Test structure in some pioneer multichambered Paleozoic foraminifera.

Foraminiferal wall microstructures, consistent with the molecular-based high-rank classification, are critical to understanding foraminiferal evolution and advanced taxonomic relationships. Although test structures are well documented for recent, Cenozoic, and some Mesozoic foraminifera, the diagnostic characteristics of Paleozoic taxa are largely unexplored. The majority of calcareous Paleozoic foraminifera have been assigned to the Fusulinata based on questionable homogeneously "microgranular" test wall microstructures, which have never been sufficiently documented for most taxa. We investigated the test structures of exceptionally well-preserved Devonian (Eifelian) Semitextularia thomasi, representing the first calcareous true multichambered (serial) foraminifera, and compared this species with a large fusiform Permian representative of "true" fusulinids (Neoschwagerinidae). The tests of Semitextularia thomasi display lamellar structures that are not observed in any other fossil or recent foraminiferal group. The Paleozoic foraminifera, traditionally referred to one taxon (the class Fusulinata), possess at least three contrasting test wall microstructures, representing separate high-rank taxonomic groups. Fusulinata is most likely a highly polyphyletic group that is in need of taxonomic revision. The term Fusulinata, defined as including all Paleozoic calcareous forms except Miliolida and Lagenata, is not phylogenetically meaningful and should no longer be used or should be restricted to true complex fusulinids with microgranular test structures, which appeared in the Carboniferous.

Immune response in breast cancer brain metastases and their microenvironment: the role of the PD-1/PD-L axis.

BACKGROUND: A better understanding of immune response in breast cancer brain metastases (BCBM) may prompt new preventive and therapeutic strategies. METHODS: Immunohistochemical expression of stromal tumor-infiltrating lymphocytes (TILs: CD4, CD8, CTLA4), macrophage/microglial cells (CD68), programmed cell death protein 1 receptor (PD-1), programmed cell death protein 1 receptor ligand (PD-L)1, PD-L2 and glial fibrillary acid protein was assessed in 84 BCBM and their microenvironment. RESULTS: Median survival after BCBM excision was 18.3 months (range 0-99). Median number of CD4+, CD8+ TILs and CD68+ was 49, 69 and 76 per 1 mm(2), respectively. PD-L1 and PD-L2 expression in BCBM was present in 53 % and 36 % of cases, and was not related to BCBM phenotype. PD-1 expression on TILs correlated positively with CD4+ and CD8+ TILs (r = 0.26 and 0.33), and so did CD68+ (r = 0.23 and 0.27, respectively). In the multivariate analysis, survival after BCBM excision positively correlated with PD-1 expression on TILs (hazard ratio (HR) = 0.3, P = 0.003), CD68+ infiltration (HR = 0.2, P < 0.001), brain radiotherapy (HR = 0.1, P < 0.001), endocrine therapy (HR = 0.1, P < 0.001), and negatively with hormone-receptor-negative/human epidermal growth factor receptor 2 (HER2)-positive phenotype of primary tumor (HR = 2.6, P = 0.01), HER2 expression in BCBM (HR = 4.9, P = 0.01). CONCLUSIONS: PD-L1 and PD-L2 expression is a common occurrence in BCBM, irrespective of primary tumor and BCBM phenotype. Favorable prognostic impact of PD-1 expression on TILs suggests a beneficial effect of preexisting immunity and implies a potential therapeutic role of immune checkpoint inhibitors in BCBM.

Functional Assessment of Synoptic Pathology Reporting for Ovarian Cancer.

