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. 2012 Jan;13(1):2-9.
doi: 10.1111/j.1751-2980.2011.00550.x.

The gastric precancerous cascade

Pelayo Correa  1 , M Blanca Piazuelo
Affiliations

The gastric precancerous cascade

Pelayo Correa et al. J Dig Dis. 2012 Jan.

Abstract

Invasive gastric carcinoma is preceded by a cascade of precancerous lesions. The first recognized histologic change is active chronic inflammation, which may persist as such: non-atrophic chronic gastritis (no gland loss), or advance to multifocal atrophic gastritis (MAG), the first real step in the precancerous cascade. The following steps are: intestinal metaplasia (first "complete" and then "incomplete"); dysplasia, first low grade and then high grade (equivalent to "carcinoma in situ"). The following step is invasive carcinoma, which is thought to be associated with degradation of the intercellular matrix.

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Conflict of interest statement

Declaration of conflict of interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Schematic representation of the main clinical outcomes of Helicobacter pylori (H. pylori) infection. The right side of the figure shows the sequential steps of the precancerous cascade.
Figure 2
Figure 2
Normal antral mucosa. Scattered mononuclear cells are normally present in the lamina propria surrounding the glandular structures (HE stain, ×200).
Figure 3
Figure 3
Nonatrophic gastritis. Antral gastric mucosa with abundant mononuclear leukocytic infiltration in the lamina propria and well-preserved glands (HE stain, ×200).
Figure 4
Figure 4
Gastric antral mucosa colonized with abundant Helicobacter pylori. The bacteria are observed in the luminal surface and attached to the epithelium (modified Steiner silver stain, ×200).
Figure 5
Figure 5
Multifocal atrophic gastritis without intestinal metaplasia. Antral mucosa with marked mononuclear leukocytic infiltration in the lamina propria and loss of glandular structures, which are replaced by fibrous tissue (HE stain, ×200).
Figure 6
Figure 6
Diagrammatic representation of the topography of the main types of chronic gastritis. The shaded portions represent the areas involved by gastritis, and the typical location of ulcers is shown. Multifocal atrophic gastritis, shown on the right, is the type of gastritis involved in the precancerous cascade leading to adenocarcinoma of the intestinal type (Diagram reproduced from reference with permission).
Figure 7
Figure 7
Complete intestinal metaplasia. The gastric epithelium has been replaced by small intestine-type epithelium, showing eosinophilic absorptive enterocytes with a brush border, interspersed with well-developed goblet cells, and presence of Paneth cells in the deep glands (HE stain, ×200).
Figure 8
Figure 8
High-grade dysplasia arising in a background of incomplete intestinal metaplasia. Dysplastic epithelium shows large, hyperchromatic and crowded nuclei with loss of polarity with respect to the basement membrane (HE stain, ×200).
Figure 9
Figure 9
Adenocarcinoma of the intestinal type. Tumor cells are cohesively arranged in irregular glandular structures infiltrating the stroma (HE stain, ×200).
See this image and copyright information in PMC

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