A temporary measure or permanent solution?

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Chronic lymphocytic leukemia in Iceland from 2003 to 2013: Incidence, presentation and diagnosis

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.B-eitilfrumna. Einstofna B-eitilfrumudreyri (monoclonal B-cell lymphocytosis, MBL) er talið forstig sjúkdómsins. Sjúkdómurinn er ólæknandi en hæggengur og greinist oft fyrir tilviljun við skoðun blóðhags. Langvinnt eitilfrumuhvítblæði hefur ekki verið rannsakað á Íslandi hvað varðar nýgengi, greiningu, sjúkdómseinkenni eða hækkanir á eitilfrumutalningu í blóði fyrir greiningu. Efniviður og aðferðir: Um er að ræða afturskyggna, lýsandi rannsókn sem nær til sjúklinga sem greindust á árunum 2003-2013. Fengin voru gögn yfir sjúklinga frá Krabbameinsskrá, blóðmeinafræðideild Landspítala og Læknasetrinu í Mjódd og var skráning tilfella rakin. Sjúkraskrár voru skoðaðar með tilliti til einkenna, greininga og meðferðar. Upplýsingar um lifun fengust úr Þjóðskrá og um dánarorsakir frá landlækni. Niðurstöður: Fjöldi sjúklinga sem greindist með langvinnt eitilfrumuhvítblæði á rannsóknartímabilinu var 161 (109 karlar, 52 konur). Nýgengi mældist 4,55/100.000 en aldursstaðlað nýgengi 3,00/100.000. Meðalaldur við greiningu var 70,9 ár (35-96 ár). Krabbameinsskrá skorti upplýsingar um 28 sjúklinga (17,4%), en upphafleg greining var í 47,2% tilfella eingöngu gerð með flæðisjá. Sjúkdómseinkenni voru til staðar við greiningu hjá 67 af 151 sjúklingi (44,4%). Rúmur þriðjungur hópsins fékk lyfjameð- ferð og var meðaltími að meðferð 1,3 ár. Fimm ára lifun var um 70% en miðgildi lifunar 9,4 ár. Hækkun eitilfrumutalningar (4,0x109 /L) í blóði (0,1- 13,4 árum) fyrir greiningu fannst hjá 85 af 99 sjúklingum (85,9%). Ályktun: Nýgengi langvinns eitilfrumuhvítblæðis á Íslandi er svipað því sem þekkist á Vesturlöndum. Bæta þarf lögbundna skráningu tilfella í Krabbameinsskrá, sérstaklega þegar greining byggir á frumuflæðisjárrannsókn eingöngu. Eitilfrumuhækkun var til staðar hjá stórum hluta sjúklinga fyrir greiningu.Introduction: Chronic lymphocytic leukemia (CLL) is characterized by the proliferation of monoclonal B-lymphocytes. MBL (monoclonal B-cell lymphocytosis) is considered a precursor state of the disease. Although CLL is incurable it is an indolent disorder and often detected incidentally on routine blood counts. Until now little information has been available on CLL in Iceland, including the incidence, diagnosis, symptoms or MBL precursor state. Material and methods: This is a retrospective, descriptive study including CLL patients diagnosed in Iceland over the years 2003-2013. Registries of patients with a CLL diagnosis were obtained from the Icelandic Cancer Registry, Landspitali National University Hospital and the Medical Center in Mjódd. Medical records were reviewed for information on symptoms, diagnosis and treatment. Survival data and causes of death were obtained from national registries. Results: The number of patients diagnosed with CLL over the study period was 161 (109 males, 52 females). The calculated incidence was 4.55/100,000, and the age-standardized incidence was 3.00/100,000. Mean age at diagnosis was 70.9 years (range 35-96 years). The Icelandic Cancer Registry lacked information on 28 patients (17.4%). The initial diagnosis of CLL was obtained exclusively with flow cytometry in 47.2% of cases. Symptoms were present at diagnosis in 67 of 151 patients (44.4%). One third of the group received chemotherapy and the average time to treatment was 1.3 years. Five-year survival was 70% and median survival was 9.4 years. Elevated lymphocyte counts (≥4,0x109 /L) in peripheral blood prior (0.1 to 13.4 years) to diagnosis of CLL was identified in 85 of 99 CLL patients (85.9%). Conclusion: The incidence of CLL in Iceland is similar to other Western countries. The registration of CLL cases in the Icelandic Cancer Registry must be improved, especially in cases where diagnosis is based solely on flow cytometry. Elevated lymphocyte counts were present in a large proportion of cases prior to the diagnosis of CLL

