Abstract
Background: We aimed to provide insight into the actual frequencies of gastric adenoma types and their association with gastritis status and associated mucosal changes with a focus on Helicobacter infection and the operative link on gastritis assessment (OLGA)/operative link on gastric intestinal metaplasia assessment (OLGIM) staging. Methods: From the archive of the Institute of Pathology in Bayreuth, we collected a consecutive series of 1058 gastric adenomas diagnosed between 1987 and 2017. Clinicopathological parameters retrieved from diagnostic reports included adenoma type and localization, associated mucosal changes in antrum and corpus (i.e., type of gastritis, the extent of intestinal metaplasia and atrophy), gender, date of birth, and date of diagnosis. Results: Intestinal-type adenoma was the most frequent adenoma (89.1%), followed by foveolar-type adenoma (4.3%), pyloric gland adenoma (3.4%), adenomas associated with hereditary tumor syndromes (2.8%), and oxyntic gland adenoma (0.4%). Adenomas were found in the background of Helicobacter pylori (H. pylori) gastritis in 23.9%, Ex-H. pylori gastritis in 36.0%, autoimmune gastritis in 24.8%, chemical reactive gastritis in 7.4%, and others in 0.1%. More than 70% of patients with gastric adenomas had low-risk stages in OLGA and OLGIM. Conclusions: We found a higher frequency of foveolar-type adenoma than anticipated from the literature. It needs to be questioned whether OLGA/OLGIM staging can be applied to all patients.
Highlights
IntroductionAccording to the current World Health Organization (WHO) classification system [1], gastric dysplasia (syn.: glandular intraepithelial neoplasia low-grade and high-grade) is defined as unequivocal neoplastic changes of the gastric epithelium without evidence of stromal invasion
Published: 5 January 2021According to the current World Health Organization (WHO) classification system [1], gastric dysplasia is defined as unequivocal neoplastic changes of the gastric epithelium without evidence of stromal invasion
All adenoma samples were classified into five groups as explained in detail in Materials and Methods: mixed adenomas were classified according to the prognostically relevant lesion (PGA); cases with multiple adenomas were merged in the TubA and all adenomas associated with hereditary tumor syndromes were grouped together as syndromic adenomas
Summary
According to the current World Health Organization (WHO) classification system [1], gastric dysplasia (syn.: glandular intraepithelial neoplasia low-grade and high-grade) is defined as unequivocal neoplastic changes of the gastric epithelium without evidence of stromal invasion. The two-tiered grading system of gastric dysplasia using the terms low- and high-grade is based on the Padova international [2] and Vienna/revised Vienna classifications [3,4] and was adopted by the current (2019) WHO-classification [1]. The term dysplasia has been used for endoscopically flat or depressed lesions and the term adenoma has been used for protruded sessile or pedunculated polypoid lesions with dysplasia [5]. According to the current consensus, adenoma is defined as a low-grade dysplasia regardless of its endoscopic appearance, whether sessile, flat, depressed, or pedunculated [1]. According to the Japanese approach regarding the diagnosis of gastric adenoma, adenoma is defined as non-invasive low-grade neoplasia [6], whereas any high-grade in-
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