Stomach

Preneoplastic / dysplasia

Dysplasia


Editorial Board Member: Aaron R. Huber, D.O.
Deputy Editor-in-Chief: Catherine E. Hagen, M.D.
Kyra Berg, M.D.
Teri A. Longacre, M.D.

Last author update: 20 June 2022
Last staff update: 20 June 2022

Copyright: 2003-2022, PathologyOutlines.com, Inc.

PubMed Search: Gastric dysplasia

Kyra Berg, M.D.
Teri A. Longacre, M.D.
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Cite this page: Berg K, Longacre TA. Dysplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachdysplasia.html. Accessed December 1st, 2022.
Definition / general
  • Gastric dysplasia is a precursor lesion to gastric adenocarcinoma; it can be flat, polypoid (adenoma) or arise on the surface of an existing nondysplastic polyp
Essential features
  • Gastric dysplasia is a precursor lesion to gastric adenocarcinoma
  • Classified into low and high grade
  • Histologic subtypes include intestinal, foveolar, crypt, tubule neck and serrated type dysplasia
  • Isolated lesions may be treated with endoscopic submucosal resection or dissection
Terminology
  • High grade dysplasia may be diagnosed as noninvasive carcinoma in Japan (Am J Surg Pathol 1999;23:511)
  • Alternate / historic name for intestinal dysplasia is adenomatous dysplasia
  • Alternate / historic names for foveolar dysplasia are type II dysplasia and hyperplastic dysplasia
ICD coding
  • ICD-10: D00 - carcinoma in situ of oral cavity, esophagus and stomach
Epidemiology
  • Male predominant
  • Higher incidence in Asia, Eastern Europe and South America
  • Risk factors include Helicobacter infection
Sites
  • Stomach
Pathophysiology
  • Most common cause of gastric dysplasia is Helicobacter pylori infection, which results in chronic active gastritis, atrophy and intestinal metaplasia
Etiology
  • Helicobacter infection is the most common cause worldwide (Gastroenterology 1997;113:S56)
  • Smoking, radiation exposure and occupation in rubber manufacturing
Clinical features
  • Predominantly asymptomatic, although larger lesions may cause bleeding or anemia
  • Can present as a flat, ulcerated or polypoid lesion on endoscopy
Diagnosis
  • Diagnosed by upper endoscopy with biopsy
Prognostic factors
  • High grade dysplasia is associated with a much higher rate of progression to adenocarcinoma (Gut 2003;52:1111)
Case reports
Treatment
  • Treated with endoscopic submucosal resection or endoscopic submucosal dissection
Microscopic (histologic) description
  • Gastric dysplasia is divided into several subtypes
  • Intestinal and foveolar type are the most common
  • Crypt dysplasia and serrated dysplasia are more recently described but are recognized subtypes in the World Health Organization gastrointestinal book
  • Tubule neck or globoid dysplasia is the rare precursor lesion to poorly cohesive gastric carcinoma
  • Intestinal type dysplasia:
    • Similar morphology to colorectal adenomas
    • Tubular architecture
    • Cells have elongated nuclei with clumped chromatin, hyperchromasia and pseudostratification
    • Frequently admixed goblet cells and Paneth cells
    • Often arising in a background of intestinal metaplasia
    • High grade intestinal dysplasia shows loss of polarity, nuclear rounding, anisonucleosis, vesicular chromatin and increased N/C ratios
  • Foveolar type dysplasia:
    • Surface involvement with irregular branching
    • Cuboidal to columnar cells with hyperchromatic oval nuclei and pale cytoplasm
    • High grade foveolar dysplasia shows loss of polarity, increased N/C ratios, vesicular chromatin and prominent nucleoli
  • Tubule neck dysplasia or globoid dysplasia:
    • Rare precursor lesion to poorly cohesive (signet ring) gastric carcinoma
    • Increased cellularity in the gastric neck region
    • Enlarged clear cells with vacuolated cytoplasm and similar appearance to signet ring cells
  • Crypt dysplasia or pit dysplasia:
    • Marked cytologic atypia characterized by nuclear pleomorphism, increased N/C ratio, irregular nuclear contours and hyperchromasia that is limited to the gastric crypts / pits and does not reach the surface (Histopathology 2016;68:843)
  • Serrated dysplasia:
    • Rare polyp similar to the colorectal traditional serrated adenoma (Histol Histopathol 2013;28:453)
    • Characterized by stratified pencillate nuclei and abundant eosinophilic cytoplasm with slit-like serrations
Microscopic (histologic) images

Contributed by Kyra Berg, M.D.
Elongated and hyperchromatic nuclei

Elongated and hyperchromatic nuclei

Elongated nuclei with visible nucleoli

Elongated nuclei with visible nucleoli

Loss of polarity

Loss of polarity

Increased cellularity

Increased cellularity

Positive stains
Molecular / cytogenetics description
Sample pathology report
  • Stomach, biopsy:
    • Low grade dysplasia, intestinal type (see comment)
    • Comment: Background of intestinal metaplasia. Negative for Helicobacter organisms by immunohistochemistry.
Differential diagnosis
Additional references
Board review style question #1
Which of the following is the most common risk factor for gastric dysplasia?

  1. Alcohol use
  2. Helicobacter infection
  3. Radiation exposure
  4. Smoking
Board review style answer #1
B. Helicobacter infection

Comment Here

Reference: Gastric dysplasia
Board review style question #2

What is the best diagnosis for the stomach biopsy shown above?

  1. High grade dysplasia
  2. Intramucosal adenocarcinoma
  3. Low grade dysplasia
  4. Radiation atypia
Board review style answer #2
A. High grade dysplasia

Comment Here

Reference: Gastric dysplasia
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