1
|
Dong N, Meng F, Yue B, Hou J. Clinicopathologic and endoscopic characteristics of ten patients with gastric hamartomatous inverted polyp: a single center case series. BMC Gastroenterol 2024; 24:139. [PMID: 38649806 PMCID: PMC11034083 DOI: 10.1186/s12876-024-03233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Gastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP. METHODS We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection. RESULTS GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective. CONCLUSIONS GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.
Collapse
Affiliation(s)
- Ningning Dong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory for Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China
| | - Fandong Meng
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory for Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China
| | - Bing Yue
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Junzhen Hou
- Department of Gastroenterology, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, 24 Shi-Jing-Shan Road Shi-Jing-Shan District, Beijing, 100040, China.
| |
Collapse
|
2
|
Hou JZ, Dong NN, Yue B, Meng FD, Wang YJ. Autoimmune gastritis with a gastric hamartomatous inverted polyp and two hyperplastic polyps: a case report. J Int Med Res 2023; 51:3000605231162451. [PMID: 36967703 PMCID: PMC10052490 DOI: 10.1177/03000605231162451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
We report an unusual case of autoimmune gastritis (AIG) complicated with a submucosal tumor (SMT) and two pedunculated polyps in a 60-year-old man. The patient was admitted for epigastric distention, heartburn, and anorexia. Endoscopy showed an SMT in the fundus, two pedunculated polyps in the body, and markedly atrophic mucosa of the body and fundus. The SMT, measuring 20 mm in diameter, was resected by endoscopic submucosal dissection and histologically diagnosed as a gastric hamartomatous inverted polyp (GHIP), which is characterized by submucosal glandular proliferation, cystic dilatation, and calcification. The gland structures consisted of foveolar cells and pseudopyloric or mucous-neck cell types. The two pedunculated polyps that were resected by endoscopic mucosal resection were histologically diagnosed as hyperplastic polyps, which are characterized by hyperplastic foveolar glands with pseudopyloric or mucous-neck glands in the inflamed stroma in the mucosa, which consisted of almost the same types of lining cells as the GHIP in the fundus. Findings may indicate the relationship between GHIP, hyperplastic polyp, and AIG. We highlight considering GHIP as a differential diagnosis for an SMT in patients with AIG.
Collapse
Affiliation(s)
- Jun-Zhen Hou
- Department of Gastroenterology, Shijingshan teaching hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
| | - Ning-Ning Dong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Bing Yue
- Department of Pathology, Beijing Friendship Hospital of Capital Medical University, Beijing, China
| | - Fan-Dong Meng
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Yong-Jun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| |
Collapse
|
3
|
Ohtsu T, Takahashi Y, Tokuhara M, Tahara T, Ishida M, Miyasaka C, Tsuta K, Naganuma M. Gastric hamartomatous inverted polyp: Report of three cases with a review of the endoscopic and clinicopathological features. DEN OPEN 2023; 3:e198. [PMID: 36618884 PMCID: PMC9812834 DOI: 10.1002/deo2.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 01/06/2023]
Abstract
Objectives A gastric hamartomatous inverted polyp (GHIP) is a rare submucosal tumor characterized histopathologically by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands. Only 42 GHIPs have been reported in English literature. Few GHIPs have been reported to accompany adenocarcinomas. We reported on three patients with a GHIP and reviewed the clinicopathological and endoscopic features of GHIPs. Methods This study included two men and one woman with a GHIP. The endoscopic, histopathological, and immunohistochemical features of the endoscopically resected specimens were analyzed. A gene mutation analysis was also performed. Results All the tumors were located in the body of the stomach, with a median size of 20 mm. Two tumors were sessile, and the remaining tumor had a pedunculated appearance. The overlying mucosa mainly appeared normal but was reddish in one tumor. The histopathological examination of the tumors revealed a well-circumscribed and lobular submucosal proliferation of cystically dilated hyperplastic glands. The immunohistochemical analysis revealed that the MUC5AC-positive foveolar epithelium was located in the center, and MUC6-positive pseudo-pyloric or pepsinogen-I and H+/K+ ATPase-positive fundic-type glands were located at the periphery of two tumors. No carcinomatous components were noted in any of the tumors. Moreover, no significant mutations in oncogenes or tumor suppressor genes were noted. Conclusions Our review revealed that approximately three fourths of GHIP cases showed an submucosal tumor-like feature, whereas endoscopic features, including the endoscopic ultrasonography findings, were not characteristic. Because an endoscopic diagnosis of a GHIP may be difficult, complete endoscopic resection may be required for a pathological diagnosis.
