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Pathology of Gastric Epithelial Dysplasia
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What is a
precancerous condition? Precancerus condition is a clinical state
associated with increased risk of cancer.
1. Atrophic gastritis with intestinal metaplasia,
2. Pernicious anaemia
3. Gastric stump
4. Certain types of gastric polyps
What is a precancerous lesion?
Precancerous lesion is a histopathological abnormality in which cancer is more likely to occur. Example: Gastric dysplasia.
While diagnosing a
case of gastric dysplasia the histopathologist must consider the
2. Whether the biopsy is from the margin of a carcinoma
3. Whether there is carcinoma elsewhere.
4. Whether the lesion is part of a wider mucosal abnormality.
Gastric dysplasia may present as a raised, circumscribed lesion (adenoma) or as a flat/depressed lesion.
- Associated with atrophic gastritis with intestinal metaplasia.
- Site: Usually antrum
- Size- About 3-4 cm in diameter
- Sessile or pedunculated lesion with a lobular surface.
- Histologically, gastric adenomas are composed of dysplastic epithelium.
- Malignancy is related to size, dysplasia and villous growth pattern.
- On the basis of architecture, adenomas are divided into tubular, tubulovillous and villous architecture.
- Degree of dysplasia (mild, moderate or severe) is based on nuclear crowding , hyperchromasia, stratification & mitotic activity.
- Adenomas may show:
(i) gastric foveolar or pyloric gland type epithelium;
(ii) gastric and intestinal type features;
(iii) paneth cell type (paneth cell adenoma).
- Treated by endoscopic polypectomy.
- Intramucosal adenocarcinoma in adenoma is
characterized by invasion of dysplastic epithelium into lamina propria.
epithelial dysplasia (flat/ depressed) :
- Gross features: Ill-defined thickened and congested mucosa which may be slightly depressed or raised from the mucosa.
Cytological and architectural atypia, irregular nuclear hyperchromatism, irregular nucleoli.
Composed of tall columnar cells with pale cytoplasm.
A few goblet cells are present.
Lack of maturation of cells.
Abrupt interphase with adjacent epithelium.
These are precursor of diffuse type gastric carcinoma.
Grading of gastric dysplasia:
Two tier system followed : High grade and low grade.
Previously three tier system: Mild, moderate, severe.
(i ) High grade adenoma/dysplasia
(ii) Non-invasive carcinoma (carcinoma in situ)
(iii) Suspicious of invasive carcinoma
(i) Intramucosal carcinoma
(ii) Submucosal carcinoma or beyond
Differential diagnosis of
Enlarged pleomorphic nuclei that show homogeneous basophilia and are basally orientated.
Prominent but small and uniform nucleoli.
Surface maturation is present.
Gradual transition with adjacent epithelium.
Atypical glands embedded in granulation tissue,fibrin and ulcer slough (useful clue).
Note : Histopathologist should be very careful while making a diagnosis of high grade dysplasia in the presence of large numbers of intraepithelial neutrophils.
2. Reflux gastritis:
3. Epithelial atypia associated with irradiation or antineoplastic chemotherapy.
- Present in specialized (deeper part )
Zhang Y-C. Typing and grading of gastric dysplasia. In: Zhang Y-C, Kawai K , eds. Precancerous conditions and lesions of the stomach. Berlin: Springer-Verlag. 1993; 64-84
Histopathology of gastric dysplasia. In : Filipe MI, Jass JR (eds) Gastric carcinoma. Churchill Livingstone, Edinburgh, 1986: 116-131
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