BACKGROUND: Ovarian cancer has one of the highest death/incidence rates and is commonly diagnosed at an advanced stage. In the recent WHO classification, new histotypes were classified which respond differently to chemotherapy. The e-standardized synoptic cancer pathology reports offer the clinicians essential and reliable information. The aim of our project was to develop an e-template for the standardized synoptic pathology reporting of ovarian carcinoma [based on the checklist of the College of American Pathologists (CAP) and the recent WHO/FIGO classification] to introduce a uniform and improved quality of cancer pathology reports. A functional and qualitative evaluation of the synoptic reporting was performed. METHODS: An indispensable module for e-synoptic reporting was developed and integrated into the Hospital Information System (HIS). The electronic pathology system used a standardized structure with drop-down lists of defined elements to ensure completeness and consistency of reporting practices with the required guidelines. All ovarian cancer pathology reports (partial and final) with the corresponding glass slides selected from a 1-year current workflow were revised for the standard structured reports, and 42 tumors [13 borderline tumors and 29 carcinomas (mainly serous)] were included in the study. RESULTS: Analysis of the reports for completeness against the CAP checklist standard showed a lack of pTNM staging in 80% of the partial or final unstructured reports; ICD-O coding was missing in 83%. Much less frequently missed or unstated data were: ovarian capsule infiltration, angioinvasion and implant evaluation. The e-records of ovarian tumors were supplemented with digital macro- and micro-images and whole-slide images. CONCLUSIONS: The e-module developed for synoptic ovarian cancer pathology reporting was easily incorporated into HIS.CGM CliniNet and facilitated comprehensive reporting; it also provided open access to the database for concerned recipients. The e-synoptic pathology reports appeared more accurate, clear and conclusive than traditional narrative reports. Standardizing structured reporting and electronic tools allows open access and downstream utilization of pathology data for clinicians and tumor registries.

Experimental modeling of pulmonary barotrauma.

The main causes of pulmonary barotrauma include loss of consciousness or panic attack of a diver and emergence from underwater with a constricted glottis. However, numerous publications and our observations indicate that the majority of fully symptomatic cases of pulmonary barotrauma develop without any evident errors in the ascending technique. Therefore, an attempt was made to examine such cases using the experimental model of pulmonary barotrauma designed by the authors. The experiment was conducted on 32 rabbits divided into three groups: Group C--not subjected to any treatment; Group E--with induced pulmonary barotrauma; and Group CT--subjected only to compression followed by quick decompression. In Groups E and CT, the same morphological markers of pulmonary barotrauma were detected in the lungs, although their severity varied. Morphological markers of pulmonary barotrauma were observed both in the group where the tube was not ob-structed (E) and in animals exposed only to rapid decompression (CT)

Survivin expression as a prognostic factor in patients with epithelial ovarian cancer or primary peritoneal cancer treated with neoadjuvant chemotherapy.

BACKGROUND: The aim of this study was to evaluate association of expression of survivin and p53 with the effects of neoadjuvant chemotherapy (NAC) in patients with advanced ovarian cancer (AOC). METHODS: We retrospectively evaluated 60 consecutive patients with AOC (International Federation of Gynecology and Obstetrics stage IIIC-IV) treated with NAC. The expression of p53 and survivin was assessed immunohistochemically. The median of expression total score survivin equals 2 was adopted to dichotomize the group. The positive and negative expression of p53 was used to dichotomize the group. RESULTS: The expression of survivin in tumor tissue taken before and after NAC was a significant difference in the percentage of stained nuclei (P = 0.0002), the intensity of staining (P = 0.0003), and total score (P = 0.0001). There was a significant difference in p53 expression in tumor tissue before and after NAC in the percentage of stained nuclei (P = 0.0424). Survivin expression, in contrast to p53 expression, was a prognostic factor in patients with AOC treated with NAC (P = 0.0484). The expression of survivin and p53 was not a predictive factor. Independent adverse predictor factors were as follows: lack of optimal interval debulking surgery and the lack of an objective response (the respective hazard ratio was 3.93 [95% confidence interval, 2.07-7.46; P < 0.0001] and 2.36 [95% confidence interval,1.25-4.47; P = 0.0080]). The suboptimal range of interval debulking surgery, resistance to platinum, and the lack of paclitaxel in the NAC were adverse prognostic factors (the respective hazard ratio was 2.61 [95% confidence interval, 1.17-5.83], 2.72 [95% confidence interval, 1.07-6.89], and 2.56 [95% confidence interval, 1.06-6.18]; P < 0.05]). CONCLUSIONS: High expression of survivin could be a prognostic factor in patients treated with NAC for AOC.

A case of a large solitary fibrous tumour of the uterine cervix.

BACKGROUND: Solitary fibrous tumour of the uterine cervix is an extremely rare phenomenon. We present a case of the largest cervical tumour of this type in this anatomical location reported so far. CASE PRESENTATION: A 45-year old white female presented with abdominal pain, abnormal uterine bleedings and a 15 cm mass of the uterine cervix/left parametrium. Histological examination with immunohistochemistry of the tumour biopsy revealed diagnosis of solitary fibrous tumour. The patient underwent radical abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. No recurrence has been observed for 8 months of follow-up. CONCLUSIONS: Solitary fibrous tumour can be occasionally found in patients with large cervical/parametrial masses. Immunohistochemistry was helpful in diagnosis and surgery was feasible and effective in treatment of our case of a large solitary fibrous tumour of the cervix.

