The role of pathologists in regional gastrointestinal polyp register of South-Hungary

Abstract

Background: The raising incidence of gastrointestinal polyps necessitates the introduction of appropriate surveillance system as well as standardized histopathological examination all over the world including in Hungary. Therefore, our aim was to obtain regional epidemiological data about gastrointestinal polyps, to evaluate the efficiency of classical and immunohistochemical methods in the diagnosis of polyps. Materials and methods: From 2007, histopathologiacal data of consequtive polypectomies and polyp-biopsies were recorded in standardized histopathological report available for further computer processing of the findings. Classical histological (HE and PAS-AB stains) and widespread immunohistochemical methods (p53, MLH1, MSH2, MLH6, COX-2, MGMT, APC, beta-catenin, BRCA) were used. Dysplasia was graded according to modified Vienna classification. Results: In this prospective study, 270 patients were recorded until december 2007. The male/female ratio was equal with a median age of 64 (33–88 ys.). At the hindgut, 60 and 20% of polyps were localised in rectosigmoideal or other parts of colon, respectively. Foregut polyps (20%) were mainly found in the stomach. Non-neoplastic hyperplastic and fundic gland polyps accounted for 20% and 10%, respectively. Serrated polyps were identified in 5% of cases. The rest of the cases (65%) proved to be adenomatous polyps, from which 30% showed high grade dysplasia. At 35 patients multiple polyposis was found with 3 familiar polyposis cases. In 8 previously treated colorectal adenocarcinoma cases adenomatous polyps were identified during the tertiary prevention. Conclusions: It is essential to use the same language between clinicians and pathologists. Therefore, precise identification and subtyping of colorectal polyps together with standardized pathomorphological examination decrease the interobserver variabilities. Moreover, detailed computerized histopathological assessment can significantly contribute not only to obtain epidemiological data but to get an inside view into genesis of gastrointestinal polyps, early and advanced cancers.