Below: Type III IM has been shown to be a more specific marker of premalignancy, with relevance, in particular, to the early and intestinal type of cancer21. A particular type of very well differentiated adenocarcinoma of the stomach mimics Type 1IM, bringing into question the relevance of typing22 and critical reviews have found many exceptions to given types of IM as precursor lesions of cancer23. However, it is most likely that a combination of bacterial, host and environmental factors will lead to cancer rather than IM alone. Infection with cagA-positive H. pylori strains is associated with an increased prevalence and intensity of antral atrophy and intestinal metaplasia, in addition to higher degrees of gastritis24. Other studies have shown that a high PCNA-labelling index in the gastric mucosa, with a histological diagnosis of incomplete intestinal metaplasia, could constitute a good prognostic marker of the severity of the histological lesion. These parameters, together with others such as the presence of sulphomucins and of cells expressing anomalous Lewis a antigen, may be used to define patients with a high risk of developing a gastric neoplasia25
Answered 4/3/2016
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