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Digestive Diseases and Sciences

, Volume 54, Issue 9, pp 1839–1846 | Cite as

Gastric Hyperplastic Polyps: A Review

  • Richa Jain
  • Runjan ChettyEmail author
Review

Abstract

Hyperplastic polyps represent the commonest polyp encountered in the stomach. They occur in patients of either gender and are commoner in the seventh decade of life. They are usually asymptomatic, small (less than 1 cm in diameter), solitary lesions occurring in the antrum but can present with dyspepsia, heartburn, abdominal pain, or upper gastrointestinal (GI) bleeding leading to anemia. Hyperplastic polyps almost never occur in normal gastric mucosa and are most commonly associated with chronic gastritis (Helicobacter pylori or autoimmune-induced). Pathologically, they are characterized by dilated, tortuous gastric foveoli set within an inflamed, edematous stroma. There is considerable histologic overlap especially with Ménétrier’s disease and hamartomatous (juvenile or retention) polyps, and clinical input is mandatory to accomplish separation of these entities. Hyperplastic polyps arise as a by-product of repair to damaged mucosa. Dysplasia and malignancy are rarely associated with these polyps, which show an array of molecular aberrations. The importance of hyperplastic polyps for both gastroenterologist and pathologist lies in their association with other gastric mucosal pathology and mandates biopsy of adjacent mucosa and diligent search for accompanying pathology by the pathologist.

