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Dysplasia-like lesions


Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 13 October 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Precursor of intestinal type adenocarcinoma; suggests possible coexisting carcinoma or high risk for developing carcinoma, particularly for high grade lesions (risk may be lower in US than Europe and Japan)
● Mostly adenomatous or intestinal type resembling colonic adenomas arising from intestinal metaplasia; foveolar (gastric) type dysplasia occurs in non-metaplastic epithelium (Lab Invest 2009;89S1:142A, Am J Surg Pathol 1987;11:788)
● Term is used for flat lesions, although adenomas also have dysplastic features


World Health Organization classification (2010):
● Negative for intraepithelial lesion (dysplasia)
● Indefinite for intraepithelial neoplasia (dysplasia): low grade features in a background of marked active inflammation or erosion with milder nuclear hyperchromatism and stratification
● Intraepithelial neoplasia (dysplasia):
      ● Low grade intraepithelial neoplasia (dysplasia): nuclear enlargement, hyperchromatism, stratification
      ● High grade intraepithelial neoplasia (dysplasia): severe cytologic atypia, glandular cribriforming or full thickness nuclear stratification

Intramucosal invasive neoplasia / intramucosal carcinoma:
● Invasive neoplasia
● High grade dysplasia is frequently classified as carcinoma in Japan (Am J Surg Pathol 1999;23:511)

Padova classification:
Am J Surg Pathol 2000;24:167
● 1 = normal: normal, reactive foveolar hyperplasia, intestinal metaplasia (complete or incomplete)
● 2 = indefinite for dysplasia: foveolar hyperproliferation or hyperproliferative intestinal metaplasia
● 3 = noninvasive neoplasia: low grade, high grade (includes suspicious for in situ [intraglandular] and in situ)
● 4 = suspicious for invasive cancer
● 5 = cancer


● Surveillance, high grade dysplasia is usually an indication for endoscopic treatment, Helicobacter eradication

Micro description

● Increased cell proliferation, abnormal cell size, configuration and orientation
● Reduced / absent mucus secretion, increased N/C ratio, loss of nuclear polarity, pseudostratification, cellular crowding
● Historically mild, moderate or severe (carcinoma in situ) now usually reported as low grade or high grade
● Foveolar type shows an irregular low power pattern composed of foveolar epithelium with cuboidal to low columnar cells with oval to round vesicular nuclei and pale cytoplasm

Micro images

high grade dysplasia

Positive stains

● p53, MIB1 in deep and superficial epithelium, although special stains not completely reliable

Differential diagnosis

● Reactive epithelial changes after mucosal injury; also called regenerative hyperplasia (uniform cells, basal or central nuclei, minimal pseudostratification; more atypical changes are associated with inflammatory infiltrate)
● Radiation/chemotherapy atypia
● Immature hyperproliferative lesions (intestinal metplasia with atypia) that may be classified as indefinite for dysplasia may be high risk lesions (Hum Pathol 2006;37:1489)

End of Stomach > Dysplasia-like lesions > Dysplasia

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