Recent studies have described a
spasmolytic polypeptide-expressing metaplastic cell lineage (SPEM) in the gastric fundic mucosa associated with both chronic H. pylori
infection and gastric
adenocarcinoma. We investigated the association of SPEM both with early gastric
adenocarcinoma and in biopsies taken from patients prior to diagnosis of
cancer. Two cohorts were examined. First, gastric resections from 29 patients with early
gastric cancer were examined. Second, biopsies taken from 18 patients prior to the diagnosis of
gastric cancer were compared with their respective resection specimens as well as with control biopsies from a cohort of 19 patients diagnosed with
gastritis without subsequent development of
cancer. The presence of SPEM and intestinal
metaplasia (IM) adjacent to and distant from the
cancer was compared and
spasmolytic polypeptide (SP) immunostaining within dysplastic/cancerous cells was identified. SPEM was present adjacent to
cancer in all early
cancer cases where the
tumor was located in the body or at the body/antrum junction, and was present in the body mucosa distant from the
cancer in 76% of cases. Intestinal
metaplasia was found adjacent to the
tumor in 76% of cases and in body sections in 52% of resections. SP immunostaining was noted within
cancer cells in 62% of
tumors, and within dysplastic cells in 76% of resections where dysplasia was present. SPEM was present in 82% of the biopsies obtained prior to the diagnosis of
cancer, compared with only 37% in the
gastritis cohort. IM was present in only 57% of biopsies. In conclusion, SPEM is strongly associated with early
gastric cancers and is observed in gastric biopsies prior to the development of
cancer. In addition, early
gastric cancers demonstrated a high incidence of SP expression. These results suggest that SPEM merits consideration as an important pre-neoplastic gastric lesion.