Keywords

Hyperplastic polyps Stomach Gastritis Juvenile/retention polyps 

References

  1. 1.
    Abraham SC, Singh VK, Yardley JH, Wu T. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Am J Surg Pathol. 2001;25:500–507. doi: 10.1097/00000478-200104000-00010.PubMedCrossRefGoogle Scholar
  2. 2.
    Morais DJ, Yamanaka A, Zeitune JMR, Andreollo NA. Gastric polyps: A retrospective analysis of 26, 000 digestive endoscopies. Arq Gastroenterol. 2007;44:14–17. doi: 10.1590/S0004-28032007000100004.PubMedCrossRefGoogle Scholar
  3. 3.
    Sanna CM, Loriga P, Dessi E, et al. Hyperplastic polyp of the stomach simulating hypertrophic pyloric stenosis. J Pediatr Gastrenterol Nutr. 1991;13:204–208.Google Scholar
  4. 4.
    Yao T, Kajiwara M, Kuroiwa S, et al. Malignant transformation of gastric hyperplastic polyps: Alteration of phenotypes, proliferative activity, and p53 expression. Hum Pathol. 2002;33:1016–1022.PubMedCrossRefGoogle Scholar
  5. 5.
    Murakami K, Mitomi H, Yamashita K, Tanabe S, Saigenji K, Okayasu I. p53, but not c-Ki-ras, mutation and down-regulation of p21WAF1/CIP1 and cyclin D1 are associated with malignant transformation in gastric hyperplastic polyps. Am J Clin Pathol. 2001;115:224–234.PubMedCrossRefGoogle Scholar
  6. 6.
    Al-Haddad M, Ward EM, Bouras EP, Raimondo M. Hyperplastic polyps of the gastric antrum in patients with gastrointestinal blood loss. Dig Dis Sci. 2007;52:105–109.PubMedCrossRefGoogle Scholar
  7. 7.
    Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, Tozun N. Antral hyperplastic polyp causing intermittent gastric outlet obstruction: Case report. BMC Gastroenterol. 2003; 27;3:16 http://www.biomedcentral.com/1471-230X/3/16.
  8. 8.
    Abraham SC. Gastric polyps: Classification and meaning. Pathol Case Rev. 2002;7:2–11.CrossRefGoogle Scholar
  9. 9.
    Burke AP, Sobin LH. The pathology of Cronkhite-Canada polyps: A comparison to juvenile polyposis. Am J Surg Pathol. 1989;13:940–946.PubMedCrossRefGoogle Scholar
  10. 10.
    Stolte M, Bethke B, Sticht T, Burkhard U. Differentiation of focal foveolar hyperplasia from hyperplastic polyps in gastric biopsy material. Path Res Pract. 1995;191:1198–1202.PubMedGoogle Scholar
  11. 11.
    Rubio CA, Ost A, Kato Y, Yanagisawa A, Rivera F, Hirota T. Hyperplastic foveolar gastropathies and hyperplastic foveolar gastritis. APMIS. 1997;105:784–792.PubMedCrossRefGoogle Scholar
  12. 12.
    Orlowska J, Jarasz D, Pachlewski J, Butruk E. Malignant transformation of benign epithelial gastric polyps. Am J Gastroenterol. 1995;90:2152–2159.PubMedGoogle Scholar
  13. 13.
    Ji F, Wang Z, Ning J, Wang Q, Chen J, Li Y. Effect of drug treatment on hyperplastic gastric polyps infected with Helicobacter pylori: A randomized, controlled trial. World J Gastroenterol. 2006;12:1770–1773.PubMedGoogle Scholar
  14. 14.
    Bamba H, Ota S, Arai S, et al. Expression of cyclooxygenase-2 in human hyperplastic gastric polyps. J Exp Clin Cancer Res. 2003;22:425–430.PubMedGoogle Scholar
  15. 15.
    Nakajima A, Matsuhashi N, Yazaki Y, Oka T, Sugano K. Details of hyperplastic polyps of the stomach shrinking after anti-Helicobacter pylori therapy. J Gastroenterol. 2000;35:372–375.PubMedCrossRefGoogle Scholar
  16. 16.
    Kume K, Hirakoba M, Murata I, Yoshikawa I, Otsuki M. Disappearance of both MALT lymphoma and hyperplastic polyps in the stomach after eradication of Helicobacter pylori. Am J Gastroenterol. 2001;96:2796–2797.PubMedCrossRefGoogle Scholar
  17. 17.
    Tanaka J, Fujimoto K, Iwakiri R, et al. Hyperplastic polyps following treatment of acute gastric ulcers. Intern Med. 1994;33:366–368.PubMedCrossRefGoogle Scholar
  18. 18.
    Niv Y, Delpre G, Sperber AD, Sandbank J, Zirkin H. Hyperplastic gastric polyposis, hypergastrinaemia and colorectal neoplasia: A description of four cases. Eur J Gastroenterol Hepatol. 2003;15:1361–1366.PubMedCrossRefGoogle Scholar
  19. 19.
    Amaro R, Neff GW, Karnam US, Tzakis AG, Raskin JB. Acquired hyperplastic gastric polyps in solid organ transplant patients. Am J Gastroenterol. 2002;97:2220–2224.PubMedCrossRefGoogle Scholar
  20. 20.
    Jewell KD, Toweill DL, Swanson PE, Upton MP, Yeh MM. Gastric hyperplastic polyps in post transplant patients: A clinicopathologic study. Mod Pathol. 2008;21:1108–1112.PubMedCrossRefGoogle Scholar
  21. 21.
    Daibo M, Itabashi M, Hirota T. Malignant transformation of gastric hyperplastic polyps. Am J Gastroenterol. 1987;82:1016–1025.PubMedGoogle Scholar