Collapse
Affiliation(s)
- Takuya Ohtsu
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan,Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Yu Takahashi
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
| | - Mitsuo Tokuhara
- JCHO Hoshigaoka Medical CenterGastroenterology and HepatologyOsakaJapan
| | - Tomomitsu Tahara
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
| | - Mitsuaki Ishida
- Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Chika Miyasaka
- Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Koji Tsuta
- Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
| |
Collapse
|
4
|
Gastric Inverted Polyps-Distinctive Subepithelial Lesions of the Stomach: Clinicopathologic Analysis of 12 Cases With an Emphasis on Neoplastic Potential. Am J Surg Pathol 2021; 45:680-689. [PMID: 33399336 DOI: 10.1097/pas.0000000000001651] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastric inverted polyps (GIPs) are rare gastric polyps characterized by a submucosal inverted growth of mucosal components. Because of their rarity, they are not well characterized and are diagnostically challenging. We examined 12 cases of GIPs arising in 8 male and 4 female patients (mean age: 56 y). Most GIPs (11/12, 92%) occurred as a single, rounded subepithelial lesion in the body or fundus (mean size: 14.9 mm). Histologically, GIPs consisted of gastric-type glandular epithelium and smooth muscle component, growing in an endophytic manner; however, they displayed significant morphologic variations. We classified GIPs into 3 subtypes by the following features: communication with the mucosal surface, smooth muscle boundary, and tissue organization. The defining characteristics of type 1 were a mucosal communicating structure at the center and a well-defined smooth muscle boundary, resulting in a characteristic low-magnification morphology of a round vase. Type 2 had an organized glandular proliferation with smooth muscle boundary and no central communicating structure. Type 3 GIPs had no mucosal communicating structure or smooth muscle boundary; its key histologic feature was the lobular organization pattern produced by proliferations of cystic or hyperplastic glands and smooth muscle. All type 1 GIPs exhibited coexisting adenocarcinoma (3 cases) or stromal proliferation (3 cases). Three patients with type 2 GIP had separate adenocarcinoma. None of the type 3 GIPs had accompanying carcinoma. In conclusion, GIPs are a heterogenous group showing different morphology and clinical behavior. Notably, type 1 GIP could be considered a precancerous lesion with the potential to develop adenocarcinoma.
Collapse
|
5
|
Lee YH, Joo MK, Lee BJ, Lee JA, Kim T, Yoon JG, Lee JM, Park JJ. [Inverted Hyperplastic Polyp in Stomach: A Case Report and Literature Review]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 67:98-102. [PMID: 26907486 DOI: 10.4166/kjg.2016.67.2.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.
Collapse
Affiliation(s)
- Yeon Ho Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Moon Kyung Joo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Beom Jae Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji-Ae Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Taehyun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin Gu Yoon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung Min Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong-Jae Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Jung M, Min KW, Ryu YJ. Gastric inverted hyperplasic polyp composed only of pyloric glands: a rare case report and review of the literature. Int J Surg Pathol 2014; 23:313-6. [PMID: 25097203 DOI: 10.1177/1066896914545395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Inverted hyperplastic polyp (IHP) in stomach is a rare benign gastric polypoid lesion, characterized by downward growth of hyperplastic mucosal glands into the submucosal layer. In most previous reported cases, gastric IHP showed mixtures of fundic-type gland, pyloric-type gland, and foveolar-type epithelium. Also, a case of IHP composed of only one type of gland is extremely rare. This report describes a case of a 70-year-old man with gastric IHP, composed only of pyloric-type gland. It was removed completely by endoscopic submucosal dissection, and patient showed no recurrence over 2 years after treatment.
Collapse
Affiliation(s)
- Minsun Jung
- Kangwon National University, Chuncheon, Korea
| | | | | |
Collapse
|
7
|
Mori H, Kobara H, Tsushimi T, Fujihara S, Nishiyama N, Matsunaga T, Ayaki M, Yachida T, Masaki T. Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth. World J Gastroenterol 2014; 20:5918-5923. [PMID: 24914354 PMCID: PMC4024803 DOI: 10.3748/wjg.v20.i19.5918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/27/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric hamartomatous inverted polyps (GHIP) are difficult to diagnose accurately because of inversion into the submucosal layer. GHIP are diagnosed using the pathological characteristics of the tumor, including the fibroblast cells, smooth muscle, nerve components, glandular hyperplasia, and cystic gland dilatation. Although Peutz-Jeghers syndrome, juvenile polyposis, and Cowden disease are hereditary, it is rare to encounter 2 cases of monostotic and asymptomatic gastric hamartomas. The pathogeneses of hamartomatous inverted polyps and inverted hyperplastic polyps remain controversial because of the paucity of reported cases. There are 3 hypotheses regarding the pathogenesis of complete gastric inverted polyps. Based on our experience with 2 successive, rare GHIP cases, we affirm the hypothesis that after a hamartomatous change occurs in the submucosal layer, some of these components are exposed to the gastric mucosa and, consequently, form a hypertrophic lesion. In Case 1, our hypothesis explains why a tiny hypertrophic change was first detected on the top of the submucosal tumor using a detailed narrow band imaging-magnified endoscopy. There was no confirmation that the milky white mucous and calcification structures were exuding directly from the biopsy site like Case 1, and in Case 2 the presence of this mucous was indirectly confirmed during an endoscopic submucosal dissection (ESD). Regarding the pathogenesis of GHIP, a submucosal hamartomatous change may occur prior to the growth of hypertrophic portions. An en bloc resection using ESD is recommended for treatment.
