Multifocal gastric carcinoma arising from hyperplastic and adenomatous polyps

This paper is a presentation of the unusual case of a 61-yr-old woman operated on for multiple gastric cancers. Two of the cancers were found in the hyperplastic polyps and one in the adenoma. Apart from cancers that arose from these polyps, there were four separate polypoid or flat gastric carcinomas and three other hyperplastic polyps with no signs of malignancy, in this case. The presentation is followed by a detailed discussion focusing on the possible development of carcinoma in gastric hyperplastic polyps in view of the data from the literature.     

Carcinoma in gastric hyperplastic polyps

One-hundred twelve hyperplastic polyps were analyzed. The aim was to study their malignant transformation. Among them, four hyperplastic polyps harbored adenocarcinoma; two were from our own institution (1.8%). The majority were pedunculated and located in the antrum with an average of 14.5 mm in diameter. The four polyps bore well-differentiated adenocarcinoma. Dysplasia and intestinal metaplasia were detected in two and three polyps, respectively. The cancer and dysplastic foci shared the same type of neutral and acid mucosubstances. p53 oncoprotein was positive in three cancer foci and in the dysplastic areas, and nucleolar organizer region counts were higher in the cancer foci. In conclusion, hyperplastic polyps have malignant potential. Such possibility increases in polyps larger than 14.5 mm. In our cases, the carcinoma foci may have arisen from dysplastic areas. Once the neoplastic changes occur, the cancer cells proliferate and behave as other adenocarcinomas of the stomach.     

Vimentin-positive gastric adenocarcinoma arising in a hyperplastic polyp

We report a case of vimentin-positive early gastric adenocarcinoma arising in a hyperplastic polyp (HP). A 72-year-old Japanese man was admitted for the detailed examination of a gastric polyp. He had a subtotal gastrectomy due to acute abdomen 12 years ago. Upper endoscopy revealed a pedunculated polyp measuring approximately 2 cm on the greater curvature of upper body of the remnant stomach. Magnifying endoscopy revealed that the microsurface pattern was irregular and partially absent accompanied with irregular microvessels at the upper end of the polyp. We speculated that the lesion was an adenocarcinoma arising in the HP. Endoscopic submucosal dissection (ESD) was performed. Histological examination of the ESD specimen revealed that the lesion consisted of well- to poorly differentiated adenocarcinoma at the protruding lesion and foveolar hyperplastic epithelia at the base of the polyp. Immunohistochemically, most of tumor cells that comprised poorly-differentiated adenocarcinoma were positive for both cytokeratin and vimentin. Although carcinomas have occasionally been found in HPs, the histological features of the present case are considered extremely unusual. To the best of our knowledge, this is the first case of vimentin-positive early gastric carcinoma arising in a HP.     

Two cases of inverted hyperplastic polyps of the colon and association with adenoma

Here we report two cases of inverted hyperplastic polyps of the colon. The first patient showed three inverted hyperplastic polyps in the ascending colon, one of which was associated with adenoma. We immunostained this adenoma-associated polyp using anti-beta-catenin antibody and found accumulation of beta-catenin in the cytoplasm of the adenomatous lesion but not in the inverted hyperplastic polyp. This suggested an adenomatous polyposis coli (APC) mutation in the adenomatous region but not in the inverted hyperplastic polyp. The inverted hyperplastic polyp in the second patient was located at the caecum and was studied using magnifying colonoscopy. The polyp appeared to be flat and elevated with a depressed pit in the centre. After spraying with methylene blue dye, the pit pattern of the lesion was observed and small asteroid pits on the polyp were found, consistent with a hyperplastic gland pattern. From these results, we diagnosed inverted hyperplastic polyp of the colon by colonoscopy.     

Pathophysiological and clinical aspects of gastric hyperplastic polyps

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.     

