Gastric Adenomatous Polyps Research Articles

The Sensitivity of Immunohistochemical Expression of p53 as an Indicator of the Malignant Potential of Gastric Hyperplastic Polyps: A Retrospective Study

Background: Hyperplastic polyps account for 30–93% of gastric polyps. Recently, there have been studies about the development of dysplasia in this type of polyp. Every cell in the body contains the p53 gene, which has anti-cancer properties. Objective: The sensitivity of immunohistochemical expression of p53 is evaluated among gastric hyperplastic polyps with and without dysplasia and gastric adenomatous polyps to know its usefulness as a diagnostic marker. Methods: A retrospective cross-sectional study was done on fifty formalin-fixed paraffin-embedded blocks of gastric polyps (44 hyperplastic polyps without dysplasia, 3 hyperplastic polyps with dysplasia, and 3 adenomas). Cases were collected from the archives of the pathology department from June 2019 to July 2023. Additional sections of the block were immunostained with P53 protein. Results: Fifty paraffin blocks from patients with gastric polyps (17 males, 33 females) were included in the study. 44 of the cases are classified as hyperplastic polyps, 3 as hyperplastic polyps with dysplasia, and 3 as adenomatous polyps. Most gastric hyperplastic polyps showed staining in different scores. All gastric hyperplastic polyps with dysplasia showed nuclear staining, whereas two out of three gastric adenomatous polyps showed no staining. Conclusion: There was no significant association between p53 protein expression and the type of gastric polyps, the presence of intestinal metaplasia, or H. pylori. However, it has a significant correlation with the size of the polyps.

Computer analysis of abnormal proliferation and transformation cells in gastric mucosa and its clinical significance

ABSTRACT To investigate the image computer analysis of abnormally proliferating transformed cells of gastric mucosa and its clinical significance. The pathological pictures of gastric adenomatous polyp cells, abnormally proliferating altered cells, and tubular adenocarcinoma cells in the stomach mucosa were assessed by image computer method on a total of 96 gastroscopic biopsy and ESD resection specimens. The data of cytoplasmic area, nuclear area, nuclear-cytoplasmic ratio, nuclear factor and N-heterotypic index of gastric adenomatous polyps, abnormal proliferative transformation and gastric intramucosal tubular adenocarcinoma were collected, and the mean, standard deviation and variance were calculated respectively. Standard Error, Maximum, Minimum Parameters and Statistical Structure. There were substantial discrepancies between gastric mucosal gastric adenomatous polyp cells and gastric mucosal abnormally proliferating transformed cells, according to the five data in the abnormal cells in the stomach mucosal proliferation area (p < 0.01); There was no significant difference between cells (p > 0.05). Computer analysis of cell images can provide quantitative values for the pathological diagnosis of gastric adenomatous polyp cells, abnormally proliferating transformed cells and tubular adenocarcinoma cells in the gastric mucosa, especially the degree of atypical proliferation. The monitoring of abnormally proliferated and transformed cells in gastric mucosa is of great significance for clinicians to accurately treat and track cell transformation, and to control the occurrence and development of gastric adenocarcinoma.