Buffering capacity explains signal variation in symbiotic calcium oscillations.

Legumes form symbioses with rhizobial bacteria and arbuscular mycorrhizal fungi that aid plant nutrition. A critical component in the establishment of these symbioses is nuclear-localized calcium (Ca(2+)) oscillations. Different components on the nuclear envelope have been identified as being required for the generation of the Ca(2+) oscillations. Among these an ion channel, Doesn't Make Infections1, is preferentially localized on the inner nuclear envelope and a Ca(2+) ATPase is localized on both the inner and outer nuclear envelopes. Doesn't Make Infections1 is conserved across plants and has a weak but broad similarity to bacterial potassium channels. A possible role for this cation channel could be hyperpolarization of the nuclear envelope to counterbalance the charge caused by the influx of Ca(2+) into the nucleus. Ca(2+) channels and Ca(2+) pumps are needed for the release and reuptake of Ca(2+) from the internal store, which is hypothesized to be the nuclear envelope lumen and endoplasmic reticulum, but the release mechanism of Ca(2+) remains to be identified and characterized. Here, we develop a mathematical model based on these components to describe the observed symbiotic Ca(2+) oscillations. This model can recapitulate Ca(2+) oscillations, and with the inclusion of Ca(2+)-binding proteins it offers a simple explanation for several previously unexplained phenomena. These include long periods of frequency variation, changes in spike shape, and the initiation and termination of oscillations. The model also predicts that an increase in buffering capacity in the nucleoplasm would cause a period of rapid oscillations. This phenomenon was observed experimentally by adding more of the inducing signal.

Skull base secretory meningioma. Value of histological and immunohistochemical findings for peritumoral brain edema formation.

Meningiomas are very common neurosurgical problem. Their histological appearance, different size and localization, adherence to vital neural and vascular structures or extensive peritumoral brain edema (PTBE), especially in deep seated tumors, may lead to severe, life-threatening complications. We report a case of tuberculum sellae meningioma (TSM). A 48-year old female presented with 7-month history of blurred vision and progressive visual impairment. Intracranial tumor was confirmed by magnetic resonance imaging (MRI). After ophtalmological and endocrinological evaluation, the patient underwent surgical removal of the tumor. She immediately recovered from her visual disturbances and no tumor recurrences were seen during follow-up. Pathological diagnosis showed a meningioma of the secretory subtype (MS). We discuss the role of immunohistochemical staining in the diagnosis and the role of different factors in the PTBE formation. Selection of surgical route to the TSM is discussed, as well. Review of the literature is presented.

Conversion of epidermal growth factor receptor 2 and hormone receptor expression in breast cancer metastases to the brain.

INTRODUCTION: We investigated the status of estrogen receptor alpha (ERα), progesterone receptor (PR), and epidermal growth factor receptor 2 (HER2) in primary tumor and in the corresponding brain metastases in a consecutive series of breast cancer patients. Additionally, we studied factors potentially influencing conversion and evaluated its association with survival. METHODS: The study group included 120 breast cancer patients. ERα, PR, and HER2 status in primary tumors and in matched brain metastases was determined centrally by immunohistochemistry and/or fluorescence in situ hybridization. RESULTS: Using the Allred score of ≥ 3 as a threshold, conversion of ERα and PR in brain metastases occurred in 29% of cases for both receptors, mostly from positive to negative. Conversion of HER2 occurred in 14% of patients and was more balanced either way. Time to brain relapse and the use of chemotherapy or trastuzumab did not influence conversion, whereas endocrine therapy induced conversion of ERα (P = 0.021) and PR (P = 0.001), mainly towards their loss. Receptor conversion had no significant impact on survival. CONCLUSIONS: Receptor conversion, particularly loss of hormone receptors, is a common event in brain metastases from breast cancer, and endocrine therapy may increase its incidence. Receptor conversion does not significantly affect survival.

