Stomach

Polyps

Hyperplastic polyp



Last author update: 8 September 2023
Last staff update: 8 September 2023

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PubMed Search: Stomach hyperplastic polyp

Omar Aljuboori, M.B.B.S.
Monica T. Garcia-Buitrago, M.D.
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Cite this page: Aljuboori O, Garcia-Buitrago MT. Hyperplastic polyp. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachhyperplastic.html. Accessed June 16th, 2024.
Definition / general
  • The second most common gastric epithelial polyp encountered during endoscopy
  • Usually a solitary polyp, commonly found in gastric antrum
  • Associated with autoimmune type gastritis, Helicobacter pylori gastritis, postsurgery and bile reflux gastritis (Am J Surg Pathol 2001;25:500, Am J Surg Pathol 2010;34:1591)
  • Usually < 1 cm, more than 50% are < 0.5 cm; large polyps up to 12 cm can occur and mimic malignancy
  • Dysplasia is more likely when > 1 cm and > 2.5 cm (Gut Liver 2009;3:271, GE Port J Gastroenterol 2021;28:328)
    • Resembles other GI dysplasia, either low grade or high grade
Essential features
  • Surface epithelium derived polyp
  • Elongated and architecturally distorted, irregular foveolar epithelium with cystic dilatations
  • Corkscrew appearance can occur
  • Lamina propria shows edema, congestion, variable acute and chronic inflammation
  • Smooth muscle strands can be seen extending from muscularis mucosae towards surface
  • Thick walled vessels may be present towards the base of the polyp
Terminology
ICD coding
  • ICD-10: K31.7 - polyp of stomach and duodenum
Epidemiology
Sites
  • Common site is gastric antrum but can occur anywhere in the stomach; recently body of the stomach has become more common due to autoimmune gastritis and the increased use of proton pump inhibitors (Am J Gastroenterol 2009;104:1524, Int J Mol Sci 2021;22:6548)
  • Hyperplastic polyps in pyloric and prepyloric regions may have features of prolapse associated polyps
  • Hyperplastic polyps at gastroesophageal junction are associated with Barrett esophagus in 33% of cases (Am J Surg Pathol 2011;35:1038)
Pathophysiology
Etiology
Clinical features
  • Mean age: 65 years
  • In the last decade, patients aged 45 - 59 had twice as many gastric polyps as 10 years ago (World J Gastroenterol 2016;22:8883)
  • Dyspepsia, heartburn and abdominal pain; patients may have anemia due to upper gastrointestinal bleeding (Dig Dis Sci 2007;52:105)
  • Obstructive symptoms if near pylorus or gastroesophageal junction
Diagnosis
  • Histopathology
Case reports
Treatment
Gross description
  • Broad based polyp with smooth lobulated contour (Surg Pathol Clin 2020;13:431)
  • Surface erosion may occur in large polyps
  • Should be submitted entirely to rule out dysplasia or malignancy
Microscopic (histologic) description
  • Elongated, architecturally distorted, irregular pits with outpouchings, cystic dilation and papillary formation
  • Foveolar epithelium with apical neutral mucin cap
    • Can show overt hypertrophic features with the formation of clustered pseudogoblet cells or even pseudo-signet ring cells, especially in damaged areas
  • Edematous lamina propria with lymphocytes, plasma cells and eosinophils
    • Erosion areas can also show neutrophils
  • Helicobacter pylori associated polyps: more likely show lymphoplasmacytic inflammation in lamina propria and neutrophils in the epithelium (Int J Surg Pathol 2016;24:704)
  • Smooth muscle strands can extend from muscularis mucosae to the surface
  • Thick walled blood vessels can be seen at the base
  • Intestinal metaplasia can be seen
  • Regenerative epithelial changes with focal mucin depletion, prominent nucleoli and hyperchromasia
  • Ulcerated areas can display increased mitotic activity in epithelium and granulation tissue with reactive fibroblasts and endothelial cells
  • Dysplasia is rare (4%); may be intestinal, foveolar or mixed (Histopathology 2021;78:106)
    • High grade dysplasia: complex architecture with cribriform formation or budding, back to back arrangement of glands
Microscopic (histologic) images

Contributed by Monica T. Garcia-Buitrago, M.D., Omar Aljuboori, M.B.B.S. and Andrey Bychkov, M.D., Ph.D.
Dilated gastric pits