Clinical and anamnestic features of patients with gastric polyps

Gastric polyps (GP) are a serious clinical problem due to the high prevalence and tendency to malignant transformation with nonspecifi c symptoms. The literature does not describe clinical and anamnestic markers that make it possible to suspect the presence of GP, and tactics for the management of patients with GP are not proposed. Aim : a study the clinical, anamnestic features of patients with GP, infection with Helicobacter pylori . Materials and methods : 61 patients with hyperplastic GP (HGP) and 41 with adenomatous GP (AGP) were examined. We conducted a general clinical study of patients’ complaints, also clarifi ed the duration and features of the course of the disease, the association with Helicobacter pylori (HP), endoscopic and ultrasound examination of abdominal organs. Results : the clinical manifestations of GP are nonspecifi c: non-intense epigastric pain after eating or without connection with food intake, a combination of dyspeptic hyperacid complaints (heartburn) and dyskinetic (nausea, belching with air) character. Symptoms of chronic atrophic gastritis are typical for HGP. There was a high family burden on oncopathology — 21.4% of patients, one in ten had a burdened hereditary history of stomach cancer. In the group of HGP, polyps of other gastrointestinal tract localizations were detected in almost 40% of cases, with AGP in more than half — 25 (61%). Colon polyps and gallbladder polyps were detected in a quarter of patients with AGP. HP infection was detected in GP in more than half of the patients. Conclusion : patients with chronic atrophic gastritis, cholelithiasis and pathology of the biliary tract, polyps of other localization, burdened with hereditary oncopathology, should be considered at risk of detection of GP. All patients with GP are shown a follow-up examination to detect chronic atrophic gastritis, patology of the biliary tract, polyps and neoplasms.

Dyslipidemia as an important risk factor for gastric adenomatous polyps in patients with gastric polyps.

Dyslipidemia as an important risk factor for gastric adenomatous polyps in patients with gastric polyps.

Gastric Polyps and Atrophic Gastritis

Aim. A study of atrophic gastritis severity and rate in patients with gastric polyps (GP).Materials and methods. The study enrolled 61 patients with hyperplastic (HGP) and 41 — with adenomatous GP (AGP). All patients had 24-h gastric pH-metry, control of the pepsinogen I, II and gastrin-17 levels, in addition to a general clinical, endoscopic, histological examination and testing for Helicobacter pylori.Results. GP patients had benign manifestations prevailed with epigastric heaviness and overflow, and a scarce history of H. pylori testing at no control of rendered eradication therapy. A symptomatic proton pump inhibitor treatment in GP was either prescribed or voluntary. Focal atrophic gastritis in endoscopy was revealed in 12 (19.7 %) HGP and 16 (39.0 %) AGP patients, diffused atrophic gastritis — in 49 (80.3 %) HGP and 25 (60.9 %) AGP patients. Low-grade chronic gastritis in histology prevailed in HGP, moderate — in AGP, and severe — in 21.9 % cases. Moderate (27.9 %) to severe (65.6 %) atrophy of gastric mucosa was registered in HGP, with 53.7 and 39.0 % respective AGP cases. Polyp dysplasia was detected in 20 % HGP and 75.6 % AGP cases. Pepsinogen I &lt;25 µg/L at a pepsinogen I/II ratio &gt;&lt;3 was observed in 38 (62.3 %) HGP and 18 (43.9 %) AGP patients. Hypo- and anacidic were 65.6 % HGP and 31.7 % AGP patients. &gt;H. pylori-positive were 52.5 % HGP and 70.7 % AGP cases.Conclusion. A largely similar aetiopathogenesis of gastric polyps and chronic atrophic gastritis warrants the H. pylori diagnosis and a more detailed patient control for chronic gastritis grading and staging, functional insufficiency of gastric mucosa and the severity of hyperplastic and dysplastic change. The H. pylori eradication, in contrast to anti-secretory therapy, allows the containment of chronic gastritis and is a critical measure in gastric cancer prevention.

S2108 Metastatic Gastric Carcinoma Masquerading as a Pedunculated Bleeding Gastric Polyp

