Dysplasia in the stomach (gastric dysplasia)

By Jason Wasserman MD PhD FRCPC
December 12, 2024


This article is designed to help you understand your pathology report for dysplasia of the stomach. Each section explains an important aspect of the diagnosis and what it means for you.

What does dysplasia in the stomach mean?

Dysplasia in the stomach (also known as gastric dysplasia) is a precancerous change that can turn into a type of stomach cancer called adenocarcinoma over time. Another name for this condition is glandular intraepithelial neoplasia.

Where in the stomach does dysplasia start?

Dysplasia in the stomach starts from specialized epithelial cells that cover the inside surface of the stomach.

Where in the stomach is dysplasia commonly found?

The most common location for dysplasia in the stomach is a part of the stomach called the antrum. However, dysplasia can be found anywhere in the stomach.

What causes dysplasia in the stomach?

Causes of stomach dysplasia include long-standing Helicobacter pylori infection, tobacco smoking, alcohol abuse, and Epstein-Barr (EBV) infection. Genetic alterations involving the genes CDH1 and APC also increase the risk of developing dysplasia.

What are the symptoms of dysplasia in the stomach?

Dysplasia in the stomach does not cause any symptoms by itself. However, the conditions that lead to dysplasia can cause symptoms such as abdominal pain, bloating, and nausea. Ulcers associated with dysplasia can lead to bleeding and anemia.

Is dysplasia in the stomach the same as cancer?

No. Dysplasia in the stomach does not mean cancer. However, if left untreated, dysplasia can turn into a type of stomach cancer called adenocarcinoma over time.

Types of dysplasia in the stomach

Pathologists often divide dysplasia in the stomach into types, the two most common being intestinal-type dysplasia and foveolar-type dysplasia. The cells in intestinal-type dysplasia look similar to those normally seen in a part of the digestive system called the intestine. In contrast, the cells in foveolar-type dysplasia look similar to those in the stomach. The type of dysplasia can only be determined after a pathologist examines the tissue under the microscope. Both types are associated with an increased risk of developing stomach cancer.

How is dysplasia in the stomach graded?

Pathologists classify dysplasia in the stomach into low grade dysplasia and high grade dysplasia. The grade is determined by examining a tissue sample under a microscope. Knowing the grade is important because it helps estimate the risk of developing stomach cancer. For low grade dysplasia, the risk of developing stomach cancer within the next year is about 10%. However, the risk increases to around 70% with high grade dysplasia.

Low grade dysplasia

In low grade dysplasia of the stomach, the cells look abnormal when examined under the microscope, but they still share some features with normal, healthy cells. Mitotic figures (cells dividing to create new cells) can be seen, but there are usually no atypical mitotic figures. The cells typically connect to form round structures called glands, separated by a thin layer of connective tissue called lamina propria.

High grade dysplasia

In high grade dysplasia of the stomach, the cells look very abnormal when examined under the microscope. The nucleus (the part of the cell that holds the genetic material) is often enlarged and hyperchromatic (darker than normal). These cells are frequently described as showing cytologic atypia. Mitotic figures (cells dividing to create new cells) are easily found, and some atypical mitotic figures may also be seen. The cells connect to form round structures called glands, and the glands are often side by side with very little connective tissue called lamina propria.

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