By Jason Wasserman MD PhD FRCPC
February 6, 2023
Dysplasia in the stomach (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.
Dysplasia in the stomach starts from specialized epithelial cells that cover the inside surface of the stomach.
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.
Causes of dysplasia in the stomach 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 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.
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.
Pathologists divide dysplasia in the stomach into low grade dysplasia and high grade dysplasia and the grade can only be determined after a tissue sample is examined under a microscope by a pathologist. The grade is important because it helps determine the risk of developing stomach cancer over time. In general, the risk of developing stomach cancer over the following 12 months is approximately 10% with low grade dysplasia but is approximately 70% with high 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 together to form round structures called glands and the glands are separated by a thin layer of connective tissue called lamina propria.
In high grade dysplasia of the stomach, the cells look very abnormal when examined under the microscope. Often the nucleus (the part of the cell that holds the genetic material) is enlarged and hyperchromatic (darker than normal). These cells are often 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.
Pathologists often divide dysplasia in the stomach into types with the two most common being intestinal-type dysplasia and foveolar-type dysplasia. The cells in intestinal-type dysplasia look similar to the cells normally seen in a part of the digestive system called the intestine. In contrast, the cells in foveolar-type dysplasia look similar to the cells normally seen in the stomach. The type of dysplasia can only be determined after the tissue is examined under the microscope by a pathologist.