Gastric epithelial histology and precancerous conditions

Abstract

The most common histological type of gastric cancer (GC) is gastric adenocarcinoma arising from the gastric epithelium. Less common variants include mesenchymal, lymphoproliferative and neuroendocrine neoplasms. The Lauren scheme classifies GC into intestinal type, diffuse type and mixed type. The WHO classification includes papillary, tubular, mucinous, poorly cohesive and mixed GC. Chronic atrophic gastritis (CAG) and intestinal metaplasia are recommended as common precancerous conditions. No definite precancerous condition of diffuse/poorly/undifferentiated type is recommended. Chronic superficial inflammation and hyperplasia of foveolar cells may be the focus. Presently, the management of early GC and precancerous conditions mainly relies on endoscopy including diagnosis, treatment and surveillance. Management of precancerous conditions promotes the early detection and treatment of early GC, and even prevent the occurrence of GC. In the review, precancerous conditions including CAG, metaplasia, foveolar hyperplasia and gastric hyperplastic polyps derived from the gastric epithelium have been concluded, based on the overview of gastric epithelial histological organization and its renewal.

Keywords: Diagnosis; Gastric cancer; Gastric epithelium; Gastric precancerous conditions; Histopathology.

Figure 1

An illustration of gastric unit and precancerous conditions shows the histological structure of gastric epithelium, possible gastric stem cells types and potential origin of different gastric precancerous conditions. CAG: Chronic atrophic gastritis; CSG: Chronic superficial gastritis; GC: Gastric cancer; GSCs: Gastric stem cells; HPs: Hyperplastic polyps; IM: Intestinal metaplasia; MNCs: Mucous neck cells; PCs: Parietal cells; SMCs: Surface mucous cells; SPEM: Spasmolytic Polypeptide-Expressing Metaplasia; ZCs: Chief cells/zymogenic cells; H. pylori: Helicobacter pylori.