INTRODUCTION: The majority of gastric polyps are found incidentally and are benign hyperplastic or fundic gland polyps with low malignant potential. Up to 10% can be adenomas which possess a higher neoplastic potential. Appropriate management of gastric polyps is vital as some may harbor underlying malignancy or cause complications, e.g. bleeding. We present a case of an elderly patient with acute upper GI bleeding from a metastatic gastric adenocarcinoma masquerading as a typical fundic gland polyp. CASE DESCRIPTION/METHODS: A 77-year-old woman presented with 2 days of loose foul-smelling black stools and fatigue, was hemodynamically stable with a benign abdominal exam, and had a hemoglobin of 7.1 g/dL. EGD revealed a 3.5 × 2.0 × 1.8cm pedunculated polyp on the lesser curvature of the stomach with large adherent clot, which was removed and hemostasis achieved (figures A/B). Histopathology showed a gastric tubular adenoma with intra-mucosal carcinoma and invasion into the lamina propria. Staging scans revealed peritoneal implants consistent with disseminated stage IV disease. Due to age, a palliative treatment approach was taken with radiotherapy. DISCUSSION: Gastric polyps can be seen in incidentally on 6% of endoscopies with gastric adenomas representing only 6–10%. While all classes of gastric polyps are usually incidental findings on EGD, gastric adenomas are more likely than all other classes to cause complications. The neoplastic potential of two other commonly encountered polys - hyperplastic and fundic gland polys - are generally quite low at 1% and virtually nonexistent outside of familial polyposis syndromes, respectively. On the contrary, gastric adenomatous polyps are associated with concurrent gastric carcinoma in 8–59% of cases. Isolated polyps that are pedunculated with normal surrounding mucosal tissue, as seen here, conventionally have a low suspicion for malignancy. Furthermore, is it uncommon to encounter a purely pedunculated gastric adenoma, as the majority of these lesions are sessile. Often, signs of upper GI bleeds can be the initial presentation of gastric carcinomas. As older populations are more prone to gastric polyps, many may also have comorbidities such as chronic anemia or on medications preventing hemostasis, which has potential to be detrimental. In conclusion, here we highlight a unique presentation of metastatic gastric carcinoma and stress vigilant assessment of all gastric polyps and discuss potential complications as even benign appearing lesions could harbor malignancy.Figure 1.: 3.5 × 2 × 1.8 cm pedunculated polyp seen on retro-flexion on the lesser curvature of the gastric body with an adherent clot with normal appearing surrounding gastric mucosa.Figure 2.: Site after local epinephrine injection and hot-snare polypectomy, prior to hemostatic clip placement.

Gastric and Colonic Polyposis in a Patient Without Genetic or Hereditary Predisposition Presenting as Iron Deficiency Anemia

A 44 year-old female with no medical history presented with a 3-week history of melena. Labs revealed hemoglobin 8.5 g/dL, iron 16 ug/dL, and ferritin 5.3 ng/mL. Imaging noted large soft tissue densities of the stomach and multiple lesions in the right colon. EGD revealed a large (>15 cm), polypoid lesion extending from the fundus into the body and several large polyps in the cardia and antrum. Colonoscopy revealed large polyps at the cecum (5 cm), transverse (8 cm), and small (< 1 cm) polyps in the rectosigmoid. Gastric histology demonstrated hyperplastic polyps (HPP), and colonic biopsies revealed tubulovillous adenomas without dysplasia or malignancy. EUS of the gastric lesion showed areas of submucosal involvement without invasion of the muscularis propria, capsule endoscopy was negative for small bowel lesions. Genetic testing for polyposis syndromes was negative. Attempts at endoscopic debulking were unsuccessful, and a total gastrectomy and right hemicolectomy were performed. This case of diffuse gastric hyperplastic and colonic adenomatous polyposis represents a rare cause of iron deficiency anemia in a young patient. Few cases detailing both gastric and colonic polyposis in an individual with no hereditary predisposition are reported. HPP are the most common gastric polyps encountered. Reports demonstrate large HPP may have malignant potential similar to adenomas. HPP greater than 1 cm in size may indicate the presence of premalignant or neoplastic changes. In cases of diffuse gastric involvement, gastrectomy may be warranted as biopsies may be insufficient in detecting cancer. An association between gastric hyperplastic polyposis, carcinomas, and colonic neoplasms has been described. Hypergastrinemia has been postulated as a possible link between gastric polyposis and colorectal neoplasms due to the role of gastrin as a growth-promoting tumoral agent. Gastric adenomatous polyps increase the risk of colorectal neoplasia, however, information is limited regarding HPP and their risk. A recent study investigated the association of sporadic gastric HPP with colorectal neoplasia and found the risk of colorectal adenomas increased in patients with sporadic gastric hyperplastic polyposis. In our case, gastrectomy histology was consistent with hyperplastic polyps and colectomy histology showed foci of invasive adenocarcinoma. This case supports the notion for consideration of surveillance colonoscopy in patients with large or multiple gastric HPP.Figure 1Figure 2Figure 3

