The risk of gastric cancer in patients with gastric intestinal metaplasia in 5-year follow-up.

BACKGROUND: Gastric intestinal metaplasia (GIM) is the premalignant stage of gastric cancer; however, consensus on its management has not been established. AIM: To determine the risk factors for gastric cancer in a population of patients with GIM to guide the appropriate clinical recommendations in a low prevalence area for gastric cancer. METHODS: This was a retrospective cohort study. Ninety-one patients with GIM diagnosed between 2004 and 2014 were recruited for surveillance EGD every 6-12 months until a diagnosis of gastric cancer or completion of the planned 5-year follow-up duration. Possible risk factors for gastric cancer were assessed. RESULTS: At initial presentation, 81 of the 91 patients (89%) had complete GIM, whereas the remaining 11% had a study entry diagnosis of incomplete GIM. No cancer developed amongst patients with complete GIM. In contrast, five of the 10 patients exhibiting incomplete GIM (50%) progressed to high-grade dysplasia (n=2) or cancer (n=3). Male gender (P=.027), and incomplete GIM (P=.001) were associated with high-risk histology (dysplasia or cancer) by study end. A trend suggested a possible association with smoking (P=.08). CONCLUSION: Male patients and those with incomplete GIM are at greatest risk of developing dysplasia or early gastric cancer. Further studies in determining optimal surveillance intervals and impact on cancer incidence and mortality are still required.

PCR detection of Mycobacterium tuberculosis in necrotising non-granulomatous lymphadenitis using formalin-fixed paraffin-embedded tissue: a study in Thai patients.

BACKGROUND: Necrotising non-granulomatous lymphadenitis can be observed in several conditions, most notably infection (including tuberculosis, yersiniosis and nocardiasis), Kikuchi-Fujimoto disease and systemic lupus erythematosus. AIMS: To evaluate the role of PCR in the detection of Mycobacterium tuberculosis in necrotising non-granulomatous lymphadenitis in Thai patients using formalin-fixed paraffin-embedded tissue. METHODS: 35 patient samples showing necrotising non-granulomatous lymphadenitis were subjected to PCR for detection of the IS6110 sequence of M tuberculosis. For comparison, sections were visually assessed for acid-fast bacilli using the Ziehl-Neelsen stain. RESULTS: Among 35 cases of necrotising non-granulomatous lymphadenitis, a conclusive diagnosis could be reached in 23 cases: 15 cases of Kikuchi-Fujimoto disease, 6 of tuberculosis and 2 of systemic lupus erythematosus. Of the 6 cases of tuberculous lymphadenitis, 4 (66.6%) were detected by PCR in formalin-fixed paraffin-embedded tissue samples. PCR was positive in 6/12 of the remaining cases (50%) in which a definitive diagnosis could not be reached by other methods. CONCLUSION: Using PCR, a significant percentage (28%) of cases of necrotising non-granulomatous lymphadenitis in this study could be attributed to M tuberculosis. PCR for identification of the organism can be extremely helpful in confirming a diagnosis of tuberculosis when Ziehl-Neelsen staining is negative.