Dysplasia
cancer sequence has not been determined in
gastric cancer yet. Dysplastic changes are not frequent.
Gastric cancer generally develops in areas of chronic
atrophic gastritis. This chronic
atrophic gastritis (CAG) is often associated with intestinal
metaplasia (IM). IM has been classified in three types, according to morphologic patterns, differentiation and
mucins production. We reviewed 55
gastrectomy specimens and 278 endoscopic biopsies. In order to determine an histological high-risk group, we chose cases with
preneoplastic conditions (60 CAG, 10 biopsies of gastric remnants, 3 flat
adenomas and 55
gastrectomies by
cancer or
ulcer). We also included 12 hyperplastic
polyps because they may contain foci of intestinal
metaplasia.
Mucin techniques (PAS-
ALCIAN BLUE Ph 2.5 and HID-A.B) were used in all cases that showed extensive intestinal
metaplasia. In addition, we used immunohistochemistry techniques to detect CEA. Dysplasia was found only in flat
adenomas (3 cases), early
gastric cancer (1 case) and advanced
cancer (3 cases). We considered a preneoplastic lesion only to moderate or severe dysplasia. Hyperplastic regenerative pathology is considered a reversible condition. Therefore, it should be differentiated from dysplasia. We found that IM type III (
sulfomucin predominance) is the most related to
carcinoma, particularly to the intestinal type. CEA
antigen is poorly specific in detecting high-risk lesions because it was seen in regenerative pathology and in
gastric cancer too. Relationship of dysplasia and
carcinoma, and/or neoplastic
polyps was similar to other series. Concerning to follow-up items, we agree with the concepts proposed by the Japanese Research Society for
Gastric Cancer.