Lens epithelial cell damage after exposure to deionized water to prevent posterior capsule opacification after phacoemulsification: an in vitro study.

BACKGROUND: The aim was to study the effects of distilled deionized water (DDW) on lens epithelial cells (LECs) after two different exposure times in the context of preventing posterior capsule opacification (PCO) after phacoemulsification. MATERIAL/METHODS: Twenty-one subjects (21 eyes) (12 women, 9 men), with a mean age of 74.5 + or - 7.1 years, were in this study. Anterior capsulotomy specimens obtained during cataract phacoemulsification were immersed in a hypotonic solution of DDW. In group I (10 eyes) the anterior capsule fragments were exposed to DDW for 1 minute and in group II (11 eyes) for 3 minutes. The fragments then underwent histological examination; photographic documentation was made and measurements were done with an image analysis system. Log-linear analysis was performed to determine the odds ratio (OR). The significance of particular histological findings was evaluated with Fisher's exact test and Kendall's tau b coefficient was determined by analyzing contingency tables. RESULTS: Basement membrane and LECs showing different degrees of damage, from vacuolar degeneration to epithelial detachment and from karyorrhexis to total cytolysis, were detected in the microscopic specimens. The probability of lens epithelial cell cytolysis after 3-minute exposure was 3.5 times higher than after 1-minute exposure to DDW. CONCLUSIONS: Exposure to DDW causes different degrees of damage to LECs, ranging from reversible changes to total cell death. The changes seen in LECs are dependent on the duration of their exposure to DDW.

[Evaluation of the number of enterochromaffin cells in gastric mucosa in subjects with functional dyspepsia]. / Ocena liczby komórek enterochromafinowych w blonie sluzowej zoladka u osób z dyspepsja czynnosciowa.

UNLABELLED: Enterochromaffin cells (EC) in gastric mucosa produce of serotonin and melatonin and trough its paracrine activity able to change motoric and secretory function. AIM OF OUR STUDIES: To evaluate the density of enterochromaffin cells in gastric mucosa in subjects with functional dyspepsia. MATERIAL AND METHODS: The investigations were performed in 50 subjects including 25 subjects with Postprandial Distress Syndrome and 25 subjects with Epigastric Pain Syndrome accordingly to Rome Criteria III. The comparative group comprised 25 healthy subjects. To identify enterochromaffin cells the bioptates were collected from the corpus and prepyloric part of the stomach and stained immunohistochemically. RESULTS: Number of EC cells in corpus part were--healthy subjects 1.68 +/- 0.35, in patients with PDS--1.26 +/-0.37 (p < 0.001) and in EPS--2.11 +/- 0.43 (p < 0.01). In antrum Number of EC cells were: K--2.52 +/- 0.52, PDS--1.79 +/- 0.3 (p < 0.01), EPS--2.69 +/- 0.46 (p > 0.05). The results of urea breath test (UBT-13C) were: PDS--13.10 +/- 6.49% per hundred, EPS--18.98 +/- 10.11% per hundred (p < 0.05). In group of patients with EPS the positive correlation between number of enterochromaffin cells and urea breath test results was observed. CONCLUSIONS: The number of EC cells in gastric mucosa in subjects with functional dyspepsia is different than in healthy subjects. Evaluation of the number of enterochromaffin cells could have clinical value in differential diagnosis in functional dyspepsia.

[Non-erosive reflux disease in endoscopy and histopathology]. / Nienadzerkowa choroba refluksowa przelyku w obrazi endoskopowym i histopatologicznym.

THE AIM: Non-erosive reflux disease is presented in reflux diseases classifications not adequately Many esophageal lesions were described in different endoscopic techniques but not one classification was proposed. In many patients with signs of prolonged gastro-esophageal reflux in endoscopic assessment pale mucosa above gastro-esophageal junction was observed. In some patients color of esophagus in distal part becomes white and grey. We decided to check what histological lesions appear in all endoscopically visible lesions. MATERIAL AND METHODS: We analyzed 29 patients with chronic reflux disease and with endoscopic assessment of upper alimentary tract in which white color was observed in distal part of esophagus was observed. Biopses were taken from sites at least 2 cm from Z-line. Endoscopic assessment was performed by one endoscopist specialized in reflux disease. Biopsies were assessed by one pathologist specialized in upper alimentary tract diseases assessment. RESULTS: In all cases biopsies taken from distal esophageal, white-coloured mucosa were assessed by pathologist as esophagitis caused by gastro-esophageal reflux. CONCLUSIONS: White color of the distal part of esophagus in patients with chronic reflux disease is unanimously associated with microscopic lesions associated with reflux disease.