Acquired hyperplastic gastric polyps in solid organ transplant patients

OBJECTIVE: We report a series of patients who developed hyperplastic gastric polyps after solid organ transplantation. METHODS: A retrospective review of patients with solid organ transplantation from January 1997 to December 1999 was performed. Patients with gastric polyps found during endoscopy were included. Demographic data, polyp characteristics (endoscopic and histological), time of endoscopy, and treatment regimens were analyzed. RESULTS: A total of 10 (seven men, three women) transplanted patients (six cardiac, three liver, and one kidney) with gastric polyps were identified. The median age was 61 yr (27-71 yr), and median time of endoscopy after transplantation was 11 months (3-28 months). Eight patients had endoscopy before or soon after transplantation, with no evidence of polyps. Nine patients had multiple polyps (three or more), and one had a single pedunculated polyp. Polyps were confined to the antrum in eight patients, antrum and body in one patient, and fundus in one patient. All polyps biopsied were found to be hyperplastic and without adenomatous or malignant changes. Cytomegalovirus serology was negative in nine patients. Each patient received standard immunosuppression that included a calcineurin inhibitor and steroids. Steroids were tapered and stopped by 3 months. Azathioprine was added in five patients and mycophenolate mofetil in one patient. CONCLUSIONS: The development of gastric polyps after organ transplantation has not been previously reported. The development of these gastric polyps (hyperplastic and multiple) is concerning as a malignant potential has been recognized in patients harboring multiple hyperplastic gastric polyps. The exact cause of these polyps is unknown. The association with immunosuppressive therapy as well as the natural history of these acquired hyperplastic gastric polyps needs further investigation.     

Giant hyperplastic polyps of the gastric remnant simulating carcinoma

Large hyperplastic polyps of the gastric remnant were detected in 2 male patients who had undergone Billroth II gastrojejunostomy for peptic ulcer disease 13 and 18 years earlier. Both patients presented with iron deficiency anemia due to chronic occult gastrointestinal bleeding. The clinical and radiographic findings were initially suggestive of gastric stump malignancy, and one of the resected hyperplastic polyps contained foci of carcinoma in situ. We illustrate the radiographic and pathologic features of these lesions together with a review of the pertinent literature.     

胃增生性息肉伴癌变的临床病理特征分析

目的探讨胃增生性息肉（gastric hyperplastic polyps,GHP）伴癌变的临床、内镜和病理特点。方法对18例病理确诊为GHP伴癌变患者的临床表现、内镜特征、病理特点、治疗情况进行回顾性分析。结果18例GHP伴癌变患者年龄（67.2±7.8）岁（45~79岁）,男6例、女12例;临床症状表现为腹痛、腹胀或无明显症状。患者合并胃内多发息肉为主（13例）,单发的癌变GHP好发部位在胃体（7例）。内镜下病灶形态多样,15例为带蒂息肉,癌变息肉直径均＞10 mm,9例直径＞20 mm。背景黏膜中14例存在萎缩性胃炎,4例合并幽门螺杆菌（Helicobacter pylori,HP）感染。结论GHP伴癌变患者缺乏特异性症状,对于HP阴性合并萎缩性胃炎的多发性胃息肉患者,需警惕较大、带蒂息肉癌变的可能。     

胃增生性息肉复发与肿瘤转化的研究进展

胃增生性息肉是我国仅次于胃底腺息肉的第二大常见胃息肉，目前治疗胃增生性息肉的首选方式是内镜下切除术，其可以明显减轻患者创伤，但术后复发仍是临床上亟待解决的问题。明确胃增生性息肉复发的危险因素，能够尽量避免切除后复发，从而减轻患者再次胃镜治疗的痛苦，降低医疗费用；除此之外，研究表明胃增生性息肉有肿瘤转化的风险，明确其肿瘤转化的危险因素能够有效预防肿瘤的发生。     

根除幽门螺杆菌对胃增生性息肉的作用

目的　探讨根除幽门螺杆菌(Hp)对胃增生性息肉的作用。方法　将胃增生性息肉 (息肉直径 3~10mm)合并Hp感染的 48例患者随机分为治疗组及对照组 (各 24例 )。治疗组患者接受四联治疗,包括质子泵抑制剂(奥美拉唑或兰索拉唑)、克拉霉素、枸橼酸铋及替硝唑,疗程 2周。对照组仅接受替普瑞酮治疗。受试者在纳入试验前及治疗结束后 1~12个月接受定期胃镜检查和Hp测定。结果　治疗组和对照组各有 22例及 21例患者完成整个研究。治疗组有 19例 ( 86. 4% )Hp得到根除,在用药后 1~12个月,平均(6. 5±1. 1)个月随访中,Hp根除者中 15例(78. 9)胃息肉消失。而在试验开始后12个月,对照组患者的胃息肉和Hp情况未发生变化 (P<0. 01 )。结论　大多数胃增生性息肉在根除Hp后消失,患者如同时患有胃增生性息肉和Hp感染,在行息肉摘除术前可先尝试Hp根除治疗。     

Two cases of histopathologically advanced (stage IV) early gastric cancer]

Various minimally invasive surgical techniques in some cases of early gastric cancer are becoming common practice. However, there are rare cases of advanced cancer with distant metastasis although the invasion of the gastric wall is limited to the mucosa and/or submucosa (defined as early gastric cancer according to UICC-TNM classification). We report two cases of early gastric cancer with distant metastasis (stage IV). Both tumors were defined as early cancer because they were confined to the submucosa. One was a type IIa early cancer, histologically classifiable as a signet ring cell carcinoma (according to the Japanese Classification of Gastric Carcinoma and UICC-TNM classification); the other was a surface spreading type IIb + IIc, classifiable as a signet ring cell carcinoma, too. Stage IV factors were ovarian metastasis (Krukenberg tumor) in the former and N3 in the latter case.     

