Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors

Figure 3 Representative images of Indefinite for neoplasm/dysplasia lesions with repeated diagnoses (from regenerating atypia to atypical epithelium), which were finally confirmed as well-differentiated adenocarcinoma at endoscopic submucosal dissection. A: A lesion with mucosal irregularity and hyperemia is seen on the lesser curvature side of the prepylorus (indicated by arrows). B: After endoscopic submucosal dissection, the yellow line illustrates the boundary of the lesion confirmed in the pathology, measuring 1.7 cm × 1.0 cm. C: Regenerating atypia at the initial forceps biopsy shows focal glandular crowding with a basally-located, hyperchromatic nucleus. Glandular transition to the surrounding mucosa is observed. D: Atypical epithelium at follow-up biopsy after 598 d shows more crowded and tortuous glands. A few glands showed irregular distention. However, the hyperchromatic but basally-located nuclear atypia was mild. E: Endoscopic submucosal dissection was performed 2249 d later. It revealed well-differentiated adenocarcinoma. The low-power view shows surface maturation. F: The neoplastic tubules were prominent from the mid-portion of the tubular pit to the bottom of the gland; G: They form crowded, back-to-back, branched, and tortuous glands with disordered nuclei; H: Surface atypia is less prominent and mild nuclear atypia is observed. IFND: Indefinite for neoplasm/dysplasia.