Dysplasia is a cancer precursor and gastric low grade dysplasia is a part of this process. However one should be very careful in making a diagnosis of dysplasia in a patient with preexistent chemo/radiotherapy. If the diagnosis of dysplasia is unequivocal and not indefinite for dysplasia then the nature of the process harboring dysplasia and it's extent (e.g., focal - polyp or diffuse - gastritis) should be addressed. Only then the  treatment options should be discussed.

thanks, do you mean that dysplasia can be related to chemio and that the diagnosis can be false ? Is there evidence on that?

There are some specific treatment types leading to changes simulating gastric dysplasia (it is not a real dysplasia) - see link:

http://www.pathologyoutlines.com/topic/stomachte.html

thanks. Interesting

giuseppe

You are welcome

There several other pitfals when diagnosing gastric dysplasia, for example regenerative changes in the edge of ulcer

I discussed with the pathologist: she seems very confident in her diagnose and was aware of the recent chemio. I had MALToma without Helicobacter. 

is there any additional exam that can help in solving the problem of the genesis of the initial dysplasia ? will a pathologist with more sophisticate apparatus be able to do that?

Currently your pathologist is the only specialist who saw the histological specimen so you do not have any other option rather than rely on her diagnosis. 

For the genesis of dysplasia you should check both surrounding non-dysplastic and more distant gastric mucosa, if available.

Of course, you may send the slides for another pathologist, preferably GI (gastrointestinal) for a second opinion which may potentially lead to additional findings.

Always ask for a second opinion. In fact, the diagnosis of dysplasia in this setting should always be confirmed by a second Pathologist.

Also, it is important if it is gastric type (foveolar) or intestinal type dysplasia.

Low grade dysplasia is NEVER treated with gastrectomy, if it covers a larger area you can have a mucosectomy performed).

thanks Sebastian,

actually it was confirmed by tho gastro in different hospitals and two pathologists. The second gastro was with contrast color indaco.It is foveolar type and it appeared in just one biopsy (over 30 biopsies). It seems also to me that the advice to have gastrectomy is a bit extreme.

Giuseppe