1. Phagocytosis of apoptotic neutrophils by adenocarcinoma cells and foveolar cells of the gastric mucosa with Helicobacter pylori infection: A histologic, immunohistochemical and ultrastructural study of three cases. Caruso RA, Crisafulli C, Fedele F. Dipartimento di Patologia Umana, Policlinico Universitario, Messina

2. Introduction We report 3 cases of an unusual type of gastric carcinoma that occurred in elderly patients 62-80 years of age. Histologically, the tumours were well to moderately differentiated intestinal-type adenocarcinomas with a focal micropapillary component (Fig 1). We report 3 cases of an unusual type of gastric carcinoma that occurred in elderly patients 62-80 years of age. Histologically, the tumours were well to moderately differentiated intestinal-type adenocarcinomas with a focal micropapillary component (Fig 1).

3. There was an abundant neutrophilic infiltration around the tumour cells both intraepithelial (“cannibalism”) and stromal. There was an abundant neutrophilic infiltration around the tumour cells both intraepithelial (“cannibalism”) and stromal.

4. FIG. 1

5. At the electron microscopy, apoptotic neutrophils were found within vacuoles of adenocarcinoma cells (Fig 2). At the electron microscopy, apoptotic neutrophils were found within vacuoles of adenocarcinoma cells (Fig 2).

6. Figure 2

7. Immunohistochemical staining for caspase-3 confirmed the presence of apoptotic neutrophils within the cytoplasm of the tumour cells (Fig 3). Immunohistochemical staining for caspase-3 confirmed the presence of apoptotic neutrophils within the cytoplasm of the tumour cells (Fig 3).

8. Figure 3

9. Antral and corporal non-neoplastic mucosa showed a Helicobacter pylori– positive gastritis with high degree of neutrophil activity.

10. Neutrophil phagocytosis by foveolar cells was also documented by light (Fig 4) and electron microscopy (Fig 5). Neutrophil phagocytosis by foveolar cells was also documented by light (Fig 4) and electron microscopy (Fig 5).

11. Fig 4 Fig 4

12. Figure 6

13. Conclusion This is the first study that provide morphological evidence of apoptotic neutrophils phagocytosed both by gastric adenocarcinoma cells and foveolar cells of gastric mucosa with Helicobacter pylori infection. This is the first study that provide morphological evidence of apoptotic neutrophils phagocytosed both by gastric adenocarcinoma cells and foveolar cells of gastric mucosa with Helicobacter pylori infection.