Endoscopic submucosal dissection as a treatment for gastric adenomatous polyps: predictive factors for early gastric cancer

Objective. Endoscopic forceps biopsy (EFB) sampling of gastric adenoma may provide inadequate specimens for a correct diagnosis and lead to inappropriate follow-up strategies for adenomas or missed carcinoma foci. The aim of this study was to determine the diagnostic concordance between an EFB and resected gastric adenomatous polyps by endoscopic submucosal dissection (ESD) and to know the efficacy of ESD for the treatment of gastric adenomatous polyps. Material and methods. Between November 2008 and May 2011, 413 ESDs were carried out at Pusan National University Yangsan Hospital. After exclusion, 282 cases were enrolled. The clinicopathological features, complete resection rate, procedure time, complication rate and associated factors for early gastric cancer (EGC) prediction were analyzed. Results. The mean age was 62.13 ± 8.91 years. Submucosal dissection results showed that the discrepancy rate between endoscopic biopsy and pathology of resected specimens was 32.9% (93/282). Additionally, 71 cases (25.2%) were adenocarcinomas. Among low-grade dysplasia (LGD) from EFB, 23 cases (11.8%) were adenocarcinomas after ESD. Among high-grade dysplasia (HGD) from EFB, 48 cases (55.2%) were adenocarcinomas after ESD. EFB procedure times were longer in the HGD group than in the LGD group (24.90 vs. 29.88 min, p = 0.017). In multivariate analysis, HGD from EFB, surface redness and lesion diameter were the significant predictive factors for EGC. Conclusions. Gastric adenomatous polyps should be removed by endoscopic resection regardless of histopathological type. ESD is a useful method for complete resection of gastric adenomas, regardless of size and location.

Tu1691 Endoscopic Submucosal Dissection as a Treatment for Gastric Adenomatous Polyps: Predictive Factors for Early Gastric Cancer

Gastric adenomatous polyps are true neoplasm with cancerous transformation potential. Endoscopic forceps biopsy (EFB) sampling may provide inadequate specimens for a correct diagnosis and lead an inappropriate follow-up strategy for an adenoma or missed foci of carcinoma. The aim of this prospective study was to know the diagnostic concordance between an EFB and resected tissues of gastric adenomatous polyps by endoscopic submucosal dissection (ESD) technique and to know the efficacy of ESD for the treatment of gastric adenomatous polyp.

Molecular markers of cancer in cartilaginous fish: immunocytochemical study of PCNA, p‐53, myc and ras expression in neoplastic and hyperplastic tissues from free ranging blue sharks, Prionace glauca (L.)

Archival formalin-fixed tissues from wild-caught adult blue sharks, Prionace glauca (L.), were used for immunocytochemical detection of proliferating cell nuclear antigen (PCNA), two oncoproteins from the oncogenes c-myc and pan-ras, and a protein product from the tumour suppressor gene p-53. All sharks were caught during summer months between 2000 and 2006 by recreational fishermen off the USA coast in the northwestern Atlantic. The sharks were necropsied on landing and selected organ samples were collected into elasmobranch formalin and processed for paraffin embedding and light microscopy. Paraffin-embedded sections from collected tissue were both stained with haematoxylin and eosin and processed by immunocytochemical techniques using antibodies raised against the PCNA, p-ras, c-myc and p-53 proteins. The lesions examined in this study included two well differentiated adenomatous gastric polyps, a testicular capsular mesothelioma, a gingival fibropapilloma with elements of ameloblastoma, three liver tumours, two pericardial fibropapillomas and six cases of proliferative serositis (pericarditis and peritonitis). Normal and hyperplastic tissues from blue sharks, and human neoplastic tissues served as negative and positive controls, respectively. We detected upregulation of PCNA in many neoplastic, one dysplastic and in some hyperplastic lesions, and positive p-ras and c-myc signals in some of the neoplastic lesions. None of the examined tissues showed positive p-53 signalling. This is the first literature report on immunocytochemical detection of molecular markers of cancer in sharks and in fish of the class Chondrichthyes.

