Virchows Archiv

, Volume 448, Issue 1, pp 80–84 | Cite as

Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa?

  • Klaus Dirschmid
  • Claudia Platz-Baudin
  • Manfred Stolte
Original Article


It is well known from the older literature that gastric carcinomas are more likely to develop in a stomach containing hyperplastic polyps. The reason why such a stomach should represent a precancerous condition is, however, largely unexplained. The aim of this study was to determine the disorders of the gastric mucosa in which hyperplastic polyps occur. In 244 patients with hyperplastic polyp, in whom at least two additional biopsies each from the antrum and corpus were available, gastritis was classified on the basis of the updated Sydney System. In none of the 244 patients was the gastric mucosa found to be normal. The most common disorder, at 51.3%, was autoimmune gastritis of the corpus mucosa, while chronic active Helicobacter pylori (Hp) gastritis was seen in 37.3% of the patients. Of the patients with Hp gastritis, 56.1% had corpus-dominant Hp gastritis. Other forms were relatively rare: when A-gastritis, corpus-dominant Hp gastritis and any other form of Hp gastritis were lumped together as a precancerous condition, these changes were found in 88.6% of the patients with hyperplastic polyps of the stomach. In the presence of hyperplastic polyps of the gastric mucosa, additional biopsies obtained from the antrum and corpus should always be performed to obtain a basis for deciding whether to apply Hp eradication treatment as potential carcinoma prophylaxis.


