[Risk findings of the gastric mucosa--a clinicopathologic discussion]

Histological results of gastric biopsies necessitate a careful discussion between the gastroenterologist and pathologist in order evaluate the significance of the findings and to determine, what should be done next. Risk factors may be defined on the basis of clinical and endoscopic as well as of histological findings. Circumscript lesions of the gastric mucosa are such risk factors; histological examination of these lesions has to be done in quite a few cases repeatedly in order to confirm the diagnosis. Especially precancerous changes maybe considered as risk factors; according to WHO-definition they are subdivided in precancerous conditions and precancerous lesions. Precancerous conditions are type A gastritis, status after surgery of the stomach, hyperplasiogenic polyps of the stomach, increased familiar incidence of carcinoma, Ménétrier's disease, and acanthosis nigricans. Precancerous lesions on the other side are circumscript, histologically definable tissue changes, like for instance adenoma of the stomach, where formation of carcinoma can be observed with higher than normal incidence. Chronic atrophic gastritis has been overestimated considerably as a precancerous lesion. Control biopsies are indicated only in large time intervals and if special, well defined histological conditions prevail. Carcinoma incidence after Billroth II-resection of the stomach is lower in Middle Europe and U.S.A. than has been assumed before. Regular gastroscopic check-ups seem only to be justified in persons over 50 years of age, or in persons who have been operated upon more than 15 years ago. The procedures to be taken if gastric polyps are present depend upon localisation and size of the tumor and histology of the forceps biopsy. If adenoma are found or borderline lesions, which are to be considered as real precancerous lesions total excision by endoscopy, or if necessary by surgery is indicated.