Liver metastases of unknown origin

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Approximately 5% of cancer patients are diagnosed with tumour of unknown origin (3-4% in Iceland). Of those 10-30% have . Liver metastases of unknown origin is thus not an uncommon problem. In the present study information about the origin and histology of liver metastases of unknown origin was compiled. Material and methods: Records of all biopsies from liver metastases performed in the years 1987-1996 were retrieved from the medical database of the Department of Pathology at the University of Iceland. The biopsies came from a group of 176 patients. Ninety-two cases, in which the origin of the primary tumour was suspected or known, were excluded from the study, leaving 84 cases where the primary was completely unknown. The database of the Icelandic Cancer Society was used to gather data about the final tissue diagnosis and the location of the primary tumour when known. Results: The Cancer Society data revealed the location of the primary tumour in 55 of the 84 cases of liver metastases of unknown origin. The most prevalent (75%) primary tumours were cancers of the pancreas (15), lung (13) and colon/rectum (12). The tissue diagnosis was adenocarcinoma in 33 of the 55 cases. In the male patients 83% of the adenocarcinoma metastases came from the colon/rectum or pancreas. The corresponding figure for the female patients was 67%, while 20% of the tumours in females originated in the gallbladder and biliary tree. Conclusions: In two thirds of the cases of liver metastases of unknown origin the primary tumour was later discovered. The most prevalent tumours were cancers in the pancreas, lung and colon/rectum. Adenocarcinoma was the tissue diagnosis in 60% of cases.Tilgangur: Um 5% krabbameinssjúklinga greinast með æxli af óþekktum uppruna (3-4% á Íslandi). Af þeim hafa 10-30% meinvörp í lifur. Lifrarmeinvörp af óþekktum uppruna er því ekki sjaldgæft vandamál. Meinafræðingar eru oft beðnir um að skoða sýni frá lifrarmeinvörpum og koma með tillögur um staðsetningu frumæxlis. Í þessari rannsókn eru teknar saman upplýsingar um uppruna og vefjagerð lifrarmeinvarpa af óþekktum uppruna. Efniviður og aðferðir: Leitað var í skrám Rannsóknastofu Háskólans í meinafræði að öllum skráðum grófnálarsýnum frá meinvörpum í lifur frá árunum 1987-1996. Alls fundust sýni frá 176 sjúklingum. Útilokaðir voru 92 sjúklingar sem höfðu þekkt frumæxli eða vísbendingu um upprunastað. Þeir 84 sjúklingar sem eftir voru töldust hafa meinvörp af óþekktum uppruna. Könnuð var niðurstaða vefjagreiningar í gögnum Rannsóknastofunnar. Leitað var í Krabbameinsskrá Krabbameinsfélags Íslands að upplýsingum um endanlega vefjagreiningu og staðsetningu frumæxlis. Niðurstöður: Krabbameinsskrá gaf upplýsingar um staðsetningu frumæxlis hjá 55 sjúklingum af 84 sem greindust með lifrarmeinvörp af óþekktum uppruna. Algengustu frumæxlin (75%) voru krabbamein í brisi (15), lunga (13) og ristli/endaþarmi (12). Hjá 33 sjúklingum af 55 var vefjagerðin kirtlakrabbamein (adenocarcinoma). Hjá körlum voru 83% kirtlakrabbameinsmeinvarpa upprunnin í ristli eða brisi, en 67% hjá konum, þar sem 20% komu frá gallblöðru/gallvegum. Ályktanir: Í tveimur þriðju tilfella kom upprunastaður að lokum í ljós fyrir lifrarmeinvörp af óþekktum uppruna. Algengustu frumæxlin voru krabbamein í brisi, lungum og ristli/endaþarmi. Kirtlakrabbamein var vefjagreiningin í 60% tilfella

