Topic Completed: 1 August 2012

Minor changes: 1 September 2020

Copyright: 2003-2021,, Inc.

PubMed Search: gastric dysplasia

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Dysplasia. website. Accessed November 29th, 2021.
Definition / general
  • 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 nonmetaplastic 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:
  • 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
Microscopic (histologic) 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
Microscopic (histologic) images

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High grade dysplasia

Positive stains
  • p53, MIB1 in deep and superficial epithelium, although special stains not completely reliable
Differential diagnosis
  • 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)
  • Radiation / chemotherapy atypia
  • 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)
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