[Role of nitric oxide system in pathogenesis of experimental model of hepatorenal syndrome]. / Rola ukladu endogennego tlenku azotu w patogenezie doswiadczalnego zespolu watrobowo-nerkowego.

UNLABELLED: Hepatorenal syndrome (HRS) is still one of a few great secrets of today's medicine. Pathomechanism of this syndrome, specially in case of an acute liver damage, is still poorly understood. AIM OF THE STUDY: In our study in experimental galactosamine (Ga1N) model, using the nitric oxide synthase (NOS) inhibitor- N omega-nitro-L-Arginine (L-NAME), we tried to explain, whether the nitric oxide plays some role in this model of HRS. MATERIAL AND METHODS: We used 56 male Sprague-Dawley rats (SDR) divided into 7 groups. To achieve acute renal failure in all tested groups of animals GalN was given intraperitoneally. To determine influence of nitric oxide inhibition, L-NAME was given before and after Ga1N injection. Control groups received adequate volume of 0.9% saline solution. RESULTS: Liver and renal failure developed in all tested groups. Inhibition of NOS significantly but dose independently prevented the development of acute renal failure both before and after Ga1N injection. Pretreatment with L-NAME was significantly more succesful than post Ga1N treatment. CONCLUSION: Our study showed that inhibition of nitric oxide synthase prevents the development of renal failure in animal model of HRS. This is probably the first observation that nitric oxide plays important role in this model of HRS.

[Race of experimental animals and development of renal failure in animal model of hepatorenal syndrome]. / Rasa zwierzat doswiadczalnych a rozwój niewydolnosci nerek w doswiadczalnym modelu zespolu watrobowo--nerkowego.

UNLABELLED: Hepatorenal syndrome (HRS) is still one of the most important challenges of medicine in 21st century. In spite of many years of experimental and clinical studies, it failed to discover precise pathomechanisms leading from hepatic damage to functional renal failure. Among many kinds and currents, experimental studies still play great role. There are few reported animal models of HRS, among them a rat model induced by galactosamine (GalN). In this model acute renal failure develops typically after hepatic damage. AIM OF THE STUDY: We tried to test, whether in this model different breeds might develop typical HRS in the same way. MATERIAL AND METHODS: We used 24 male Wistar and 16 Sprague-Dawley rats to achieve HRS by intraperitoneal injection of Ga1N. RESULTS. Liver failure with significant increase in serum concentration of bilirubin, alanine transaminase (ALT) and ammonia, as well as huge microscopic necrosis of hepatocytes developed in both groups, but we did not achieved any evidence of acute renal failure in Wistar rats group. Nevertheless, we found typical biochemical evidence of renal failure in Sprague-Dawley group. CONCLUSION: We conclude, that opposite to Sprague-Dawley model, the Wistar rat model does not develop functional renal failure typical for HRS, probably because of some congenital, genetic predispositions.

Changes in distribution pattern of CD8 lymphocytes in the scalp in alopecia areata during treatment with diphencyprone.

For many years, the role of T lymphocytes was hypothesized as being a major factor responsible for hair loss in alopecia areata (a.a.). While numerous lymphocytic populations were found around hair bulbs, changes in their distribution patterns in the skin during the course and recovery of the disease remain unknown. In the present study, distribution of CD8 lymphocytes in biopsies obtained from a.a. patients was measured before and during treatment using diphencyprone (DCP). Results show about a 600% increase in the number of CD8 lymphocytes under the epithelium and about a 250% increase around hair bulbs and other epidermal appendages during the study. These results were more significant in a group, which had good clinical response to the treatment. No change in the quantity of CD8 lymphocytes was observed around the blood vessels. Since CD8 lymphocytes are considered to be directly involved in the hair destruction process in a.a., their increased number around hair bulbs followed by hair regrowth may suggest that during DCP treatment they regain normal reactivity to hair antigens.

[Endoscopic polypectomy in colorectal cancer prophylaxis]. / Endoskopowa polipektomia w profilaktyce raka jelita grubego.