  22. 22.
    Nogueira AMMF, Carneiro F, Seruca R, et al. Microsatellite instability in hyperplastic and adenomatous polyps of the stomach. Cancer. 1999;86:1649–1656.PubMedCrossRefGoogle Scholar
  23. 23.
    Hattori T. Morphological range of hyperplastic polyps and carcinomas arising in hyperplastic polyps of the stomach. J Clin Pathol. 1985;38:622–630.PubMedCrossRefGoogle Scholar
  24. 24.
    Zea-Iriarte WL, Sekine I, Itsuno M, et al. Carcinoma in gastric hyperplastic polyps: A phenotypic study. Dig Dis Sci. 1996;41:377–386.PubMedCrossRefGoogle Scholar
  25. 25.
    Dirschmid K, Platz-Baudin C, Stolte M. Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa? Virchows Arch. 2006;448:80–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Hirano H, Yoshida T, Yoshimura H, et al. Poorly differentiated adenocarcinoma with signet-ring cell carcinoma in a hyperplastic polyp of the stomach: Report of a case. Surg Today. 2007;37:901–904.PubMedCrossRefGoogle Scholar
  27. 27.
    Hirasaki S, Suzuki S, Kanzaki H, Fujita K, Matsumura S, Matsumoto E. Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp. World J Gastroenterol. 2007;13:5779–5780.PubMedGoogle Scholar
  28. 28.
    Wu CH, Chen MJ, Chang WH, Chan YJ, Wang HY, Shih SC. Signet-ring type adenocarcinoma arising from a tiny gastric polyp. Gastrointest Endosc. 2008;67:724–725.PubMedCrossRefGoogle Scholar
  29. 29.
    Dijkhuizen SMM, Entius MM, Clement MJ, et al. Multiple hyperplastic polyps in the stomach: Evidence for clonality and neoplastic potential. Gastroenterology. 1997;112:561–566.PubMedCrossRefGoogle Scholar
  30. 30.
    Lauwers GY, Wahl SJ, Melamed J, Rojas-Corona RR. p53 expression in precancerous gastric lesions: an immunohistochemical study of Pab 1801 monoclonal antibody on adenomatous and hyperplastic gastric polyps. Am J Gastroenterol. 1993;88:1916–1919.PubMedGoogle Scholar
  31. 31.
    Weiss MM, Kuipers EJ, Postma C, Snijders AM, Stolte M, et al. Genome wide array comparative genomic hybridisation analysis of premalignant lesions of the stomach. Mol Pathol. 2003;56:293–298.PubMedCrossRefGoogle Scholar
  32. 32.
    Seruca R, Carneiro F, Castedo S, David L, Lopes C, Sobrinho-Simoes M. Familial gastric polyposis revisited: Autosomal dominant inheritance confirmed. Cancer Genet Cytogenet. 1991;53:97–100.PubMedCrossRefGoogle Scholar
  33. 33.
    Carneiro F, David L, Seruca R, Castedo S, Nesland JM, Sobrinho-Simoes M. Hyperplastic polyposis and diffuse carcinoma of the stomach: A study of a family. Cancer. 1993;72:323–329.PubMedCrossRefGoogle Scholar
  34. 34.
    Davion T, Lescanne-Darchis I, Maunoury V, et al. Hyperplastic gastric polyposis and familial colonic adenomas. Apropos of a case. Gastroenterol Clin Biol 1996;20:298–302.Google Scholar
  35. 35.
    Mochizuka A, Uehara T, Nakamura T, Kobayashi Y, Ota H. Hyperplastic polyps and sessile serrated ‘adenomas’ of the colon and rectum display gastric pyloric differentiation. Histochem Cell Biol. 2007;128:445–455.PubMedCrossRefGoogle Scholar
  36. 36.
    Owens SR, Chiosea SI, Kuan SF. Selective expression of gastric mucin MUC6 in colonic sessile serrated adenoma but not in hyperplastic polyp aids in morphological diagnosis of serrated polyps. Mod Pathol. 2008;21:660–669.PubMedCrossRefGoogle Scholar
  37. 37.
    Yao T, Nishiyama KI, Oya M, Kouzuki T, Kajiwara M, Tsuneyoshi M. Multiple serrated adenocarcinomas of the colon with a cell lineage common to metaplastic polyp and serrated adenoma: Case report of a new subtype of colonic adenocarcinoma with gastric differentiation. J Pathol. 2000;190:444–449.PubMedCrossRefGoogle Scholar
  38. 38.
    Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP. Serrated polyps of the large intestine: A morphologic and molecular review of an evolving concept. Am J Clin Pathol. 2005;124:380–391.PubMedCrossRefGoogle Scholar
  39. 39.
    Liang JJ, Alrawi S, Tan D. Nomenclature, molecular genetics and clinical significance of the precursor lesions in the serrated polyp pathway of colorectal carcinoma. Int J Clin Exp Pathol. 2008;1:317–324.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of PathologyUniversity Health Network/University of TorontoTorontoCanada
  2. 2.Department of PathologyUniversity Health Network/Toronto Medical Laboratories, The Toronto General HospitalTorontoCanada

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