Erosion and soft drinks

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Acidic soft drinks are well-known causes of dental erosion. This study aimed to determine differences in the in-vitro erosive effect of a selection of drinks on the Icelandic market. Materials and methods: 20 different brands of soft drinks were investigated. 13 freshly extracted human teeth were sawn in 2 pieces. The erosive effect of drinks was determined as the percentage weight loss of tooth pieces after immersion in the drinks. Drink samples were renewed daily, and the weight of the teeth was recorded. Results: Drinks containing citric acid had an average of 12.5% greater erosive effect than drinks containing phosphoric acid. Sugared soft drinks and energy drinks had a considerably higher erosive potential than water-based drinks. Flavored water containing citric acid showed similar erosive potential to cola drinks that contain phosphoric acid. Flavored and non-flavored water not containing acidic additives showed similar erosive effect to the control drinks water and milk. Overall, energy and sports drinks showed the most erosive effect, with sugary citric acid drinks close behind. Discussion: Advice to patients on consumption of soft drinks should recognize their erosive effects especially regarding flavored waters. Citric acid in drinks appears to be more erosive than phosphoric acid, particularly where sugar is also an ingredient, perhaps balancing sweetness and acidity.Þekkt er að gosdrykkir geta valdið glerungseyðingu. Með rannsókninni var ætlað að mæla glerungseyðandi mátt mismunandi gosdrykkja á tilraunastofu. Efniviður / Aðferð: 13 nýúrdregnar tennur voru sagaðar í tvennt og lagðar í 20 mismunandi gosdrykkjaböð og glerungseyðingarmáttur var metin út frá prósentu-þyngdartapi tannhlutanna. Daglega voru drykkirnir endurnýjaðir og tennurnar vigtaðar. Niðurstöður: Drykkir sem innihalda sítrónusýru hafa meiri glerungseyðandi mátt en þeir sem innihalda fosfórsýru. Sykraðir gosdrykkir og orkudrykkir eru meira glerungseyðandi en vatnsdrykkir. Bragðbætt vatn með sítrónusýru er jafn glerungseyðandi og þeir drykkir sem innihalda fosfórsýru. Bæði sýrulaust bragðbætt og óbragðbætt vatn var ekki glerungseyðandi líkt og samanburðardrykkirnir vatn og mjólk. Orku og íþróttadrykkir voru mest glerungseyðandi en sykur- og sítrónusýrudrykkir lágu mjög nálægt. Ályktun: Í leiðbeiningum ætti að leggja áherslu á mismunandi glerungseyðingamátt vatns/íþrótta- og orkudrykkja. Drykkir sem innihalda sítrónusýru eru meira glerungseyðandi en drykkir með fosfórsýru

Contaminated dicloxacillin capsules as the source of an NDM-5/OXA-48-producing Enterobacter hormaechei ST79 outbreak, Denmark and Iceland, 2022 and 2023

Publisher Copyright: © 2023 European Centre for Disease Prevention and Control (ECDC). All rights reserved.From October 2022 through January 2023, nine patients with NDM-5/OXA-48-carbapenemase-producing Enterobacter hormaechei ST79 were detected in Denmark and subsequently one patient in Iceland. There were no nosocomial links between patients, but they had all been treated with dicloxacillin capsules. An NDM-5/OXA-48-carbapenemase-producing E. hormaechei ST79, identical to patient isolates, was cultured from the surface of dicloxacillin capsules in Denmark, strongly implicating them as the source of the outbreak. Special attention is required to detect the outbreak strain in the microbiology laboratory.Peer reviewe

Genetic and Epigenetic Profiling of Mantle Cell Lymphoma and Chronic Lymphocytic Leukemia

Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) both belong to the group of mature B-cell malignancies. However, MCL is typically clinically aggressive while the clinical course of CLL varies. CLL can be divided into prognostic subgroups based on IGHV mutational status and into multiple subsets based on closely homologous (stereotyped) B-cell receptors. In paper I we investigated 31 MCL cases using high-density 250K single-nucleotide polymorphism arrays and gene expression arrays. Although most copy-number aberrations (CNAs) were previously reported in MCL, a novel deletion was identified at 20q (16%) containing the candidate tumor suppressor gene ZFP64. A high proliferation gene expression signature was associated with poor prognosis, large CNAs, 7p gains and 9q losses. Losses at 1p/8p/13q/17p were associated with increased genomic complexity. In paper II we sequenced exons 4 to 8 of the TP53 gene in 119 MCL cases. 17p copy-number status was known from previous studies or determined by real-time quantitative polymerase chain reaction. TP53 mutations were detected in 14% of cases and were strongly associated with poor survival while 17p deletions were more common (32%) but did not predict survival. In papers III and IV we applied high-resolution genomic 27K methylation arrays to 20 MCL and 39 CLL samples. In paper III MCL displayed a homogenous methylation profile without correlation with the proliferation signature whereas MCL was clearly separated from CLL. Gene ontology analysis revealed enrichment of developmental genes, in particular homeobox transcription factor genes, among targets methylated in MCL. In paper IV we compared three different stereotyped CLL subsets: #1 (IGHV unmutated), #2 (IGHV3-21) and #4 (IGHV mutated). Many genes were differentially methylated between each two subsets and immune response genes (e.g. CD80 and CD86) were enriched among genes methylated in subset #1 but not in subsets #2/#4. In summary, CNAs were frequent and not random in MCL. Specific CNAs correlated with a high proliferation gene expression signature or genomic complexity. TP53 mutations predicted short survival whereas 17p deletions did not. A high proliferation signature was not associated with differential DNA methylation in MCL, which demonstrated a homogeneous methylation pattern. In contrast, genomic methylation patterns differed between MCL and CLL and between stereotyped CLL subsets

Genetic and Epigenetic Profiling of Mantle Cell Lymphoma and Chronic Lymphocytic Leukemia

Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) both belong to the group of mature B-cell malignancies. However, MCL is typically clinically aggressive while the clinical course of CLL varies. CLL can be divided into prognostic subgroups based on IGHV mutational status and into multiple subsets based on closely homologous (stereotyped) B-cell receptors. In paper I we investigated 31 MCL cases using high-density 250K single-nucleotide polymorphism arrays and gene expression arrays. Although most copy-number aberrations (CNAs) were previously reported in MCL, a novel deletion was identified at 20q (16%) containing the candidate tumor suppressor gene ZFP64. A high proliferation gene expression signature was associated with poor prognosis, large CNAs, 7p gains and 9q losses. Losses at 1p/8p/13q/17p were associated with increased genomic complexity. In paper II we sequenced exons 4 to 8 of the TP53 gene in 119 MCL cases. 17p copy-number status was known from previous studies or determined by real-time quantitative polymerase chain reaction. TP53 mutations were detected in 14% of cases and were strongly associated with poor survival while 17p deletions were more common (32%) but did not predict survival. In papers III and IV we applied high-resolution genomic 27K methylation arrays to 20 MCL and 39 CLL samples. In paper III MCL displayed a homogenous methylation profile without correlation with the proliferation signature whereas MCL was clearly separated from CLL. Gene ontology analysis revealed enrichment of developmental genes, in particular homeobox transcription factor genes, among targets methylated in MCL. In paper IV we compared three different stereotyped CLL subsets: #1 (IGHV unmutated), #2 (IGHV3-21) and #4 (IGHV mutated). Many genes were differentially methylated between each two subsets and immune response genes (e.g. CD80 and CD86) were enriched among genes methylated in subset #1 but not in subsets #2/#4. In summary, CNAs were frequent and not random in MCL. Specific CNAs correlated with a high proliferation gene expression signature or genomic complexity. TP53 mutations predicted short survival whereas 17p deletions did not. A high proliferation signature was not associated with differential DNA methylation in MCL, which demonstrated a homogeneous methylation pattern. In contrast, genomic methylation patterns differed between MCL and CLL and between stereotyped CLL subsets

