Surgical Pathology Criteria

Hyperplastic Polyp of the Stomach

Differential Diagnosis

 

Chronic Gastritis vs. Hyperplastic Polyp

 

Gastric Hyperplastic Polyp Focal Foveolar Hyperplasia
Polypoid Flat
Generally cuboidal lining cells Generally taller columnar lining cells
Marked distortion of pits Primarily elongation with less distortion of pits
Associated with chronic gastritis Frequently follows healing of erosive gastritis or an ulcer
May be indistinguishable on superficial biopsies and if endoscopic findings are not provided

 

Gastric Hyperplastic Polyp Gastric Adenomatous Polyp, Pyloric Type
Edematous, inflamed stroma Stroma not prominent
Irregular, branched pits Clusters of small regular glands with interspersed cystic glands
Cysts lined by mucin positive foveolar epithelium Cysts lined by mucin negative pyloric gland epithelium

 

Gastric Hyperplastic Polyp with Regenerative Epithelial Atypia Gastric Adenomatous Polyp, Intestinal and Foveolar Types
Atypia associated with erosion and acute inflammation Adenomatous features (intestinal type only) should be independent of inflammation
Edematous, inflamed stroma Stroma not prominent
Cystic dilation usually present Cystic dilation is unusual in adenomas
Frequently has regular, single, prominent nucleoli in regenerative areas Irregular chromatin pattern in most cases

 

Gastric Hyperplastic Polyp Juvenile Polyposis
No association with similar polyps in the colorectum Most cases involve the colorectum
Gastric hyperplastic polyps are indistinguishable from juvenile polyps
In the case of solitary polyps, the distinction is of no significance
Juvenile polyposis has an increased risk of carcinoma and thus should be distinguished
based on multiplicity, colorectal involvement or family history

 

Gastric Hyperplastic Polyp Cowden Disease
No association with similar polyps in the colorectum Many cases involve the colorectum
No associated mucocutaneous lesions Most have facial and oral papillomas, fibromas and skin tumors
No association with breast hamartomas or carcinomas Frequent breast hamartomas and carcinomas
No association with thyroid carcinomas Frequent thyroid carcinomas
PTEN mutations not seen PTEN mutations in 80%
Not familial Autosomal dominant (half are new mutations without family history)
Gastric hyperplastic polyps are indistinguishable from the polyps of Cowden disease

 

Cronkhite-Canada Syndrome, Gastric Involvement Hyperplastic Polyps of the Stomach
Usually >50 polyps Usually solitary
Hair, nail, skin pigmentation changes present No associated extra-GI lesions
Colorectal polyps very common Not associated with colorectal polyps
The polyps in some cases are indistinguishable

 

Gastric Hyperplastic Polyp Peutz-Jeghers Polyposis
Scant smooth muscle in polyps Arborizing muscle in polyps
Frequent cystic dilation Cystic dilation not prominent
No polyps in small intestine Most polyps in small intestine
Not familial Autosomal dominant
No associated mutations LKB1/STK11 mutations in 50-90%
Histologic distinction between these two is poor; clinical findings and distribution are more important

 

Gastric Hyperplastic Polyp Inflammatory Fibroid Polyp
Mucosal lesion with prominent epithelial component Submucosal stromal lesion with no intrinsic epithelial component
These are similar in name only

 

Gastric Hyperplastic Polyp Menetrier Disease
Localized, distinct polyps, with chronic gastritis of intervening mucosa Diffuse hyperplastic changes
May involve all regions of stomach Involves body of stomach
May be indistinguishable on superficial biopsies and if intervening mucosa is not biopsied

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