The lesion most related to the gastric carcinogenesis is gastric dysplasia. The worldwide use of flexible endoscopes, made the sampling of early gastric carcinomas and gastric precancerous lesions possible. The diagnosis of these lesions gained importance. Because of the metaplastic potential of gastric mucosa, gastric dysplasias are a heterogeneous group of lesions consisting of adenomatous dysplasia, hyperplastic dysplasia and tubular neck dysplasia. They can also be classified as low and high grade according to their architectural disorganization and cytological atypia. The grading of hyperplastic dysplasia and its differential diagnosis with regenerative atypia is problematic. As a rule, it is better not to make a diagnosis of dysplasia if there is no involvement of the superficial foveolar epithelium. These lesions have high interobserver variability and the diagnosis of high grade dysplasia may cause radical resections, as mucosectomy operation is not common in our country. So, it is better to confirm the diagnosis of high grade dysplasia by taking a second opinion from an experienced gastrointestinal pathologist before a radical operation.