胃增生性息肉与自身免疫性化生性萎缩性胃炎的相关性分析

目的 探讨胃增生性息肉与自身免疫性化生性萎缩性胃炎的相关性。方法 回顾性分析2011年1月—2017年6月于首都医科大学附属北京友谊医院内镜中心行内镜切除术的56例胃增生性息肉患者,包括17例伴肿瘤性改变和39例不伴肿瘤性改变的患者,分析患者血清学、内镜表现和病理的特点。结果 男22例、女34例,年龄（61.88±9.01）岁。空腹胃泌素升高率50.0%（28/56）,血清抗壁细胞抗体（anti-parietal cell antibody,PCA）阳性率62.5%（35/56）,贫血率37.5%（21/56）,幽门螺旋杆菌阴性率64.3%（36/56）。与血清PCA阴性患者相比,血清PCA阳性患者以女性多见（P=0.034）,易发生高胃泌素血症（P＜0.001）、贫血（P=0.001）、多发GHPs（P=0.019）,且以血清铁缺乏为主（P=0.044）。35例血清PCA阳性患者共108枚息肉,胃底、体91枚（84.３%）、胃窦17枚（15.7%,P=0.005）;21例贫血患者共63枚息肉,胃底、体54枚（85.7%）、胃窦9枚（14.3%,P=0.075）。56例患者共142枚增生性息肉,73.2%（104/142）为带蒂息肉,69.0%（98/142）为“草莓状”息肉。17例伴肿瘤性改变中,6例高分化腺癌、2例中分化腺癌、3例高级别异型增生、6例低级别异型增生。结论 胃增生性息肉与自身免疫性化生性萎缩性胃炎有关,可能在其基础上向肿瘤性改变转化。     

Evaluation of eight cases of early gastric cancer

We review eight cases of early gastric cancer which occurred in five female and three male patients. In seven patients the main complaint was epigastric pain and in one melena. In seven of the eight cases, endoscopic diagnosis was established on the first examination and confirmed by biopsy. Types of early gastric cancer observed were: type I, one case; IIa, one case; IIc three cases: III, two cases and type III + IIc, one case. In five cases the neoplasia was located in the antrum, two in the pre-pyloric region, two along the greater curvature and one in the anterior wall. Three cases were located in the body of the stomach, two in the lower third of the lesser curvature and one in the upper third of the greater curvature. From the histopathologic standpoint four cases were differentiated adenocarcinomas, three undifferentiated adenocarcinomas and one case mucus carcinoma. In no case did we encounter regional lymph node metastases. Postoperative survival rates at the present time varies between one and five years.     

早期胃癌250例临床病理分析及EMR适应范围的探讨

目的 为临床实施早期胃癌内镜下黏膜切除术(EMR),从病理学角度提供一定的参考依据.方法 参照EMR适应证条件,提取2005-2008年间我院诊断的250例早期胃癌的术后病理资料进行回顾性分析.结果 250例早期胃癌中高分化癌共184例,其中Tis 26例,Tm 58例,Tsm 100例;低分化癌共66例,其中Tm 29例,Tsm 37例.淋巴结转移:高分化癌共发生转移11例,其中Tsm病变≤1 cm者中Ⅱb转移1例,其余10例发生在Tsm病变Ⅱc和Ⅲ型组中;低分化癌66例共发生转移10例,其中Tm病变≤2 cm者中Ⅱb转移2例,其余8例发生在Tsm病变Ⅱb和Ⅱc型组中.结论 EMR的绝对适应证为Tis和高分化癌Tm(共51例);相对适应证为高分化癌Tm(17例),高分化Tsm中Ⅰ、Ⅱa、Ⅱb型(共19例)是比较安全的选择对象;而对于＞1 cm Tsm,高分化Ⅱc、Ⅲ型Tsm及低分化癌,由于存在较高的转移可能性,在选择时均应慎重严格掌握.