Is that a 'lesion' !

This patient is under surveillance after having had two previous EGC's. The stomach has been sprayed with indigo carmine dye when this lesion caught my eyes. 
WHAT IS THE LIKELY DIAGNOSIS?

■ Likely to be gastritis only

The non-staining is suspicious and rarely lie...

■ Likely to be a patch of intestinal metaplasia

There appears to be a crypt pattern in the centre but it can still be neoplastic!

■ Likely to be neoplastic

Non-staining, slightly raised and in an 'unstable stomach' - surely!

explanation

Clearly this is an unstable stomach having given rise to two previous EGC's.  In patients attending for surveillance, I always spray indigo-carmine dye throughout the stomach using a spray catheter.  I then look carefully at any spots where the dye seems to have slid off.  This is such a 'lesion' which was confirmed as a subtle EGC.  After my samples had confirmed my suspicion it was removed by ESD and was confirmed as HGD/IMca.  I consider the both as the same histology as one pathologists HGD is another pathologists IMca.  There was no LVI. However, I was surprised to find that one mucosal resection edge was involved by cancer. Looking back at the clip, I think that it's the 4 O'clock border which has an  irregular extension which I failed to spot. 

Most EGC's look like this, a shallow depression with a subtle elevated margin.  I find the crypt pattern more difficult to interpret. However, as you know, the more destroyed it is, the more likely the lesion is to be poorly differentiated.