We often see many patients or family members who are confused after getting the pathology report of gastroscopy biopsy. Because they cannot understand the pathology report, they often stop the doctor and repeatedly ask for a detailed explanation. In order to give patients a general understanding of the gastroscopy pathology report, this article provides a brief explanation of some common pathology findings in the biopsy pathology report for reference. Chronic gastritis It reflects a superficial infiltration of lymphocytes or plasma cells in the gastric mucosa, while the deeper gastric glands are normal. Depending on the degree of inflammatory cell infiltration, superficial gastritis can be classified as mild, medium, or with acute activity. Depending on the situation, patients can be cured with the use of different drugs. Yang Liusu, Department of Gastroenterology, Lu’an Group General Hospital Atrophic gastritis It refers to the partial or complete disappearance of gastric glands in addition to the infiltration of inflammatory cells in the mucosa. The gastric mucosal glands are atrophied to varying degrees and even disappear completely, leaving only the small gastric recesses remaining. Depending on the degree of reduction, they are classified as mild, moderate or severe. While the gastric glands are atrophied, the epithelium in the deeper part of the gastric notch proliferates to form glands and can become intestinal, or form polyps or even cancer. Since atrophy occurs in the pylorus (gastric sinus) of the stomach, and the mucosa of the stomach body and fundus is less involved and retains its secretory function, it is reasonable to explain that some patients with atrophic gastritis still have acid reflux and heartburn symptoms clinically. What does intestinal metaplasia refer to? A change in the morphology and histochemical composition of the epithelium of the gastric mucosal surface and the epithelium of the crypt, which becomes similar to the epithelium of the small or large intestine. Mild intestinal metaplasia of the gastric mucosa is more common and suggests damage to the gastric mucosa. Complete intestinal metaplasia turns the gastric mucosal epithelium into a normal intestinal epithelium. Incomplete intestinal metaplasia still has the same morphology as the gastric mucosal epithelium, but the chemical composition of the mucus cells is changed. It is further divided into incomplete small intestinal metaplasia and incomplete large intestinal metaplasia. Incomplete intestinal metaplasia requires special staining to differentiate. Among them, incomplete intestinal chemosis, especially incomplete colorectal chemosis may be closely related to gastric cancer. Therefore, if the pathology report shows both intestinal chemosis and atypical hyperplasia, it is necessary to do special staining to identify the type of intestinal chemosis – complete? or incomplete? Small bowel or large bowel? It is crucial! Clinicians and patients alike need to keep this in mind. However, special staining is not a routine part of the pathology of the gastric mucosa and needs to be ordered separately. Atypical hyperplasia (intraepithelial neoplasia) that requires attention Atypical hyperplasia is the appearance of abnormal nature of cell proliferation, including abnormal cell size, morphology, and arrangement, decreased mucus secretion, decreased nucleocytoplasm ratio, loss of nuclear polarity, pseudomultilayers, increased nuclear schizophrenia, and atypical nuclear schizophrenia. The disease is classified as mild, moderate or severe. The international academic community now renames atypical hyperplasia as intraepithelial neoplasia, and mild to moderate atypical hyperplasia is classified as low-grade intraepithelial neoplasia, while severe atypical hyperplasia is classified as high-grade intraepithelial neoplasia. There are two types of atypical hyperplasia: 1) adenomatous atypical hyperplasia – thought to progress to highly differentiated intestinal-type gastric adenocarcinoma; 2) proliferative atypical hyperplasia – closely related to incomplete intestinal metaplasia and thought to progress to poorly differentiated intestinal-type gastric adenocarcinoma. This test result should be given high priority because it can be considered as a precancerous lesion. According to some data, the cancer rate is 2.35% in mild anisotropic hyperplasia, 4-5% in moderate and 10-84% in severe cases. However, it is important to understand that mild atypical hyperplasia needs to be distinguished from inflammation-induced cell regeneration. Some pathology reported as mild atypical hyperplasia disappeared after treatment, which probably turned out to be an inflammatory reactive regenerative phenomenon rather than a true atypical hyperplasia. Therefore, patients should not be alarmed by the results of mild atypical hyperplasia (low-grade intraepithelial neoplasia) reports. A comprehensive analysis, appropriate treatment and review by the doctor are needed. As for severe atypical hyperplasia, i.e. high-grade intraepithelial neoplasia, it is already equivalent to carcinoma in situ and involves surgery. Cancer If cancer is directly reported in the report, it is a definite diagnosis. So is cancer early, intermediate or advanced? Generally, gastroscopic biopsy only determines the nature of lesion, and the degree of lesion development has to be determined by the depth of cancer tissue infiltration, the degree of differentiation, and the metastasis of lymph nodes after the removal of the bulk specimen.