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In 1980, an international group of pathologists and clinicians led by Basil Morson published a critical review entitled Precancerous Conditions and Epithelial Dysplasia in the Stomach.1 This seminal article attempted to merge Eastern and Western pathological experiences in the evaluation of preneoplastic conditions into a systematic approach to the evaluation of gastric precancerous conditions. Thirty-five years after its publication, we pay homage to Professor Morson's team by revisiting their positions in light of the dramatic advances of our understanding of gastric disease that have occurred during this time. To this end, we have selected from the original article those statements that warranted reappraisal and, after reproducing them verbatim, have provided our comments.
When considering problems of pre-malignancy, it is essential to define exactly what is meant by this term. A distinction can be made between a precancerous condition and a precancerous lesion. The former is best regarded as a clinical state associated with a significantly increased risk of cancer, whereas a precancerous lesion is a histopathological abnormality in which cancer is more likely to occur than in its apparently normal counterpart. In many clinical conditions with an increased risk of cancer, there is also an identifiable precancerous lesion, but this is not invariably so.
Studies carried out in the last three decades have supported the multifactorial aetiology of sporadic gastric cancer and have led to the concept of a progressive ‘cascade’ of phenotypic and molecular changes that may eventually result in neoplasia.2 In 1994, Helicobacter pylori was added to the cascade, providing the hitherto missing crucial aetiological element that initiates the entire process.3 ,4 While the distinction between precancerous condition and lesion remains useful, the current understanding of gastric oncogenesis (including its early molecular disarrangements) begs an expansion of the concept of ‘lesion’, …