Biological Significance of Dysplasias of the Epithelium and of Atrophic Gastritis

Abstract

Systematic investigations on resected specimens carried out by Büchner [1] and Konjetzny [15, 16] during the 1920s and 1930s, have proved that particular cellular alterations occur very regularly in the vicinity of carcinomas of the stomach, and that these may be regarded as forming the earlier stages. This assumption of the earlier investigators was confirmed by findings obtained by light and electron microscopic examinations from different stages of the experimental carcinogenesis of the stomach in the rat and in the dog [13, 33]. These changes of the gastric mucosa are now commonly recognized as precancerous lesions. The definition of precancerous lesions covers alterations like chronic gastritis accompanied by mucosal atrophy and intestinal metaplasia. It also refers, however, to advanced processes of dedifferentiation of the gastric mucosa, as for example the borderline lesion [20], a proliferation of the glandular neck cells associated with atypical forms [9], the different varieties of dysplasia [11, 24, 20] and the carcinoma of the surface or intra-epithelial carcinoma [19, 28] or the carcinoma in situ, respectively [3]. From the scientific point of view, it might be interesting to find out whether these changes of the gastric mucosa within the resected specimens of the stomach are to be defined as facultative or obligatory precancerous lesions, but this is of no consequence to the treatment of the individual patient.