The early characteristics of cancer and gastric ulcer are similar. How to distinguish them? Gastroscopic biopsy tells you：
Gastric ulcer doesn’t sound like a big problem, but it can be benign or malignant. Benign gastric ulcer itself can also cause epigastric pain and hematemesis, and sometimes the microscopic appearance of early gastric cancer or early gastric cancer is similar to that of ulcer, and there is also a tendency of canceration at the lesion edge of gastric ulcer. Therefore, in this case, tissue biopsy and pathology is the most reliable way to distinguish benign and malignant lesions.
Gastroscopic biopsy means that if some suspicious gastrointestinal lesions (such as irregular erosion and ulcer) are found during gastroscopy, after obtaining the consent of the patient, quickly and accurately obtain the mucosal samples of these lesions through the biopsy hole of gastroenteroscope with disposable biopsy forceps, and then send them to the pathology department for pathological detection to identify the nature of the lesions, To provide pathological basis for the diagnosis of gastroenteroscopy.
Clinically, it is found that about 2% of gastric ulcer may become cancerous. Canceration of ulcer is a slow process. When typical features such as obvious mass have not been formed in the early stage of canceration, there is often only a slight change in the color of mucosa at the edge of ulcer. If pathological examination is performed on the gastric mucosa around the ulcer, early gastric cancer that cannot be determined by the naked eye can be found as soon as possible. In addition, gastroscopic biopsy is also the gold standard to distinguish benign and malignant gastrointestinal diseases such as gastrointestinal polyps and atrophic gastritis.
Since the tissue obtained is only a few millimeters and the trauma is very small, the patient will not have additional pain. However, in addition to the precautions for routine gastroscopy, there is a special requirement for biopsy tissue examination, that is, you have not taken aspirin and other antithrombotic drugs within a week, otherwise it will cause bleeding at the biopsy, and in severe cases, anemia or even hemorrhagic shock.
So, how to interpret the pathological report of gastric mucosal biopsy? Let’s get to know.
Early stage: chronic superficial, inflammatory cells infiltrate the superficial mucosal layer between gastric pits.
Progressive stage: inflammatory cells develop deep into the mucosa and can reach the whole layer of gastric mucosa, often accompanied by gastric gland atrophy.
The final stage: inflammation subsided and all gastric glands atrophied.
It should be noted that inflammation is a process. The reduction of inflammation mostly refers to the improvement of the condition. If the progress of inflammation is not controlled all the time, the result can also be that inflammation destroys the tissue and shows the elimination of inflammation.
Activity refers to the number of neutrophils in the inflammatory cells invading the gastric mucosa, which represents the degree of acute inflammation or chronic inflammation.
Mild activity: there are a small or medium amount of neutrophils in the lamina propria of gastric mucosa.
Moderate activity: there are many neutrophils in the lamina propria, and infiltrate into the gastric gland epithelium.
Severe activity: extensive gastric mucosal crypt inflammation with mucosal epithelial erosion and crypt abscess formation.
It refers to the change in the morphology and histochemical composition of the superficial and fossa epithelium of gastric mucosa, which becomes similar to the epithelium of small intestine or large intestine.
Complete intestinal metaplasia: gastric mucosal epithelium becomes normal intestinal epithelium.
Incomplete intestinal metaplasia: the morphology is still the same as that of gastric mucosal epithelium, but the chemical composition of mucus cells has changed. Incomplete colorectal metaplasia may be closely related to gastric cancer, and special staining is needed to identify the type.
Atypical hyperplasia is the abnormal nature of cell proliferation, which can be divided into two types. Adenomatous atypical hyperplasia: it is considered to develop into well differentiated intestinal gastric adenocarcinoma. Proliferative atypical hyperplasia: closely related to incomplete intestinal metaplasia, it is considered to develop into poorly differentiated intestinal gastric adenocarcinoma.
It refers to the atrophy, reduction or even complete disappearance of gastric mucosal glands in varying degrees, leaving only the remnant of gastric fovea. According to the degree of reduction, it can be divided into light, medium and heavy. The risk of gastric cancer in atrophic gastritis mainly comes from associated intestinal metaplasia and polyps.