The pathology of gastric and duodenal polyps: current concepts

Abstract

The liberal use of upper endoscopy has led to an increased detection of gastric and duodenal polyps, which are identified in as many as 6 and 4.6% of patient examinations, respectively. Gastroduodenal polyps are a heterogeneous group of lesions that can be neoplastic or non‐neoplastic (e.g. hyperplastic or heterotopical). Most polyps present characteristic topographical features, as well as endoscopic appearance and size. Evaluation of the surrounding mucosa is essential in assessing the underlying pathology (e.g. Helicobacter pylori, autoimmune gastritis or inherited polyposis syndromes). Phylogenetically, gastric and duodenal polyps can be classified according to the epithelial compartment from which they derive. Polyps that arise from the surface epithelium can either be of foveolar or intestinal type, and they can develop from either the native mucosa or the metaplastic epithelium (gastric intestinal metaplasia or duodenal foveolar metaplasia). Other polyps develop from the deeper glandular component, such as pyloric/oxyntic gland derived subtypes. In this review we focus upon epithelial polyps, with an emphasis on the most common and clinically relevant lesions, and present recently described entities.

Fundic gland polyps related to diverse aetiologies show subtle morphological differences: a multicentre retrospective study

“…luminal protrusions, hobnail cells and luminal dilation of oxyntic glands) detected in the non‐polypoid oxyntic mucosa. These alterations are usually observed within the first months of omeprazole therapy and are related to increased gastrin levels 16,19,23–25 …”

“…Irrespective of the clinical setting, FGPs are considered to be fairly homogeneous microscopically, with variable gland dilatation and disarray and with microcysts lined by mainly oxyntic and partly mucin‐secreting epithelium. In addition, the surface of the FGPs is covered by gastric foveolar epithelium, which may show dysplasia, particularly in syndromic polyps 3,14–17 …”

Risk Factors of Non-en Bloc Resection and Non-R0 Resection During Endoscopic Resection in the Treatment of Superficial Duodenal Epithelial Lesions

“…Polyps are defined as: discrete abnormal tissue masses that protrude into the lumen of the digestive tract, and duodenal polyps include neoplastic and non-neoplastic lesions. The polyps mentioned in the histological results in this study refer to non-neoplastic polypoid lesions ( 10 ).…”

Small Bowel Epithelial Precursor Lesions: A Focus on Molecular Alterations

“…The widespread use of gastrointestinal endoscopic procedures has led to increased detection of small bowel polyps, most of which are incidental lesions located in the duodenum [ 1 , 2 , 3 ]. Small bowel neoplastic lesions may be epithelial or non-epithelial.…”

“…Precursor lesions, including adenomas, hamartomatous lesions, and neuroendocrine hyperplastic/dysplastic lesions, may precede epithelial malignancies, such as adenocarcinomas or neuroendocrine tumors. Small bowel (ampullary and non-ampullary) adenomas may show intestinal or gastric differentiation, as well as, very rarely, serrated morphology and may be either sporadic or related to polyposis syndromes or immune-mediated disorders [ 1 , 2 , 4 ]. The identification of such precursor lesions may have clinical implications, requiring specific endoscopic surveillance programs on the bases of their malignant potential [ 5 ] or screening of remaining organs and family members, when they are associated with hereditary tumor syndromes, such as familial adenomatous polyposis 1 (FAP), MUTYH -associated polyposis (MAP) or multiple endocrine neoplasia 1 syndrome (MEN1).…”