Polipose gastroduodenal em doentes com polipose adenomatosa familiar Pós-Retocolectomia

The extra colonic manifestations, like upper gastrointestinal tract polyps and duodenal cancer are disorders that affect long-term morbidity and mortality of patients with familial adenomatous polyposis, after rectocolectomy. To describe the frequency of those disorders in patients with familial adenomatous polyposis and to review efficacy of upper gastrointestinal endoscopic surveillance. Between 1984 and 2005, 62 patients with familial adenomatous polyposis after rectocolectomy, were studied retrospectively, by Coloproctology Group, Medical Sciences Faculty, State University of Campinas, SP, Brazil. It was possible to analyze 53 patients (85,5%) in this study. Twenty seven (50,9%) of 53 patients in follow-up had upper gastrointestinal polyps. Eight (15,4%) had gastric adenomatous polyps, 14 (27%), duodenal polyps and 5 (9,6%) duodenal and gastric polyps. Two patients (3,8%) had adenomatous duodenal polyps with severe dysplasia, and one (1,9%) had adenocarcinoma of the duodenal papilla. The upper gastrointestinal endoscopic surveillance has importance and the aim is to detect as early as possible the occurrence of duodenal adenocarcinoma and upper gastrointestinal polyps with severe dysplasia.

FAMILIAL ADENOMATOUS POLYPOSIS IN CHILDREN

Background: Familial Adenomatous Polyposis (FAP) is the most common genetic colonic polyposis syndrome characterized by the development of hundreds of colorectal adenomatous polyps. The aim of our study was to review cases of FAP diagnosed at The Children's Hospital of Philadelphia (CHOP) over a 15-year period. Methods: Medical records of patients diagnosed with FAP at CHOP between January 1990 and December 2005 were reviewed. The records included hospital charts, an endoscopy database, and a pathology database. FAP was defined as the presence of multiple adenomatous polyps on colonoscopic examination. The collected data included: disease presentation, demographics, genetic profile, extra-intestinal manifestations, and treatment. Results: During the study period we identified 13 patients with FAP. The median age at presentation was 13 years, and 4 patients were female. The most common presentations were: rectal bleeding (5/13, 38%) and family history alone (4/13, 30%). Two patients had osteomas, one presented in infancy with hepatoblastoma, and one had multiple desmoid tumors. In total, nine patients (69%) had a family history of FAP, and all three patients who underwent genetic testing for FAP were positive for the APC gene mutation. During the follow up period, a total number of 25 colonoscopies and 20 upper endoscopies were performed: 4 patients (31%) had gastric fundic-gland polyps, 2 (15%) had gastric adenomatous polyps, and 7 (54%) had duodenal adenomatous polyps. On colonoscopy, the number of adenomatous polyps ranged from five to more than 200. Capsule endoscopy was performed in two patients, and one had multiple polyps identified in the duodenum, jejunum and ileum. Six of the thirteen patients (46%) underwent total colectomy at an average age of 13.7 years and no major complications were recorded. Conclusions: FAP is a rare condition in children that should be managed in a multidisciplinary referral center with genetic counseling,endoscopic surveillance and adherence to established clinical guidelines.