Genetic and Epigenetic Profiling of Mantle Cell Lymphoma and Chronic Lymphocytic Leukemia

Mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) both belong to the group of mature B-cell malignancies. However, MCL is typically clinically aggressive while the clinical course of CLL varies. CLL can be divided into prognostic subgroups based on IGHV mutational status and into multiple subsets based on closely homologous (stereotyped) B-cell receptors. In paper I we investigated 31 MCL cases using high-density 250K single-nucleotide polymorphism arrays and gene expression arrays. Although most copy-number aberrations (CNAs) were previously reported in MCL, a novel deletion was identified at 20q (16%) containing the candidate tumor suppressor gene ZFP64. A high proliferation gene expression signature was associated with poor prognosis, large CNAs, 7p gains and 9q losses. Losses at 1p/8p/13q/17p were associated with increased genomic complexity. In paper II we sequenced exons 4 to 8 of the TP53 gene in 119 MCL cases. 17p copy-number status was known from previous studies or determined by real-time quantitative polymerase chain reaction. TP53 mutations were detected in 14% of cases and were strongly associated with poor survival while 17p deletions were more common (32%) but did not predict survival. In papers III and IV we applied high-resolution genomic 27K methylation arrays to 20 MCL and 39 CLL samples. In paper III MCL displayed a homogenous methylation profile without correlation with the proliferation signature whereas MCL was clearly separated from CLL. Gene ontology analysis revealed enrichment of developmental genes, in particular homeobox transcription factor genes, among targets methylated in MCL. In paper IV we compared three different stereotyped CLL subsets: #1 (IGHV unmutated), #2 (IGHV3-21) and #4 (IGHV mutated). Many genes were differentially methylated between each two subsets and immune response genes (e.g. CD80 and CD86) were enriched among genes methylated in subset #1 but not in subsets #2/#4. In summary, CNAs were frequent and not random in MCL. Specific CNAs correlated with a high proliferation gene expression signature or genomic complexity. TP53 mutations predicted short survival whereas 17p deletions did not. A high proliferation signature was not associated with differential DNA methylation in MCL, which demonstrated a homogeneous methylation pattern. In contrast, genomic methylation patterns differed between MCL and CLL and between stereotyped CLL subsets

Þvagfærasýkingar á Íslandi af völdum ESBL-myndandi E. coli sýkla. Greining á faraldsfræði og áhættuþáttum árin 2012-2021

