Korean J Gastroenterol.  2011 Oct;58(4):184-189. 10.4166/kjg.2011.58.4.184.

Clinical Factors Predicting for Neoplastic Transformation of Gastric Hyperplastic Polyps

• Kang HM
• Oh TH
• Seo JY
• Joen TJ
• Seo DD
• Shin WC
• Choi WC
• Kim JY

• KMID: 1718426
• DOI: http://doi.org/10.4166/kjg.2011.58.4.184

Abstract

BACKGROUND/AIMS
Hyperplastic polyps (HPs) are the most common cause of all benign epithelial gastric polyps, constituting 30 to 93%. Although gastric HPs are usually considered as benign lesions compared with adenoma, neoplastic transformation has been known to occur rarely. We aimed to identify the clinical factors of gastric HPs predicting for neoplastic transformation.
METHODS
Between January 2002 to August 2010, a total of 274 gastric HPs, which had been removed by endoscopic polypectomy or surgical resection from 210 patients, were analyzed retrospectively.
RESULTS
Neoplastic transformation was found in 15 cases (5.5%) of 274 HPs including 10 cases of low grade dysplasia (3.7%), 2 cases of high grade dysplasia (0.7%) and 3 cases of adenocarcinoma (1.1%). Neoplastic transformations were significantly associated with >1 cm in size (n=10 [66.7%] vs. n=91 [35.1%], p=0.024), with pedunculated shape (n=9 [60.0%] vs. n=62 [23.9%], p=0.002), with previous history of gastrectomy (n=3 [20.0%] vs. n=3 [1.2%], p=0.002) and with synchronous neoplastic lesions occurring elsewhere in the gastric mucosa (n=5 [33.3%] vs. n=31 [12.0%], p=0.021). However, no significant difference was found between HPs with and without neoplastic transformation in terms of age, sex, number of polyps detected per patient, location, macroscopic appearance such as erosion, hyperemia.
CONCLUSIONS
Neoplastic transformation of gastric HPs had significant relationships with >1 cm in size, pedunculated shape, postgastectomy state, and synchronous neoplastic lesion. Therefore, endoscopic polypectomy should be considered in these HPs to avoid the risk of missing HPs with neoplastic potential.

Keyword

Stomach; Hyperplastic; Polyps; Neoplastic; Transformation

MeSH Terms

Adenocarcinoma/*pathology/surgery
Age Factors
Aged
Cell Transformation, Neoplastic
Female
Gastroscopy
Humans
Hyperplasia
Male
Middle Aged
Polyps/*pathology/surgery
Predictive Value of Tests
Retrospective Studies
Sex Factors
Stomach Neoplasms/*pathology/surgery

Figure

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  Fig. 1. Relationship between shape and size of total hyperplastic polyps.

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  Fig. 2. (A) Endoscopic finding of the case of hyperplastic polyp with neoplastic transformation. A 4.0×1.2 cm sized pedunculated lesion with spontaneous bleeding is noted on the greater curvature side of the mid body in a patient with melena. Endoscopic snare polypectomy was immediately performed for the hemostasis. (B) Microscopic finding showed focal adenocarcinomatous transformation (cir-cle) and dysplastic foci (square) in the background of the hyperplastic polyp (H&E stain, ×40).

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