Epithelial dysplasia of the gastric mucosa – The cytological diagnosis of diseases of the alimentary canal

Due to changes in the secretory function of the glandular cells, two types of epithelial dysplasia of the gastric mucosa:

• Giposekretorny;
• Hyper(Thesis)secretory.

Both are accompanied by severe proliferation of the columnar epithelium of the stomach with signs of cellular atypia. These changes are often combined with intestinal metaplasia.

Giposekretornogo dysplasia type characterized by a decrease in the number of epithelial cells secretory granules. It may occur in two variants.

In the first version giposekretornoy dysplasia epithelial cells of cylindrical shape, slightly increased, part of polychrome, often with elongated hyperchromatic nucleus, settling down basal, and clear cytoplasm. Such changes are observed in low-grade dysplasia (I степени).

In cases of moderate dysplasia (II степени) these changes strengthened the larger core, displaced in the central parts of the cells.

In severe dysplasia (III степени) polymorphic cell nuclei. In addition there are bright hyperchromatic nuclei with well-contoured nucleoli. They are located at different levels of the nucleus cells, as if randomly. The cells are immature.

The second option giposekretornoy dysplasia characterized, that the epithelial cells acquire a cubic shape. This option can also be dysplasia three degrees.

When mild dysplasia cubic epithelium presented monomorphic cells with roundish, basal nuclei located with fine-grained chromatin. One viewed, less two small nucleoli, basophilic cytoplasm, It contains few secretory granules. For moderate dysplasia characterized by enlarged cells with large pale, multiple polymorphic nuclei polychrome, containing fine, unevenly distributed chromatin. In the nuclei of visible nucleoli ortohromnye. In some places there are cells with elongated hyperchromatic nucleus.

For severe dysplasia giposekretornoy the second embodiment is characterized polihromaziya polymorphism and moderate mucosal epithelium. Kernels light, round or oval, with coarse-grained chromatin, condensing under karyotheca. Nucleoli are large. Besides, there may be elongated hyperchromatic nuclei. The cells are arranged separately, groups and clusters papilliform. Secreting granules in the cytoplasm is almost no.

When hyper dysplasia(Thesis) secretory type there is a significant accumulation of granules in the cytoplasm of Secrets. Cytochemical revealed intensively positive PAS-reaction. Epithelial cells elongate, acquire a cylindrical shape. Kernels round, relatively light, They are basal. There are cells with oval nuclei lie centrally.

For mild dysplasia characterized by monomorphic high cylindrical epithelium cells.

Moderately severe dysplasia manifests the, cells acquire similarity to goblet, often located clusters, the secret of their intense PAS-positive. Severe dysplasia is accompanied by an increase in epithelial cells and their nuclei enlargement. Epithelial cells resemble goblet, arranged disorderly clusters. Due to the accumulation of secretions in the cytoplasm to the nucleus pushed tsitolemmy, become more hyperchromatic, compacted or become sickle-shaped, with the nuclear-cytoplasmic ratio can be reduced.

In case of epithelial dysplasia of the gastric mucosa pronounced degree in peptic ulcer, chronic gastritis, polyps of the stomach is suspected malignant process. Symptoms epithelial dysplasia of the gastric mucosa can be detected in tissues, located next to the existing cancer of the stomach. Differentiation of severe dysplasia and preinvasive cancer is extremely difficult. Stomach cancer is often combined with severe dysplasia.

For the differential diagnosis of severe dysplasia and carcinoma neinfiltriruyuschey cytochemically invited to explore the DNA content. In severe dysplasia of the number of proliferating cells, synthesizing DNA, increases, there are some tetraploid cells. The site neinfiltriruyuschey carcinoma increased number of tetraploid cells and the level of DNA, there are signs of aneuploidy.