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Stomach

Dysplasia-like lesions

Dysplasia

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

General
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● 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

Classification
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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

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

Micro description
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● 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
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high grade dysplasia

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

Differential diagnosis
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● 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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