Collapse
|
8
|
Oshima T, Joh T, Sasaki M, Tanida S, Itoh K, Mizoshita T, Kawade M, Ohara H, Nomura T, Itoh M. Gastric gland heterotopic in muscularis mucosa treated by endoscopic polypectomy: a case report. Gastrointest Endosc 2004; 60:664-7. [PMID: 15472707 DOI: 10.1016/s0016-5107(04)01888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Tadayuki Oshima
- Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Al-Gahtany M, Bilbao J, Kovacs K, Horvath E, Smyth HS. Juxtaposition of an ectopic corticotroph adenoma of the sphenoid sinus with orthotopic intrasellar corticotroph hyperplasia in a patient with Cushing disease. Case report. J Neurosurg 2003; 98:891-6. [PMID: 12691418 DOI: 10.3171/jns.2003.98.4.0891] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ectopic pituitary adenomas (EPAs) are rare and their association with orthotopic corticotroph hyperplasia has not been published. The case of a 30-year-old woman with clinical and biochemical evidence of Cushing disease (CD) is reported. A magnetic resonance image obtained preoperatively revealed asymmetrical inhomogeneity of the pituitary gland, which was suggestive of localized adenoma. It also showed what was thought to be a small sphenoid polyp. Postoperatively the latter lesion was found to be an ectopic corticotroph adenoma. The pituitary gland, which was free from any tumor, exhibited diffuse unilateral corticotroph hyperplasia. Clinical, radiological, laboratory, and histopathological findings are presented. A review of the literature and a discussion of possible causes of this unique association between the ectopic corticotroph adenoma and the pituitary hyperplasia are provided.
Collapse
Affiliation(s)
- Mubarak Al-Gahtany
- Department of Neurosurgery, St. Michael's Hospital and University of Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
10
|
Yamashita M, Hirokawa M, Nakasono M, Kiyoku H, Sano N, Fujii M, Koyama T, Yoshida S, Sano T. Gastric inverted hyperplastic polyp. Report of four cases and relation to gastritis cystica profunda. APMIS 2002; 110:717-23. [PMID: 12583438 DOI: 10.1034/j.1600-0463.2002.1101005.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Gastric inverted hyperplastic polyp (IHP) is a rare type of gastric polyp, and is characterized by downward growth of the hyperplastic mucosal components into the submucosa. To the best ofour knowledge, 16 gastric IHP cases have been described in the English literature, but the pathogenesis has not been established. We report the clinical and pathological findings of four gastric IHP cases. The lesions were mainly composed of hyperplastic foveolar-type glands with focal cystic dilatation. Pyloric type glands, endocrine cells, acinic cell metaplasia, and smooth muscle bundles were also seen as components of the polyp. Two cases (cases 1 and 4) coexisted with multifocal gastritis cystica profunda (GCP) and gastric adenocarcinoma. Case 4 furthermore exhibited an intermediate form between IHP and GCP. We suggest that IHP may be GCP associated with exaggeratedly hyperplastic and metaplastic changes. In case 4, the coexisting gastric carcinoma was mainly located in the submucosa, whilst the mucosal component was minimal. Five out of twenty reported gastric IHP cases, including our cases, coexisted with gastric adenocarcinoma. These facts would lead us to further investigate the relation between gastric IHP and carcinoma.
Collapse
Affiliation(s)
- Michiko Yamashita
- Department of Pathology, University of Tokushima School of Medicine, Tokushima, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hou W, Haruma K, Sumii K, Yoshihara M, Tsuda T, Shimamoto T, Kajiyama G, Ito H. Solitary pedunculated polypoid gastric gland heterotopia. GASTROENTEROLOGIA JAPONICA 1993; 28:415-9. [PMID: 8344503 DOI: 10.1007/bf02776987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A solitary pedunculated gastric polyp in the gastric fundus was removed from an asymptomatic 36-year-old woman with normal gastric acid secretion and a normal serum gastrin level. This lesion exhibited distinctive histological features including prominent proliferation of pseudopyloric glands, fundic glands, foveolar epithelium and a fibromuscular stroma. Moreover, its surface was entirely covered by a layer of normal gastric epithelium. Biopsies of the background mucosa taken from the gastric fundus revealed only mild superficial gastritis. A gastric gland heterotopia was diagnosed because of its unique morphology.
Collapse
Affiliation(s)
- W Hou
- First Department of Internal Medicine, Hiroshima University School of Medicine, Japan
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Erdozain JC, Sánchez-Ruano JJ, San Román AL, Boixeda D, Moreira VF, Plaza AG. Solitary gastric hamartomatous polyp and upper gastrointestinal haemorrhage: an exceptional presentation of an unusual diagnosis. Postgrad Med J 1990; 66:1084-5. [PMID: 2084662 PMCID: PMC2429804 DOI: 10.1136/pgmj.66.782.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of solitary gastric hamartomatous polyp, presenting as upper gastrointestinal haemorrhage, is reported. Both the entity itself, and the clinical presentation, are exceptional. The significance of the solitary gastric hamartomatous polyp and implications of its diagnosis are discussed.
Collapse
Affiliation(s)
- J C Erdozain
- Servicio de Gastroenterología, Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | | | | |
Collapse
|