Hyperplastic polyps Gastritis Precancerous condition 


  1. 1.
    Abraham SC, Singh VK, Yardley JH, Wu TT (2001) Hyperplastic polyps of the stomach. Associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol 25:500–507PubMedCrossRefGoogle Scholar
  2. 2.
    Carneiro F, David L, Seruca R, Castedo S, Nesland JM, Sobrinho-Simoes M (1993) Hyperplastic polyposis and diffuse carcinoma of the stomach. A study of a family. Cancer 72:323–329PubMedCrossRefGoogle Scholar
  3. 3.
    Carneiro F, Huntsman DG, Smyrk TC, Owen DA, Seruca R, Pharaoh P, Caldas C, Sorbrinho-Simoes M (2004) Model of the early development of diffuse gastric cancer in E-cadherin mutation carriers and its implications for patient screening. J Pathol 203:681–687PubMedCrossRefGoogle Scholar
  4. 4.
    Daibo M, Itabashi M, Hirota T (1987) Malignant transformation of gastric hyperplastic polyps. Am J Gastroenterol 82:1016–1025PubMedGoogle Scholar
  5. 5.
    Dijkhuizen SMM, Entius MM, Clement MJ, Polak MM, van den Berg FM, Craanen ME, Slebos RJC, Offerhaus GJA (1997) Multiple hyperplastic polyps in the stomach: evidence for clonality and neoplastic potential. Gastroenterology 112:561–566PubMedCrossRefGoogle Scholar
  6. 6.
    Dixon MF, Genta RM, Yardley JH, the Participants in the International Workshop on the Histopathology of Gastritis (1996) Classification and grading of gastritis: the updated Sydney system. Am J Surg Pathol 20:1161–1181PubMedCrossRefGoogle Scholar
  7. 7.
    El-Omar EM, Carrington M, Chow WH, McColl KE, Bream SW, Young HA, Herrera S, Lissowska J, Yuan CC, Rothman N, Lanyon G, Martin M, Fraumeni JF, Rabkin CS (2000) Interleukin-1 polymorphisms associated with increased risk of gastric cancer. Nature 404:398–402PubMedCrossRefGoogle Scholar
  8. 8.
    Elsborg L, Andersen D, Myrhe-Jensen O, Bastrup-Madsen P (1977) Gastric mucosal polyps in pernicious anaemia. Scand J Gastroenterol 12:49–52PubMedGoogle Scholar
  9. 9.
    Hansson LE, Nyren O, Hsing AW, Bergstrom R, Josefsson S, Chow WH, Fraumeni JF, Adami HO (1996) The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med 335:242–249PubMedCrossRefGoogle Scholar
  10. 10.
    International Agency for Research on Cancer (IARC) (1994) Schistosomes, liver flukes and Helicobacter pylori. Working group on the evaluation of carcinogenic risks to humans. IARC Monogr Eval Carcinog Risks Hum 61:177–241Google Scholar
  11. 11.
    Knight T, Wyatt JI, Wilson A, Greaves S, Newell D, Hengels K, Corlett M, Webb P, Forman D, Elder J (1996) Helicobacter pylori gastritis and serum pepsinogen levels in a healthy population: development of a biomarker strategy for gastric atrophy in high risk groups. Br J Cancer 73:819–824PubMedGoogle Scholar
  12. 12.
    Laxen F, Kekki M, Sipponen P, Siurala M (1983) The gastric mucosa in stomach with polyps: morphologic and dynamic evaluation. Scand J Gastroenterol 18:503–511PubMedCrossRefGoogle Scholar
  13. 13.
    Leodolter A, Ebert M, Kahl S, Vieth M, Malfertheiner P (2003) Age-dependent prevalence of H. pylori associated gastritis phenotypes with increased risk for gastric cancer. Gastroenterology 124(Suppl):A648CrossRefGoogle Scholar
  14. 14.
    Ljubicic N, Banic N, Kujundzic M, Antic Z, Vrkljan M, Kovacevic I, Hrabar D, Doko D, Doko M, Zowvak M, Mihatov S (1999) The effect of eradicating Helicobacter pylori infection on the course of adenomatous and hyperplastic gastric polyps. Eur J Gastroenterol Hepatol 11:722–730Google Scholar
  15. 15.
    Meining A, Bayerdörffer E, Müller P, Miehlke S, Lehn N, Hölzel D, Hatz R, Stolte M (1998) Gastric carcinoma risk index in patients infected with Helicobacter pylori. Virchows Arch 432:311–314PubMedCrossRefGoogle Scholar
  16. 16.
    Meining A, Bayerdörffer E, Stolte M (1999) Helicobacter pylori gastritis of the gastric cancer phenotype in relatives of gastric carcinoma patients. Eur J Gastroenterol Hepatol 11:717–720PubMedCrossRefGoogle Scholar
  17. 17.
    Miehlke S, Hackelsberger A, Meining A, Hatz, Lehn N, Malfertheiner P (1998) Severe expression of corpus gastritis is characteristic in gastric cancer patients infected with Helicobacter pylori. Br J Cancer 78:263–266PubMedCrossRefGoogle Scholar
  18. 18.
    Mocek FW, Ward WW, Wolfson SE, Rumage WT, Wieman TJ (1994) Elimination of recurrent hyperplastic polyps by eradication of Helicobacter pylori. Ann Intern Med 120:1007–1008PubMedGoogle Scholar
  19. 19.
    Müller H, Rappel S, Wündisch T, Bayerdörffer E, Stolte M (2001) Healing of active, non-atrophic autoimmune gastritis by H. pylori eradication. Digestion 64:30–39PubMedCrossRefGoogle Scholar
  20. 20.
    Nakano H, Persson B, Slezak P (1990) Study of the gastric mucosal background in patients with gastric polyps. Gastrointest Endosc 36:39–42PubMedCrossRefGoogle Scholar
  21. 21.
    Ohkusa T, Takashimizu I, Fujiki K, Suzuki S, Shimoi K, Horiuchi T, Sakurazawa T, Ariake K, Ishiik, Kumagai J, Zanizawa T (1998) Disappearance of hyperplastic polyps in the stomach after eradication of Helicobacter pylori. Ann Intern Med 129:712–715PubMedGoogle Scholar
  22. 22.
    Orlowska J, Jarosz D, Pachlewski J, Butruk E (1995) Malignant transformation of benign epithelial gastric polyps. Am J Gastroenterol 90:2152–2159PubMedGoogle Scholar
  23. 23.
    Seifert E, Gail K, Weismüller J (1983) Gastric polypectomy—long term results (survey of 23 centers of Germany). Endoscopy 15:8–11PubMedGoogle Scholar
  24. 24.
    Sipponen P, Stolte M (1997) Clinical impact of routine biopsies of the gastric antrum and body. Endoscopy 29:671–678PubMedGoogle Scholar
  25. 25.
    Stolte M, Baumann H, Bethke B, Ritter M, Lauer E, Eidt H (1992) Active autoimmune gastritis without total atrophy of the glands. Z Gastroenterol 30:729–735PubMedGoogle Scholar
  26. 26.
    Stolte M, Sticht T, Eidt S, Ebert D, Finkenzeller G (1994) Frequency, location and age and sex distribution of various types of gastric polyps. Endoscopy 22:203–207Google Scholar
  27. 27.
    Stolte M (2001) Hyperplastic polyps of the stomach. Letter to the editor. Am J Surg Pathol 25:1342–1343PubMedCrossRefGoogle Scholar
  28. 28.
    Torbenson M, Abraham SC, Boitnott J, Yardley JH, Wu TT (2002) Autoimmune gastritis: distinct histological and immunohistochemical findings before complete loss of oxyntic glands. Mod Pathol 15:102–109PubMedCrossRefGoogle Scholar
  29. 29.
    Uemura M, Okamoto S, Yamamoto S, Matsumara N, Ymaguche I, Yamakido M, Taniyama K, Sasaki N, Schlemper RJ (2001) Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 345:784–789PubMedCrossRefGoogle Scholar
  30. 30.
    Ye W, Nyrén O (2003) Risk of cancers of the oesophagus and stomach by histology or subsite in patients hospitalised for pernicious anaemia. Gut 52:938–941PubMedCrossRefGoogle Scholar
  31. 31.
    Zea-Iriarte WL, Sekine I, Istuno M, Makiyama K, Naito S, Nakayama T, Nishisawa-Takano JE, Hattori T (1996) Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 41:377–386PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Klaus Dirschmid
    • 1
  • Claudia Platz-Baudin
    • 1
  • Manfred Stolte
    • 1
  1. 1.Institute of PathologyKlinikum BayreuthBayreuthGermany

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