As early as 1999, Schmidt et al. identified the occurrence of a mucous-secreting lineage expressing trefoil factor family 2 (TFF2, also known as spasmolytic polypeptide) in 91% of resected gastric carcinomas, and these spasmolytic polypeptide-expressing metaplasia (SPEM) lineages were located adjacent to areas of carcinoma or dysplasia (22). Here, TFF2 is linked to carcinoma.