Dilated gastric pits

Tortuous gastric pits

Tortuous gastric pits

Edematous lamina propria

Edematous lamina propria

Pseudogoblet cells Pseudogoblet cells

Pseudogoblet cells

Dysplasia

Dysplasia


Dysplastic polyp

Dysplastic polyp

Dysplasia

Dysplasia

Adenocarcinoma

Adenocarcinoma

Polypoid lesion

Polypoid lesion

Hemorrhagic and ulcerated

Hemorrhagic and ulcerated

Cystic hyperplastic glands

Cystic hyperplastic glands

Molecular / cytogenetics description
Sample pathology report
  • Stomach, esophagogastroduodenoscopy:
    • Gastric hyperplastic polyp (see comment)
    • Comment: Large gastric hyperplastic polyps typically arise in a background of damaged mucosa and are frequently associated with Helicobacter pylori or autoimmune gastritis. Follow up sampling of the flat mucosa from both the antrum and body / fundus in such patients may provide information on the setting in which the polyp has arisen.
Differential diagnosis
  • Polypoid gastritis:
    • Normal architecture, no smooth muscle wisps
  • Polypoid foveolar hyperplasia:
    • No cystic dilation, no smooth muscle wisps
  • Gastritis cystica profunda:
    • Entrapped, distorted, dilated glands in muscularis
  • Fundic gland polyp:
    • Distorted glands and cysts lined by parietal and chief cells
  • Ménétrier disease:
    • Affects gastric body only; foveolar hyperplasia, atrophy of glands, adjacent epithelium normal
  • Cronkhite-Canada syndrome:
    • Affects entire stomach; foveolar hyperplasia, atrophy of glands, adjacent epithelium shows atrophy of glands and microcystic change
  • Juvenile polyposis:
    • Adjacent mucosa is normal as opposed to hyperplastic polyp, which often has chronic gastritis
  • Peutz-Jeghers polyposis:
    • Autosomal dominant inherited disorder with multiple hamartomatous polyps and mucocutaneous hyperpigmentation
  • Pyloric adenoma:
    • Closely packed tubular glands lined by cuboidal to low columnar epithelium with ground glass cytoplasm, bland nuclei and no well formed apical mucin cap
  • Inflammatory fibroid polyp:
    • Submucosal lesion composed of spindle and stellate stromal cells
  • Dysplasia must be differentiated from regenerative change:
    • Dysplasia is present at the surface; regenerative change shows surface maturation and atypia like changes only in the proliferative zones, not at the surface
    • Dysplasia is typically abrupt
    • Dysplasia has architecturally complex patterns (cribriform, budding and branching)
    • Dysplasia has nuclear pleomorphism, elongation and hyperchromasia without prominent nucleoli
    • Regenerative epithelium shows gradual change, lacks complex patterns, has hyperchromasia but with ovoid nuclei and prominent nucleoli
Board review style question #1
Which Helicobacter pylori protein is associated with a role in the development of gastric neoplasia?

  1. CagA
  2. PAR1
  3. SHP2
  4. SRC
Board review style answer #1
A. CagA. CagA in Helicobacter pylori can cause aberrant activation of SHP2, a human oncoprotein, in the stomach (Proc Natl Acad Sci USA 2008;105:1003). Answer B is incorrect because PAR1 is a human kinase inhibited by CagA. Answer C is incorrect because SHP2 is a human oncoprotein, not a Helicobacter pylori protein. Answer D is incorrect because SRC is a human tyrosine kinase that mediates CagA phosphorylation and cytoskeletal rearrangements.

Comment Here

Reference: Hyperplastic polyp
Board review style question #2

Which of the following polyps is seen in this picture?

  1. Fundic gland polyp
  2. Hyperplastic polyp
  3. Polypoid foveolar hyperplasia
  4. Polypoid gastritis
Board review style answer #2
B. Hyperplastic polyp. Gastric polyp showing elongated, tortuous and dilated gastric pits and edematous lamina propria (Surg Pathol Clin 2020;13:431). Answer A is incorrect because the polyp shows dilated pits lined by foveolar epithelium, not oxyntic epithelium. Answer C is incorrect because the polyp shows cystically dilated pits. Answer D is incorrect because the polyp has abnormal architecture and does not show predominant plasmacytic and neutrophilic inflammation.

Comment Here

Reference: Hyperplastic polyp
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