The increasing incidence of colorectal cancer force to find new and enhance old methods of diagnostic methods that could allow the pre-magnant or early cancer lesions diagnosing. Those could be more effectively and with less invasive surgical and endoscopic methods cured. The proposed method in prophylaxis is colonoscopy that allow the lesion detection as well as apply curative method what is better for patient and decrease cost of procedure. Diagnostic efficacy is dependant on the experience of the person performing the procedure. Only in some cases applying methods as inking or magnifying increase diagnostic yield. Early lesion detection and treatment of colorectal adenomas that could be protruding, flat or concave lead to significant decrease of colorectal cancer incidence. Implementing the wider array of indications and mucosectomy to clinical practice improve treatment efficacy but require proper preparation and experience as well as qualification for the procedure. Despite the development of new diagnostic methods basis the proper evaluation of mucosal layer during endoscopy and histopatological assessmnet of found lesions. Colonoscopy is also widely accepted method of colorectal cancer surveillance after endoscopic or surgical procedures in colorectal treatment.

[Clinico-pathological cooperation rules in biologic material processing]. / Zasady wspólpracy k iniczno-patomorfologicznej w opracowywaniu materialu biologicznego.

The principles of collaboration between a clinician and a pathomorphologist in diagnosis of the intestinal diseases were presented. The optimal criteria of drawing and fixing cytological and tissue samples were presented. The importance of extensive clinical information for pathomorphological diagnosis was proved. It was indicated that an early collaboration between a clinician and a pathomorphologist in the proccess of clinical diagnostic planning is necessary.

[The possibilities and barriers in endoscopic examination and treatment of esophagus cancer]. / Mozliwosci endoskopli w rozpoznawaniu i leczeniu nowotworów przelyku.

When it comes to the effective treatment of esophagus tumor is one of the most difficult tumor to treat of all tumors of alimentary tract. It is due to the biological features of this tumor and lack of its early clinical symptoms, which would allow to recognize it in the early stage and to begin with a radical treatment. The main method to recognize the esophagous tumor is the endoscopic treatment with histopathology, and the endosonography is the best method which allows to estimate its local advancement. Endoscopy allows to detect pre-malignant phase and the early stage as well use of the alternative to surgical endoscopic methods of the treatment. Unfortunately, endoscopy made to patients with swallow discordance usually shows the advanced esophagus tumor, which is to be qualified for palliative treatment that include: widening of esophagus, different methods of ablation, endoscopic stenting and implementing alimentary gastrostomy. The choice of the treatment method should be based on the type of the tumor and the advancement stage of disease, but the clinical practice shows that the method of treatment is determined by the availability of the methods and experience. The parallel use of different methods of treatment may give better results, but the wide range of treatment methods shows the lack of optimal way of treatment, on the other hand gives the possibility to chose the individual method of optimal treatment. Surgical treatment is still method of choice in the esophagus tumor, but it is often impossible to perform or is appears to be ineffective and it creates the possibility of use of alternative endoscopic methods. The article shows the possibilities of diagnosing and different endoscopic techniques for radical treatment of earlyphase and palliative treatment of advanced tumor of esophagus.

[Histoclinic of "indeterminate colitis"]. / Histoklinika "colitis indeterminata".

Indeterminate colitis is an ill definied, preliminary and temporary descriptive term overused in clinical and morphological practice. The aim of this paper is to offer an opinion, supported by published data, about the appropriate use of this term. There is no generally accepted definition of indeterminate colitis. All current temporary definitions of this term relay on exclusionary criteria and there is no confirmatory diagnostic tests. Nevertheless the diagnosis of indeterminate colitis appears to define subgroup of patients with special phenotype of inflammatory bowel disease. A diagnosis of indeterminate colitis should be reached with description of criteria applied.

[Pathomorphologic diagnostic guidelines for colon polyps]. / Zasady diagnostyki patomorfologicznej polipów jelita gubego.

Among polypoid laesions of the large bowel the great attention should be payed to Adenomas because of they neoplastic transformation capabilities. In this paper a classification of neoplastic adenomas extended with serrated adenoma and hyperplastic polyps with presence of tubular adenoma structures has been presented. The recommended laboratory procedures used in preparing of endoscopy material has been discussed. The role of Pathologists and Gastrologist in proper diagnosis of precancerous and early cancerous changes has been also discussed.