Cyclooxygenase 2, p53, β-Catenin, and APC Protein Expression in Gastric Adenomatous Polyps

Gastric adenomatous polyps are rare findings in upper gastrointestinal endoscopy; however, they are associated strongly with malignant transformation. Few series describe the oncogenic characteristics of gastric adenomas. In the present study, we immunohisto-chemically assessed the expression of cyclooxygenase (COX)-2, β-catenin, p53, and adenomatous polyposis coli (APC) in paraffin-embedded specimens of 14 gastric adenomas. Control samples of normal gastric tissue and gastric adenocarcinoma also were analyzed. Of the adenomas, 7 demonstrated overexpression of COX-2, and all demonstrated nuclear p53 accumulation. Accumulation of β-catenin in the nucleus and cytoplasm was detected in 38% (3/8) of specimens. Loss of APC staining was observed in 50% (4/8). Similar alterations in oncoprotein expression were seen in gastric cancers but not in normal control sections. Gastric adenomas display alterations in the expression of COX-2, β-catenin, and APC similar to those seen in adenocarcinomas; however, accumulation of p53 was significantly more common in adenomas than in cancers.

Cyclooxygenase 2, p53, b-Catenin, and APC Protein Expression in Gastric Adenomatous Polyps

Gastric adenomatous polyps are rare findings in upper gastrointestinal endoscopy; however, they are associated strongly with malignant transformation. Few series describe the oncogenic characteristics of gastric adenomas. In the present study, we immunohisto-chemically assessed the expression of cyclooxygenase (COX)-2, beta-catenin, p53, and adenomatous polyposis coli (APC) in paraffin-embedded specimens of 14 gastric adenomas. Control samples of normal gastric tissue and gastric adenocarcinoma also were analyzed. Of the adenomas, 7 demonstrated overexpression of COX-2, and all demonstrated nuclear p53 accumulation. Accumulation of beta-catenin in the nucleus and cytoplasm was detected in 38% (3/8) of specimens. Loss of APC staining was observed in 50% (4/8). Similar alterations in oncoprotein expression were seen in gastric cancers but not in normal control sections. Gastric adenomas display alterations in the expression of COX-2, beta-catenin, and APC similar to those seen in adenocarcinomas; however, accumulation of p53 was significantly more common in adenomas than in cancers.

Gastric atrophy, metaplasia, and dysplasia: a clinical perspective.

Gastric carcinoma of the intestinal type originates in dysplastic epithelium, which in turn develops in the milieu of atrophic gastritis and intestinal metaplasia. Cancers also may develop less often from gastric adenomatous polyps, which represent dysplastic epithelium arising in a raised lesion. The main causes of chronic atrophic gastritis and gastric atrophy are autoimmune due to pernicious anemia or chronic Helicobacter pylori infection. In the former condition, there is severe atrophy of the corpus (oxyntic mucosa), with the antrum being speared. In contrast, chronic atrophic gastritis consequent to H. pylori infection is a multifocal pangastritis, involving independent foci in the corpus and antrum of the stomach. For the most part, these clinical conditions are silent; the only manifestation of both these forms of chronic atrophic gastritis is cobalamin (vitamin B(12)) deficiency. In the case of the autoimmune gastritis of pernicious anemia, cobalamin deficiency results form the absence of intrinsic factor. When cobalamin deficiency occurs in patients with H. pylori-related gastritis, for the most part, it is because these patients have hypochlorhydria and are therefore unable to release cobalamin from its bound form in food. Patients may have advanced neuropsychiatric manifestations of cobalamin deficiency and yet not be anemic, have a normal blood smear, and even have serum cobalamin levels in the normal range. The condition may be identified by demonstrating elevated levels of homocysteine and methylmalonic acid. Intestinal metaplasia may be of the enteric (grade I), enterocolic (grade II), or colonic (grade III) type. Grade III intestinal metaplasia has traditionally been thought of as the most sinister variety, although the extent of atrophy and metaplasia may be a better marker for premalignancy than the mere identification of small areas of grade III intestinal metaplasia. Over the years, there has been much disagreement and a high degree of interrater variability, especially between Western and Japanese pathologists, as to the different grades of dysplasia and early gastric cancer. Recent consensus conferences at Vienna and Padova have resulted in better understanding of what constitutes these lesions, and it is hoped that in the near future agreement between pathologists will improve as a consequence. For the present, it is imperative that clinicians obtain second opinions from two or more expert pathologists on biopsy specimens before arriving at a diagnosis of either low- or high-grade dysplasia. The former histologic diagnosis is tantamount to subjecting the patient to endoscopic surveillance and the latter is tantamount to a decision regarding the resection of the lesion, both decisions being psychologically disturbing for patients. At this time, population screening for H. pylori is not recommended in Western countries, but most experts would agree that H. pylori should be eradicated if detected as part of the appropriate investigation of a clinical disorder such as dyspepsia. Certain other specific conditions may also be considered to be precancerous, such as the gastric remnant after a partial gastrectomy and the gastric mucosa in familial adenomatous polyposis syndrome and in familial Peutz-Jeghers syndrome and perhaps Ménétrier disease.

