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The following is a summary of “Relationship between gastric mucosal atrophy, cystic dilatation, and histopathological characteristics,” published in the February 2025 issue of the BMC Gastroenterology by Wang et al.

This study investigates the intricate relationship between gastric mucosal atrophy and cystic dilatation, emphasizing their histopathological characteristics and potential malignant progression. A total of 527 endoscopic biopsy and endoscopic submucosal dissection (ESD) specimens were analyzed, comprising 313 male (59.4%) and 214 female (40.6%) cases. The age distribution revealed that 207 cases (39.3%) were ≤60 years, while 320 cases (60.7%) were >60 years. Histological examination classified the cystic dilatations into simple cystic dilatation (287 cases, 54.5%) and compound cystic dilatation (240 cases, 45.5%). Notably, gastric mucosal atrophy was a universal finding across all cases, initially manifesting as a disruption of the gastric glandular architecture, followed by increased interstitial tissue deposition and glandular septal widening. 

These structural alterations triggered compensatory hyperplasia, culminating in cystic cavity formation. Simple cystic dilatation, characterized by limited architectural distortion, demonstrated a potential for malignant transformation into early gastric cancer, specifically gastric papillary cystadenocarcinoma. In contrast, compound cystic dilatation exhibited more pronounced cellular atypia and glandular complexity, frequently progressing to tubular papillary adenocarcinoma. The transition from simple cystic dilatation to more complex lesions involved a sequential histopathological cascade, progressing through low- and high-grade intraepithelial neoplasia before culminating in mixed cystadenocarcinoma-glandular tube papillary carcinoma. This stepwise progression underscores the pivotal role of early histopathological assessment in predicting malignant transformation. Immunohistochemical analysis further corroborated the differential expression of key markers associated with cellular proliferation and neoplastic transformation, reinforcing the clinical significance of cystic dilatation classification in gastric mucosal pathology. 

These findings highlight the necessity for precise histopathological evaluation and stratification of gastric mucosal cystic dilatation to facilitate targeted surveillance and timely intervention. Clinicians should adopt a proactive approach in monitoring patients with cystic dilatation, particularly those exhibiting high-risk histological features, to mitigate the progression toward gastric malignancy. The classification and grading of these lesions not only enhance diagnostic accuracy but also provide valuable prognostic insights, reinforcing the importance of vigilant screening strategies. Ultimately, this study underscores the clinical imperative of early detection and histopathological differentiation in optimizing patient outcomes and reducing the burden of gastric cancer.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03662-z