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The Clinicopathological Features of Gastric Hyperplastic Polyps With Neoplastic Transformations: A Suggestion of Indication for Endoscopic Polypectomy

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The Clinicopathological Features of Gastric Hyperplastic Polyps With Neoplastic Transformations: A Suggestion of Indication for Endoscopic Polypectomy

A-Reum Han et al. Gut Liver.

Abstract

Background/aims: Although gastric hyperplastic polyps are usually considered as benign lesions, a low risk of carcinomatous conversion is currently recognized. We aimed to identify the characteristics of hyperplastic polyps undergoing neoplastic transformation.

Methods: A total of 269 gastric hyperplastic polyps from 216 patients removed by endoscopic polypectomy (EP) or surgical resection were enrolled in this study, and their endoscopic pictures and pathology slides were reviewed.

Results: Neoplastic transformation was detected on forceps biopsy specimen in 11 cases. However, the pathology findings from the EP or surgical specimen revealed neoplastic transformation in 14 cases (5.2%; 4 with dysplasia and 10 with adenocarcinoma). No significant difference was found between hyperplastic polyps with and without neoplastic transformation in age, sex, location, number of polyps or gross appearance. However, neoplastic transformations were more frequently found in gastric hyperplastic polyps >1 cm than in polyps </=1 cm (12 of 143; 8.4% vs. 2 of 126; 1.6%) (p=0.013).

Conclusions: Neoplastic transformations were more frequently found in gastric hyperplastic polyps >1 cm. Therefore, EP should be considered for gastric hyperplastic polyps >1 cm for the accurate diagnosis and definitive treatment.

Keywords: Endoscopic polypectomy; Hyperplastic polyp; Neoplastic transformation.

Figures

Fig. 1
Fig. 1
Endoscopic finding of the case of hyperplastic polyp with neoplastic transformation. A 3.5 cm sized pedunculated lesion was observed at the greater curvature side of the high body. The polyp showed nodular surface and hyperemic discoloration. The pathology findings from the forceps biopsy showed hyperplastic polyp. However, pathology findings following endoscopic mucosal resection showed dysplasia arising from hyperplastic polyp.
Fig. 2
Fig. 2
Endoscopic finding of the case of hyperplastic polyp with malignant transformation. A 1.5 cm sized pedunculated lesion was observed at the posterior portion of the antrum. The polyp showed nodular surface and hyperemic discoloration. The pathology findings from the forceps biopsy showed hyperplastic polyp with dysplasia. However, pathology findings following endoscopic mucosal resection showed adenocarcinoma arising from hyperplastic polyp.
Fig. 3
Fig. 3
Micrograph of an adenocarcinoma arising from a hyperplastic polyp (circle) (H&E stain, ×40). Dysplastic foci were found around the cancerous components (square).
Fig. 4
Fig. 4
Micrograph of a hyperplastic polyp with dysplasia (H&E stain, ×100). The boundary between the dysplastic foci and the hyperplastic foveolar epithelium was distinct (long arrow).

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