Endoscopic Submucosal Dissection of Gastric High-Grade Foveolar Dysplasia With Normal Background Mucosa

Most gastric neoplastic lesions appear in patients with gastric premalignant conditions. Here, we present the case of a 75-year-old woman with no prior history of <i>Helicobacter pylori</i> infection, with a big gastric adenoma resected by endoscopic submucosal dissection. Histopathological examination revealed high-grade foveolar dysplasia. Interestingly, surrounding mucosa was normal, without signs of <i>H. pylori</i> infection or gastric preneoplastic conditions. The presented case emphasizes that high-risk gastric lesions may be present within a normal stomach without endoscopic signs of <i>H. pylori</i> infection or premalignant conditions. This underscores the importance of careful examination in regular practice of esophagogastroduodenoscopy, even in low-risk patients.