicine, Dentistry and Pharmacy.

    **

    Address correspondence and reprint requests to Woo Ho Kim, MD, Department of Pathology, Seoul National University College of Medicine 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea.

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