Unmasking the high-risk phenotype in autoimmune gastritis - A pathologist’s roadmap for the clinician

Sep 28, 2026

Uploaded by Pentious

Li et al’s recent work on the risk factors for autoimmune gastritis provides clinical context for the vast majority of gastric neuroendocrine tumors (G-NETs). However, a deeper understanding of the underlying pathology is needed for precise clinical management. This letter details the predictable stepwise progression of type 1 G-NETs, from autoimmune-driven corporal atrophy and hypergastrinemia, through defined microscopic precursor stages. It specifies diagnostic thresholds separating precursors from overt neoplasia, including a 0.5 mm size rule and submucosal invasion, and proposes a prognostic biopsy protocol using Ki-67 grading. This pathology-centric strategy enables objective, earlier risk-guided surveillance rather than waiting for visible tumors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

LETTER TO THE EDITOR

Unmasking the high-risk phenotype in autoimmune gastritis

TO THE EDITOR

Core Tip

BEYOND ENDOSCOPY: DEFINING NEOPLASTIC RISK THROUGH PATHOLOGICAL CORRELATION

| W | J | G | World Journal of
Gastroenterology | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastroenterol 2025 December 28; 31(48): 115244 DOI: 10.3748/wjg.v31.i48.115244 ISSN 1007-9327 (print) ISSN 2219-2840 (online) LETTER TO THE EDITOR Unmasking the high-risk phenotype in autoimmune gastritis: A pathologist’s roadmap for the clinician Cheng-Long Wang, Min Zeng, Yan Luo Specialty type: Gastroenterology and hepatology Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade B Novelty: Grade B, Grade D Creativity or Innovation: Grade B, Grade C Scientific Significance: Grade B, Grade B P-Reviewer: Cerwenka H, MD, Professor, Austria; Shukla A, MD, Assistant Professor, India Received: October 15, 2025 Revised: October 28, 2025 Accepted: November 12, 2025 Published online: December 28, 2025 Processing time: 76 Days and 0.5 Hours Cheng-Long Wang, Min Zeng, Department of Pathology, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China Yan Luo, Department of Stomatology, The People’s Hospital of Dadukou District, Chongqing 400084, China Co-corresponding authors: Min Zeng and Yan Luo. Corresponding author: Yan Luo, MD, Doctor, Department of Stomatology, The People’s Hospital of Dadukou District, No. 102 Cuibai Road, Dadukou District, Chongqing 400084, [China.](China. luokate88@gmail.com)[ luokate88@gmail.com](China. luokate88@gmail.com) Abstract Li et al’s recent work on the risk factors for autoimmune gastritis provides clinical context for the vast majority of gastric neuroendocrine tumors (G-NETs) . However, a deeper understanding of the underlying pathology is needed for precise clinical management. Our letter details the predictable stepwise progression of type 1 G-NETs from autoimmune-driven corporal atrophy and hypergastrinemiato a clear microscopic sequence of enterochromaffin-like cell precursor lesions, including linear hyperplasia, micronodular hyperplasia, and dysplasia. We highlight the definitive diagnostic thresholds that separate these precursors from overt neoplasia: The 0.5 mm size rule and the presence of submucosal invasion. We advocate for a “prognostic biopsy protocol” in which pathologists actively report these precursor lesions and use Ki-67 to grade G-NETs, providing a quantitative risk assessment. This pathology-centric approach transforms surveillance, allowing clinicians to act on objective microscopic milestones rather than waiting for macroscopically visible tumors. Key Words: Pathology; Autoimmune gastritis; Gastric neuroendocrine tumors; Precursor lesions; Dysplasia ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. WJG [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 28, 2025 Volume 31 Issue 48 Wang CL et al. Pathology-guided risk in AIG Core Tip: Clinical risk models identify patients with autoimmune gastritis who may develop neuroendocrine tumors, but pathology guides what to do next. We advocate for a “prognostic biopsy protocol” where pathologists report the specific stage of microscopic pre-cancerous lesions. Finding high-risk changes, especially dysplasia, serves as a clear trigger to intensify surveillance. This approach allows clinicians to manage risk proactively based on a patient’s real-time biology, rather than waiting for a visible tumor to develop. Citation: Wang CL, Zeng M, Luo Y. Unmasking the high-risk phenotype in autoimmune gastritis: A pathologist’s roadmap for the clinician. World J Gastroenterol 2025; 31(48): 115244 URL: [https://www.wjgnet.com/1007-9327/full/v31/i48/115244.htm](https://www.wjgnet.com/1007-9327/full/v31/i48/115244.htm) DOI: [https://dx.doi.org/10.3748/wjg.v31.i48.115244](https://dx.doi.org/10.3748/wjg.v31.i48.115244) TO THE EDITOR We

FAQs

What key diagnostic thresholds are used to separate precursor lesions from overt neoplasia in autoimmune gastritis-related G-NETs?

The letter highlights a 0.5 mm size rule and the presence of submucosal invasion as decisive thresholds that distinguish precursor lesions from overt neoplasia.

What progression does the letter describe for type 1 gastric neuroendocrine tumors in autoimmune gastritis?

It outlines a predictable stepwise sequence: autoimmune-driven corporal atrophy and hypergastrinemia followed by a microscopic path that includes enterochromaffin-like cell precursor lesions such as linear hyperplasia, micronodular hyperplasia, and dysplasia.

How does the proposed “prognostic biopsy protocol” change clinical surveillance?

It asks pathologists to report specific precursor lesion stages and to use Ki-67 to grade G-NETs, enabling quantitative risk assessment so clinicians can intensify surveillance based on objective microscopic milestones rather than macroscopic tumor appearance.

Sep 28, 2026

Uploaded by Pentious