Diagnosis and management of gastric dysplasia

Abstract

Gastric dysplasia is a neoplastic lesion and a precursor of gastric cancer. The Padova, Vienna, and World Health Organization classifications were developed to overcome the discrepancies between Western and Japanese pathologic diagnoses and to provide a universally accepted classification of gastric epithelial neoplasia. At present, the natural history of gastric dysplasia is unclear. Much evidence suggests that patients with high-grade dysplasia are at high risk of progression to carcinoma or synchronous carcinoma. Therefore, endoscopic resection is required. Although patients with low-grade dysplasia have been reported to be at low risk of progression to carcinoma, due to the marked histologic discrepancies between forceps biopsy and endoscopic specimens, endoscopic resection for this lesion is recommended, particularly in the presence of other risk factors (large size; depressed gross type; surface erythema, unevenness, ulcer, or erosion; and tubulovillous or villous histology). Helicobacter pylori eradication in patients with dysplasia after endoscopic resection appear to reduce the incidence of metachronous lesions.

Keywords: Adenoma; Dysplasia; Intraepithelial neoplasia; Stomach.

Figure 1.

A lesion whose diagnosis was upgraded from gastric low-grade dysplasia to early gastric cancer after endoscopic resection. (A) Endoscopic findings before endoscopic resection show a 0.6 × 0.5 cm superficial elevated mass at the lesser curvature of the antrum. (B) Histologic features of low-grade dysplasia in the initial forceps biopsy specimen (H&E, ×200). (C) The endoscopic submucosal dissection specimen (3.7 × 2.7 cm). (D) Histologic features of the resected specimen. Moderately differentiated tubular adenocarcinoma arising from a tubular adenoma is evident. The tumor was 0.5 × 0.4 cm in size (H&E, ×200).

Figure 2.

Proposal of treatment strategy for gastric intraepithelial neoplasia/dysplasia diagnosed by endoscopic biopsy. ^aHelicobacter pylori eradication is recommended if identified after endoscopic resection in patients with dysplasia.