Superficial oeso-gastric cancer and endoscopic mucosal resection: the pathologist's approach

Dysplasia is the earliest phase in cancer development that can be recognized by routine morphology. High grade dysplasia, intraepithelial carcinoma and in situ carcinoma are synonymous terms identifying a non invasive lesion whereas superficial (early) carcinoma is defined as a lesion confined to the mucosa or to the mucosa and sub-mucosa with or without lymph node metastasis. In the Vienna classification, proposed by a panel of Western and Japanese experts in 2000, the term "dysplasia" was replaced by the term "intraepithelial neoplasia" because this term defines more clearly the nature and the extent of the lesion, allowing recommendations for further diagnostic and therapeutic measures. Intraepithelial neoplasia is divided into two groups : low grade and high grade. Superficial oeso-gastric cancer can be treated by endoscopic mucosal resection (EMR). EMR provides specimens that must be handled and reported as surgical specimens by the pathologist.