Is it true that gastric metaplasia is a precancerous lesion?

Patient's Query

Hi doctor,

After testing positive for celiac disease, I had an EGD and biopsy three weeks ago. The pathology report stated that I had marked acute and chronic inflammation with severe reactive epithelial changes including villus blunting and gastric metaplasia. I was negative for H. pylori as I was treated for that approximately four years ago. My GI mentioned that the pathology report did not specifically say celiac disease as many he gets back to do. Why did they not name celiac specifically? I have read that gastric metaplasia is considered as a precancerous lesion. Is this true? I had a CT scan in before four months, and that revealed extensive mesenteric adenopathy. I was referred to an oncologist, and he ordered for an endoscopic ultrasound with fine needle aspiration biopsy. It was negative and showed some shrinking of lymph nodes, but they were still enlarged. My symptoms leading up to CT were several months of nausea, abdominal pain, fatigue, and weight loss. In the last few weeks, I noticed a small lump on my neck and my GI doctor confirmed in a physical examination this week that I have two swollen lymph nodes in my neck. He wants to see me again in a month or sooner if they get larger. I have attached a copy of my CT scan report. The duodenum biopsy report showed active duodenitis with gastric metaplasia in duodenum bulb in duodenum biopsy.

Answer

Dr. Parth R Goswami

Hematology Pathology

Hi,

Welcome to icliniq.com.

Here according to your history, you were positive for gluten disease. So, you might have done tissue transglutaminase antibody testing. It is very sensitive for that and then, a biopsy for confirmation.

In histopathology report, villous blunting present but intra-epithelial increase lymphocytes like finding is not present.

Continue on the gluten-free diet if your antibody testing that I have mentioned was positive.

Secondly, your mesenteric adenopathy infective etiology must be ruled out. For example tuberculosis, HIV (human immunodeficiency virus), chronic non-specific inflammation, etc. If present, then gets it treated accordingly.

Metaplasia means replacement of one epithelium by another one. It is not a cancer condition, but it can be a precancerous lesion. It needs monitoring and suitable management.

Chronic inflammation or infection can lead irritation, and hence, metaplasia can present.

For enlarged neck lymph node, FNAC (fine needle aspiration cytology) or biopsy can be taken for further work up.

If no improvement and chance of malignancy seem high, then work up to rule out malignancy should be done. Peripheral smear examination also should be done.

For further information consult a pathologist online -->https://www.icliniq.com/ask-a-doctor-online/pathologist

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