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Hyperplastic Polyp of the Stomach

Definition

  • Reactive gastric polyp composed of irregular elongate and cystic foveolae set in an edematous stroma

Alternate/Historical names:

  • Gastritis polyposa
  • Hyperplasiogenic polyp
  • Hyperplastic-adenomatous polyp
  • Inflammatory hyperplastic polyp
  • Regenerative polyp
  • Retention polyp

Diagnostic Criteria

  • May occur throughout the stomach
    • 80% solitary
  • Elongated, irregular, branched gastric pits
    • Frequently cystic
    • Lined by mature foveolar epithelium
      • May be hypertrophic and resemble goblet cells
    • May contain foci of intestinal metaplasia
    • Rarely contains chief or parietal cells
  • Edematous, inflamed stroma
    • Frequent plasma cells, lymphocytes, eosinophils
    • Frequent surface erosion
    • Frequent vascular congestion
    • May contain smooth muscle fibers from an irregular muscularis mucosae
    • May be fibrotic
    • Features may be similar to mucosal prolapse polyps of intestine
  • Erosion of surface may produce atypical features
    • Neutrophils and granulation tissue
    • Regenerative epithelial atypia may be prominent
      • May appear adenomatous in areas
    • Atypical stromal cells may be present
      • May have pleomorphic nuclei and atypical mitotic figures
  • Usually arise in a setting of chronic gastritis
    • Most frequently with Helicobacter
    • Some cases with associated autoimmune gastritis
    • Intestinal metaplasia frequently present
    • Polyps of the esophagogastric junction not associated with chronic gastritis
  • Adenomatous change may infrequently occur in the polyp
    • Reported incidence 1-5%
    • Usually associated with intestinal metaplasia
  • Carcinoma may occur elsewhere in the stomach
    • Reported incidence as high as 6% of cases
    • May be synchronous or metachronous
    • Rarely occurs within the hyperplastic polyp
    • In most cases appears to reflect the background gastritis rather than derivation from the polyp

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting/updates: 11/29/09, 7/15/11

 

Differential Diagnosis

 

Chronic Gastritis vs. Hyperplastic Polyp
  • May be indistinguishable on a superficial biopsy
  • Endoscopic description and/or a polypectomy specimen are required to distinguish

 

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

Bibliography

  • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
  • Bosman FT, Carneiro F, Hruban RH, Thiese ND (Eds). WHO Classifiication of Tumors of the Digestive System, IARC, Lyon 2010
  • Park YD, Lauwers GY. Gastric polyps: classification and management. Arch Pathol Lab Med. 2008 Apr;132(4):633-40.
  • Oberhuber G, Stolte M. Gastric polyps: an update of their pathology and biological significance. Virchows Arch. 2000 Dec;437(6):581-90.
  • Jain R, Chetty R. Gastric Hyperplastic Polyps: A Review. Dig Dis Sci. 2009 Sep;54(9):1839-46
  • Abraham SC, Singh VK, Yardley JH, Wu TT. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001 Apr;25(4):500-7.
  • Dirschmid K, Walser J, Hügel H. Pseudomalignant erosion in hyperplastic gastric polyps. Cancer. 1984 Nov 15;54(10):2290-3.
  • Jewell KD, Toweill DL, Swanson PE, Upton MP, Yeh MM. Gastric hyperplastic polyps in post transplant patients: a clinicopathologic study. Mod Pathol. 2008 Sep;21(9):1108-12.
  • Zea-Iriarte WL, Sekine I, Itsuno M, Makiyama K, Naito S, Nakayama T, Nishisawa-Takano JE, Hattori T. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci. 1996 Feb;41(2):377-86.
  • Lam-Himlin D, Park JY, Cornish TC, Shi C, Montgomery E. Morphologic Characterization of Syndromic Gastric Polyps. Am J Surg Pathol. 2010 Nov;34(11):1656-62.
  • Gonzalez-Obeso E, Fujita H, Deshpande V, Ogawa F, Lisovsky M, Genevay M, Grzyb K, Brugge W, Lennerz JK, Shimizu M, Srivastava A, Lauwers GY. Gastric hyperplastic polyps: a heterogeneous clinicopathologic group including a distinct subset best categorized as mucosal prolapse polyp. Am J Surg Pathol. 2011 May;35(5):670-7.
  • Long KB, Odze RD. Gastroesophageal junction hyperplastic (inflammatory) polyps: a clinical and pathologic study of 46 cases. Am J Surg Pathol. 2011 Jul;35(7):1038-44.
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