Gastric High-grade Dysplasia Can Be Associated With Submucosal Invasion

Abstract

Gastric neoplasms classified as high-grade dysplasia (HGD) by Western pathologists are frequently diagnosed as tubular adenocarcinoma in Japan. Here, we evaluated the prevalence of submucosal and lymphovascular invasion in a series of 125 endoscopically resected gastric neoplasms. On the basis of Western criteria, the lesions were classified as poorly cohesive carcinomas (n=4) (excluded from further analysis), low-grade dysplasia (n=4), pure HGD (n=78), HGD with tubular adenocarcinoma (n=4), and pure tubular adenocarcinoma (n=35). Submucosal invasion was found in 3.8% of the 78 HGDs, 75.0% of the 4 HGDs combined with adenocarcinoma, and 11.4% of the 35 adenocarcinomas. Venous invasion was detected in 1.3% of the 78 HGDs, 75% of the 4 HGDs combined with adenocarcinoma, and none of the 35 tubular adenocarcinomas. Lymphatic invasion was absent in HGD but noted in 25% of the HGDs combined with adenocarcinoma, and 2.9% of the tubular adenocarcinomas. Thus, we demonstrated that lesions characterized as HGD on the basis of Western criteria can be associated with submucosal and lymphovascular invasion. Endoscopic therapy has made it less crucial to differentiate between HGD and intramucosal adenocarcinoma in biopsy samples of small tubular neoplasms. However, it is important to recognize that the criteria for dysplasia currently used in the West may understate the degree of malignant potential. To limit any diagnostic discrepancy between biopsy, endoscopic resection, and surgical specimens, it is suggested that the features of HGD and adenocarcinoma be reevaluated, which may result in some lesions being classified as mucosal adenocarcinoma.

Molecular profiling and comprehensive genome-wide analysis of somatic copy number alterations in gastric intramucosal neoplasias based on microsatellite status

“…This difference results most commonly from histological criteria of stromal invasion [6, 29–31]. The WHO histological classification of gastric neoplasia published at 2011 proposed new histological criteria for stromal invasion occurring in the mucosa propria [6, 31].…”

“…The histological diagnosis of intramucosal neoplasia differs substantially between Western and Japanese pathologists [ 30 – 32 ]. This difference results most commonly from histological criteria of stromal invasion [ 6 , 29 – 31 ]. The WHO histological classification of gastric neoplasia published at 2011 proposed new histological criteria for stromal invasion occurring in the mucosa propria [ 6 , 31 ].…”

“…This difference results most commonly from histological criteria of stromal invasion [ 6 , 29 – 31 ]. The WHO histological classification of gastric neoplasia published at 2011 proposed new histological criteria for stromal invasion occurring in the mucosa propria [ 6 , 31 ]. In the present study, LGD was more frequent in subgroup 3 than in subgroups 1 and 2, whereas IMC was significantly more frequent in tumors in subgroups 2 and 3 than in tumors in subgroup 1.…”

Body mass index, serum total cholesterol, and risk of gastric high-grade dysplasia

“…Gastric high-grade dysplasia has progressed to GC in a high percentage of cases (74%), [62] and some lesions with gastric high-grade dysplasia have been associated with submucosal invasion. [63] Consequently, gastric high-grade dysplasia might be considered as a histological marker for gastric carcinoma. However, data were scarce concerning the relationship between obesity and the risk of gastric high-grade dysplasia or the relationship between serum total cholesterol level and the risk of gastric high-grade dysplasia.…”

Differences in Prevalence of Lymphovascular Invasion among Early Gastric Cancers between Korea and Japan

“…Nonetheless, the prevalence of adenoma and early gastric cancer (EGC) differ between countries because of differences in the applied pathologic criteria 1,2. For example, structural invasion is necessary to diagnose EGC outside of Japan, while severe cytologic atypia with enlarged oval nuclei and prominent nucleoli is diagnosed as EGC in Japan regardless of the presence of invasion 3–5.…”