Inngangur: Nýgengi sýkinga af völdum sýklalyfjaónæmra baktería sem framleiða „extended-spectrum“ beta-laktamasa (ESBL) hefur aukist hratt í heiminum síðustu ár og stafar heilbrigðisþjónustu víða ógn af þessari þróun. Escherichia coli (E. coli) sýklar sem framleiða ESBL ensím greinast æ oftar í tengslum við þvagfærasýkingar. Markmið þessarar rannsóknar var að rannsaka tengsl valinna þátta við þvagfærasýkingar af völdum ESBL-myndandi E. coli (tilfelli) samanborið við þvagfærasýkingar án ESBL-myndandi E. coli (viðmið). Aðferðir: Þessi áhorfsrannsókn er tilfella-viðmiðarannsókn innan ferilhóps 27.747 einstaklinga (22.800 konur, 4.947 karlar) á víðu aldursbili sem greindust með þvagfærasýkingu af völdum E. coli á árunum 2012 til 2021 samkvæmt skrám sýklafræðideildar Landspítala. Við notuðum tvíkosta (lógistíska) aðhvarfsgreiningu til að reikna gagnlíkindahlutfall (OR) sem mælikvarða á tengsl milli ESBL og valinna útsetningarbreyta, eftir leiðréttingu fyrir kyni, aldri og fylgisjúkdómum (Charlson stig). Helstu útsetningarbreytur voru ávísanir á sýklalyf, prótonpumpuhemla, barkstera og ónæmisbælandi lyf, auk fyrri sögu um þvagfærasýkingar, skurðaðgerðir og sjúkrahúsinnlagnir. Niðurstöður: Árlegt hlutfall þvagsýna með ESBL-myndandi E. coli jókst á rannsóknartímabilinu, úr 2,6% árið 2012 í 7,6% árið 2021 (p<0,001). ESBL-jákvæðir stofnar greindust hjá 1207 einstaklingum (4,4%), 905 konum (4,0%) og 302 körlum (6,1%). Karlkyn og hærri aldur voru sjálfstæðir áhættuþættir fyrir ESBL í fjölþátta lógistískri aðhvarfsgreiningu. Aðrir forspárþættir voru gerð stofnunar (sjúkrahús, hjúkrunarheimili), spítalatengd þvagfærasýking, Charlson stig ≥3, saga um blöðrubólgu eða sjúkrahúsinnlögn síðasta árið, og ávísanir á sýklalyf eða prótonpumpuhemla síðasta hálfa árið. Það sýklalyf sem hafði sterkust tengsl við ESBL var cíprófloxacín (OR 2,45). Pivmecillin, mest ávísaða sýklalyfið, var einnig forspárþáttur fyrir ESBL-myndun (OR 1,20). Ályktun: Þessar niðurstöður sýna að algengi þvagfærasýkinga af völdum ESBL-myndandi E. coli á Íslandi hefur aukist síðustu ár. Sterkustu forspárþættirnir voru ávísanir á ýmis sýklalyf og prótonpumpuhemla, en þessi lyf eru almennt talin ofnotuð. Því er mikilvægt að stuðla að skynsamlegri notkun þessara lyfja í framtíðinni, með fræðslu fyrir lækna og almenning. Frekari rannsókna er þörf til þess að kanna möguleg áhrif ferðalaga og mataræðis á þessar sýkingar í íslensku þýði.Introduction: The incidence of infections due to antibiotic-resistant bacteria producing extended-spectrum β-lactamases (ESBL) has increased rapidly worldwide in recent years and poses a threat to health care. ESBL-producing Escherichia coli (E. coli) is increasingly implicated in urinary tract infections (UTIs). The aim was to investigate the association of selected factors with UTI caused by ESBL-producing E. coli (cases) compared to UTI caused by E. coli without ESBL (controls). Materials and methods: This observational, case-control study includes a cohort of 27,747 patients (22,800 females, 4,947 males) of all ages diagnosed with UTI caused by E. coli in 2012 to 2021 according to records at the Department of Microbiology at Landspitali University Hospital. We used logistic regression to calculate odds ratios (ORs) as a measure of the association between ESBL and selected exposure variables, controlling for sex, age and the Charlson co-morbidity index (CCI) score. Exposures include previous prescriptions for antibiotics, proton pump inhibitors (PPIs), corticosteroids and immunosuppressants, as well as previous UTIs, surgeries, and hospitalizations. Results: The proportion of samples with ESBL-producing E. coli per year increased during the study period, from 2.6% in 2012 to 7.6% in 2021 (p<0.001). ESBL-positive strains were detected in 1207 individuals (4.4%), 905 females (4.0%) and 302 males (6.1%). Male sex and higher age were independent risk factors for ESBL in multivariate logistic regression. The following additional risk factors were identified; institution type (hospital, nursing home), hospital-associated (HA)-UTI, CCI score ≥3, history of cystitis or hospitalization in the past year, and specific antibiotic or PPI prescriptions in the past half year. The antibiotic associated with the highest risk was ciprofloxacin (OR 2.45). Pivmecillinam, the most frequently prescribed antibiotic, was also a risk factor for ESBL-production (OR 1.20). Conclusion: These data demonstrate increasing prevalence of UTIs caused by ESBL-producing E. coli in Iceland in recent years. The factors most strongly associated with ESBL were various antibiotics and PPIs, both widely considered to be overprescribed. Therefore, it is of considerable importance to promote the prudent use of these drugs in the future, by educating physicians and the public. Further studies are needed to address the effect of travel and diet on ESBL risk in the Icelandic population

Spasmolytic polypeptide-expressing metaplasia (SPEM) associated with gastric cancer in Iceland

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldRecent 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