Role of Lkb1, the causative gene of Peutz-Jegher's syndrome, in embryogenesis and polyposis.

Peutz-Jeghers syndrome (PJS) is a dominantly inherited human disorder characterized by gastrointestinal hamartomatous polyposis and mucocutaneous melanin pigmentation. LKB1 (STK11) serine/threonine kinase is the product of the causative gene of PJS, which has been mapped to chromosome 19p13.3. However, several studies have produced results that are not consistent with a link between LKB1 gene mutation and PJS. We constructed a knockout gene mutation of Lkb1 to determine whether it is the causative gene of PJS and to examine the biological role of the Lkb1 gene. Lkb1(-/-) mice died in utero between 8.5 and 9.5 days postcoitum. At 9.0 days postcoitum, Lkb1(-/-) embryos were generally smaller than their age-matched littermates, showed developmental retardation, and did not undergo embryonic turning. Multiple gastric adenomatous polyps were observed in 10- to 14-month-old Lkb1(+/-) mice. Our results indicate that functional Lkb1 is required for normal embryogenesis and that it is related to tumor development. The Lkb1(+/-) mouse is suitable for studying molecular mechanism underlying the development of inherited gastric tumors in PJS.

Cyclooxygenase 2 (COX-2) is overexpressed in adenomatous gastric polyps

Cyclooxygenase 2 (COX-2) is overexpressed in adenomatous gastric polyps

The effect of eradicating Helicobacter pylori infection on the course of adenomatous and hyperplastic gastric polyps.

