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

Abstract

Background/AimsAlthough 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.MethodsA 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.ResultsNeoplastic 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).ConclusionsNeoplastic 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.

Gastric hyperplastic polyps coexisting with early gastric cancers, adenoma and neuroendocrine cell hyperplasia

“…The histological criteria of Nakamura for the malignant transformation of GHP are as follows: 1) the coexistence of benign and malignant lesions in the same polyp; 2) sufficient evidence that the malignant lesion was previously a benign polyp; and 3) sufficient cellular and structural atypia in the malignant lesion. Polyps found to be positive for these criteria are to be diagnosed as cancerous [23]. The cases of GHP with malignant transformation discussed in the present paper also fulfilled these criteria.…”

Gastric polyps and polypoid lesions: Retrospective analysis of 36650 endoscopic procedures in 29940 patients

“…They are often seen in the antrum (4,5,16,19) but in the study of Han et al (20), 64% were in the body, and in the study of Dirschmid et al (21) 53.3% were located in the corpus/ fundus. In this study 74% of HPs were smaller than 1 cm in size, mostly located in the antrum (44.2%) and single (77.9%).…”

“…Malignant transformation is more frequently found in gastric HPs >1 cm in diameter (6,20), and is assumed to be associated with dysplasia, with p53 protein playing a crucial role in the process (25,26). Mutations of the p53 gene, chromosomal aberrations, and microsatellite instability have also been detected in these polyps (25,27,28).…”

A Case of Recurrent Cronkhite-Canada Syndrome Containing Colon Cancer

“…1 cm for the accurate diagnosis and definitive treatment. 8,16 However polyps in Cronkhite-Canada syndrome are most frequently described as being hamartomatous or juvenile type, different from hyperplastic polyps and serrated adenomas found in familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC). 17 If serrated adenomas or sessile serrated adenomas were found in a colonoscopy of a CCS patient, treatment is needed because it is considered that the traditional serrated pathway often shows low levels of chromosomal instability and an increased methylation pattern.…”