Pathophysiological and clinical aspects of gastric hyperplastic polyps

Abstract

Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori (H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later.

Keywords: Gastric cancer; Gastric hyperplastic polyp; Pathophysiology; Surveillance.

Figure 1

Endoscopic view. Large gastric hyperplastic polyp.

Figure 2

Histopathological findings. A: Gastric hyperplastic polyp with dilated, elongated, branched and foveolar epithelium and edematous end inflamed stroma (original magnification × 10); B: Gastric hyperplastic polyp with well visible elongated foveolar epthelium (original magnification × 20); C: A cross-section of mucosal crypt shows a serrated ligh of the gland and the goblet cells (original magnification × 40); D: The green arrow indicates a regeneration zone in the foveolar epthelium with hyperchromatic nuclei (original magnification × 40); E: Focus of adenocarcinoma in the gastric hyperplastic polyp (original magnification × 40). Hematoxylin-eosin staining.