Histologic precursors of gastrointestinal tract malignancy☆

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Squamous dysplasia

Squamous cell dysplasia is accepted as the precursor lesion for esophageal carcinoma. In North America, this lesion is usually found on examination of esophagectomies for squamous cell carcinoma. In high-risk regions for squamous cell carcinoma, squamous dysplasia has been noted on endoscopic screening examination, particularly in patients with previously detected abnormal cytology. Individuals with head and neck cancers are at increased risk for the development of squamous dysplasia, probably

Epithelial precursor lesions

Gastric dysplasia is usually found in the context of a chronic atrophic gastritis. This observation supports Correa's model for intestinal gastric carcinogenesis, which places dysplasia and invasive carcinoma as endpoints seen in a subset of patients following the development of chronic gastritis, IM, and atrophy [41]. Both multifocal atrophic gastritis and autoimmune atrophic gastritis are considered precursor conditions, but the former is far more commonly associated with dysplasia. Other

Small intestine

Adenomas, the most common precursor lesion of the small intestine, are most often found in FAP patients, with >90% of these patients having adenomas in the periampullary region (Fig. 8). In patients without a precursor condition, small-intestinal adenomas are infrequent. These lesions represent only one third of small-intestinal polyps and <0.1% of all intestinal adenomas, reflecting the fact that adenocarcinoma in this region of the GIT is a rare event. Sporadic adenomas are most commonly seen

Adenomas

The large intestinal adenoma is the prototype of dysplasia in the GIT, the “yardstick” with which other dysplastic lesions are compared [60]. It is the most common precursor lesion seen in the GIT in individuals both with and without a familial hereditary colon cancer syndrome. In an autopsy study of high-risk regions, colonic adenomas have been reported in as much as 60% of the population [61]. Adenomas are rare before the age of 40 and are seen with increasing frequency after age 50. Colonic

Summary

Precursor lesions in the GIT include flat dysplasias, adenomas, dysplasia superimposed on nonneoplastic polyps, endocrine cell dysplasia, ACF, and condyloma accuminatum. Interobserver variability can be a problem in reporting dysplasia, and ancillary techniques including flow cytometry, image analysis, proliferation markers, and examination for p53 expression can help in this task. Squamous dysplasia seen in the esophagus and anus is graded on either a two-tiered or three-tiered system largely

Acknowledgements

The author gratefully acknowledges Dr. Fernando U. Garcia for his editorial assistance and Ms. Lorraine Reichart for her secretarial support.

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    Reprinted with permission from Gastroenterology Clinics of North America 2002;31(2):395–419.

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