Histopathological and clinical data strongly suggest that Helicobacter pylori is the cause of chronic gastritis and peptic ulceration. However, little has been written about the potential causal relation of H. pylori infection to hyperplastic and adenomatous gastric polyps. We therefore carried out a prospective study to determine the effect of eradicating H. pylori infection on the course of hyperplastic and adenomatous gastric polyps. From November 1996 to December 1997, 6700 patients who had undergone upper gastrointestinal endoscopy at the two centres in Zagreb, Croatia, were candidates for participation in the study. Hyperplastic and adenomatous polyps were diagnosed on a basis of at least three histological samples taken from the polyp. In seven patients endoscopy had to be repeated because forceps biopsy sampling either provided inadequate tissue for correct histological diagnosis, or accurate characterization of gastric polyp histology was not possible. Upon completion of all endoscopic examinations before and after treatment, biopsy samples were taken from the antrum (two) and the body of the stomach (two) so that gastritis could be graded and classified, and the presence of H. pylori sought by histology. Two other samples were taken from the antrum for a rapid urease test. Follow-up examinations were performed by using endoscopy. Control endoscopy was performed at least 4 weeks after the treatment of H. pylori infection had been completed, and then every 3-4 months. The follow-up ranged from 4 to 17 months, with a median of 14 months. The treatment of H. pylori infection consisted of a 1-week course of either omeprazole (20 mg twice daily) or pantoprazole 40 mg twice daily), and a 1-week course of amoxicillin 2g twice daily) and metronidazole (400 mg three times daily), and clarithromycin (500 mg twice daily). Eradication of H. pylori infection was assessed by repeated histology and rapid urease test. Twenty-one patients (nine women, 12 men; median age 52 years) with histologically proven hyperplastic gastric polyps, and seven patients (two women, five men; median age, 67 years) with adenomatous gastric polyps were included in the study. Among 21 patients with hyperplastic gastric polyps, 16 patients (76%) were positive for H. pylori infection. Only two patients (29%) with adenomatous gastric polyps were positive for the infection. Complete eradication of H. pylori was initially achieved in all patients positive for H. pylori. Total regression of the gastric polyps was observed only among the patients with hyperplastic gastric polyps in whom H. pylori had been eradicated. Complete regression of the hyperplastic gastric polyps was observed in seven of the 16 evaluable patients (44%; 95% CI, 19-68%) after H. pylori eradication. The endoscopic snare polypectomy was carried out in nine patients with hyperplastic polyps and two patients with adenomatous gastric polyps in whom regression of the polyps was not observed after H. pylori eradication, as well as in five patients with hyperplastic and four with adenomatous gastric polyps who were negative for H. pylori. Exploratory laparotomy and gastrotomy with polyps excision were carried out in one patient with multiple adenomatous gastric polyps. In only one patient who was not positive for H. pylori recurrence of hyperplastic gastric polyp was recorded during follow-up, and no re-infection with H. pylori has been detected. Our results suggest that the development of hyperplastic gastric polyps may be directly related to chronic active gastritis and concomitant H. pylori infection. Cure of H. pylori infection associated with hyperplastic gastric polyps resulted in complete polyp regression in more than 40% of patients. Therefore, for patients with hyperplastic gastric polyps and concurrent H. pylori infection an antibiotic treatment designed to eradicate H. pylori appears to be recommended before further therapeutic options are consi

Gastric polypoid lesions—illustrative cases and literature review

Currently, upper gastrointestinal endoscopies are frequently performed for patients with various gastrointestinal symptoms. From time to time, lumps and bumps in the stomach are encountered on endoscopy. Four cases of gastric polypoid lesions are presented. The classification, differentiation, and management approach to these lesions are discussed. Although there is consensus that all gastric adenomatous polyps should be removed, as should gastric hyperplastic polyps that are symptomatic and/or bear dysplastic foci on forceps biopsy, controversy still exists over the management of asymptomatic gastric hyperplastic polyps that do not bear any dysplastic focus on forceps biopsies. Endoscopic ultrasonography (EUS) has a promising role in the evaluation of gastric submucosal polypoid lesions.

Association between histologic type of polyp and carcinoma in the stomach

During a 5-year period, we examined by endoscopy or surgery 2634 stomachs: 2536 (group A) were free of lesions commonly recognized as mucosal "polyps"; 74 (group B) exhibited hyperplastic polyps; and 24 (group C) were found with neoplastic (adenomatous) polyps. Carcinomas were present in 318 (12.5%) of specimens in group A, compared with 10 (13.5%) in group B and 20 (83.3%) in group C. In the third group, 14 carcinomas were encountered within polyps, and 4 carcinomas occurred separately. The frequency of cancer associated with neoplastic polyps was relatively low (1 of 3) in patients younger than 50 years, but significantly high (19 of 21) in older patients. This series confirms the prevailing concept that patients harboring gastric adenomatous polyps are at distinct risk of gastric carcinoma, a risk that sharply rises with age. We conclude that patients found with gastric adenomatous polyps should be subject to careful and continued surveillance to ensure that supervening carcinoma be detected at the earliest possible phase.