Gastric crypt dysplasia: a distinct subtype of gastric dysplasia with characteristic endoscopic features and immunophenotypic and biological anomalies

Kim, Ahrong; Ahn, Sang Ho; Park, Do Youn; Lee, Bong-Eun; Song, Geum-Am; Kim, Gwang Ha; Lauwers, Gregory Y.

doi:10.1111/his.12860

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…As we previously noted in the oesophagus, 24 the four lines evaluating surface cell polarity cannot be used when the dysplasia does not involve the surface. Isolated ‘gastric pit/gland dysplasia’ has been described adjacent to gastric adenocarcinomas and may represent a precursor lesion 25,26 . If additional levels do not show surface involvement the pathologist must rely upon other features of dysplasia, such as nuclear atypia, compared to the non‐dysplastic epithelium, glandular crowding and architecture and increased mitoses and apoptosis, while adjusting for any inflammation that may account for these changes.…”

Section: Discussionmentioning

confidence: 99%

Cell polarity (the ‘four lines’) distinguishes gastric dysplasia from epithelial changes in reactive gastropathy

et al. 2020

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Aims Gastric dysplasia is a risk factor for synchronous and subsequent gastric carcinoma. Distinguishing gastric dysplasia from reactive changes is subject to interobserver disagreement and is a frequent reason for expert consultation. We previously used assessment of surface cell polarity (the ‘four lines’) as a key feature to decrease equivocal diagnoses in Barrett oesophagus. In the current study, we examined for the presence or absence of the four lines in gastric dysplasia and reactive gastropathy. Materials and methods The study includes all (n = 91) in‐house biopsies with at least gastric dysplasia from the surgical pathology archives of two academic institutions during a 5‐year period from 2008 to 2012. A reactive gastropathy group (n = 60) was created for comparison. Results The dysplasia/neoplasia group was comprised of 14 biopsies of gastric foveolar‐type dysplasia, 59 of intestinal‐type dysplasia, 14 with dysplasia in fundic gland polyps, three pyloric gland adenomas and one oxyntic gland adenoma. Loss of surface cell polarity was seen in all 88 dysplasia cases with evaluable surface epithelium. All 57 reactive gastropathy cases with evaluable surface epithelium showed intact surface cell polarity except in focal areas directly adjacent to erosions in 17 cases, where the thin wisp of residual surface mucin could not be appreciated on haematoxylin and eosin. Conclusion Surface cell polarity (the four lines) was lost in all gastric dysplasia biopsies with evaluable surface epithelium and maintained in all biopsies of reactive gastropathy. Caution should be taken in using this feature adjacent to erosions in reactive gastropathy.

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Section: Discussionmentioning

confidence: 99%

Cell polarity (the ‘four lines’) distinguishes gastric dysplasia from epithelial changes in reactive gastropathy

et al. 2020

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“…For these cases, the term “indefinite for dysplasia” may be applied. Gastric dysplasia limited to the pit region, without superficial epithelial involvement, is defined as crypt dysplasia 24 .…”

Section: Precancerous Lesionsmentioning

confidence: 99%

Precancerous lesions of the stomach, gastric cancer and hereditary gastric cancer syndromes

Gullo¹,

Grillo

Mastracci

et al. 2020

Pathologica

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Summary Gastric cancer accounts for about 6% of cancers worldwide, being the fifth most frequently diagnosed malignancy and the third leading cause of cancer related death. Gastric carcinogenesis is a multistep and multifactorial process and is the result of the complex interplay between genetic susceptibility and environmental factors. The identification of predisposing conditions and of precancerous lesions is the basis for screening programs and early stage treatment. Furthermore, although most gastric cancers are sporadic, familial clustering is observed in up to 10% of patients. Among them, hereditary cases, related to known cancer susceptibility syndromes and/or genetic causes are thought to account for 1-3% of all gastric cancers. The pathology report of gastric resections specimens therefore requires a standardized approach as well as in depth knowledge of prognostic and treatment associated factors.

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“…Even when histochemistry is used, however, IM subtyping based on the histochemical expression of MUCs requires considerable operator experience, and its clinical reliability is conditioned by the consistency of the biopsy sampling protocol. MUC immunohistochemistry can also be used to classify the different IM subtypes; while all IM subtypes express MUC2 and MUC4, the expression of MUC5AC and MUC6 are decreased in the complete variant [6][7][8]. Again, the use of these sophisticated cytochemical and immunohistochemical distinctions is restricted to the research setting.…”

Section: Introductionmentioning

confidence: 99%

“…Based on this simplified distinction, the clinical impact of IM has been recently addressed by a focused conference sponsored by the American Gastroenterological Association (AGA) [11], and management guidelines have been issued by other national and international gastroenterological organizations [12] as well as expert committees [13] and individual specialists [5]. The AGA has recently issued guidelines for the management and follow-up of patients with IM [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Incomplete Intestinal Metaplasia Is Rare in Autoimmune Gastritis

Genta¹,

Turner²,

Robiou³

et al. 2023

Dig Dis

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Background: Incomplete intestinal metaplasia (IM) is reportedly associated with higher gastric cancer (GC) risk than its complete variant. AGA Guidelines recommend including IM subtyping in routine pathology reports. This study assesses the prevalence of complete versus incomplete IM in gastric conditions with different GC risks. Methods: IM-subtyping (complete versus incomplete) and grading (IM extension: G1: ≤30%; G2: >30%) were assessed in 386 patients with IM+ve gastric biopsy sets that included both antral and oxyntic samples. Cases were categorized as: a) IM foci in otherwise normal mucosa (n = 59); b) H. pylori gastritis (n = 138); c) reactive gastropathy (141); d) Autoimmune atrophic gastritis ([AIG] n = 48). Odds ratios (OR) and their 95%CI were used in comparing the prevalence of incomplete-IM and the correlation between subtype and IM extension. Results: Incomplete-IM was presents in 37.7% of patients with H. pylori gastritis; 8.3% of those with AIG; 5.0% of those with reactive gastropathy, and none of those with otherwise normal mucosa. Incomplete-IM was strongly associated with more extensive (G2-IM) mucosal intestinalization (OR=6.69; CI95%: 2.77 – 9.40). Conclusion: Incomplete-IM is significantly more prevalent in conditions (H. pylori gastritis) known to carry a higher risk of GC, and is strongly associated with its extension. The low prevalence of incomplete IM in AIG (8.3%), and reactive gastropathy (5.2%) is in keeping with the low GC risk associated with these conditions.

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Gastric crypt dysplasia: a distinct subtype of gastric dysplasia with characteristic endoscopic features and immunophenotypic and biological anomalies

Abstract: Our results demonstrated that GCD can be an endoscopically identifiable lesion, sharing many similarities with foveolar and hybrid GED, for which it may represent a precursor lesion in the gastric carcinogenic sequence.

Cited by 8 publications

References 18 publications

Cell polarity (the ‘four lines’) distinguishes gastric dysplasia from epithelial changes in reactive gastropathy

Cell polarity (the ‘four lines’) distinguishes gastric dysplasia from epithelial changes in reactive gastropathy

Precancerous lesions of the stomach, gastric cancer and hereditary gastric cancer syndromes

Incomplete Intestinal Metaplasia Is Rare in Autoimmune Gastritis

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