Although reports have suggested the incomplete type of Intestinal metaplasia (IM) had a close correlation with carcinoma, considerable data showed no apparent relationship between the particular type of IM and the intestinal type carcinoma. The purpose of this study was to establish a novel classification of IM using brain-type glycogen phosphorylase (BGP) from a carcinogenetic viewpoint. The only isoform expressed in gastric cancer was BGP using polymerase chain reaction analysis. We studied 136 specimens with gastric carcinoma and the adjacent IM using specific anti-BGP antibody with its correlation to subtypes of IM, proliferating cell nuclear antigen-labeling index, and various oncogene products. Brain-type glycogen phosphorylase was expressed in 80.5% of the intestinal type and 18.8% of the diffuse type of carcinoma and in 87.5% and 41.6% in the generative zone of IM adjacent to cancer It is generally accepted that intestinal metaplasia (IM) in the stomach increases the risk of gastric cancer. [1][2][3][4][5] A paucity of gene rearrangements common to IM and carcinoma, however, makes it difficult to establish a direct carcinogenetic link between them. Intestinal metaplasia has been classified into subtypes with the aim of clarification of gastric carcinogenesis.
6~9Different authors used different definitions of the subtypes from the viewpoints of morphologic, enzymatic, and mucin-secreting patterns and proposed that the incomplete type, type III, or sulfomucinsecreting form of IM, carries a higher risk of cancer This work was supported in part by grant 6-28 from the Ministry of Health and Welfare of Japan, Cancer Research, Tokyo, Japan.Manuscript received December 30, 1996; revision accepted June 3,1997.Address reprint requests to Dr Ogawa: Department of Surgery II, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860, Japan.foci, respectively, whereas no reactivity was observed in the normal gastric mucosa. The proportion of the positiviry in the cancer and IM was significantly greater in the intestinal-type carcinoma than in the diffuse type. The expression of BGP in the generative cells of IM had no significant correlation with the conventional type of IM.Intestinal metaplasias with BGP expression were significantly higher in a proliferating state than in those without BGP, and some of them that were coexpressed accumulated p53 in the generative cells. The relationship between IM with BGP in the generative cells and intestinal-type carcinoma was apparently closer than the conventional subtype of IM and gastric cancer. Intestinal-type carcinoma might arise from some of these proliferating cells with BGP. (Key words: Gastric carcinoma; Intestinal metaplasia; Glycogen phosphorylase, p53) Am I Clin Pathol 1998,109:181-189. induction than the complete type. In such a classification, the subtyping is complicated and subjective, resulting in the existence of many variants within it. However, a high incidence of microscopic carcinoma surrounded by complete-type IM in the junctional area b e t ...