2016-08-31_0001.jpgAuthor: Dr Tim Bracey |
2016-08-31_0001.jpgAuthor: Dr Tim Bracey |
2016-08-31_0001.jpgAuthor: Dr Tim Bracey |
2016-08-31_0001.jpgAuthor: Dr Tim Bracey |
2016-08-31_0001.jpgAuthor: Dr Tim Bracey |
2016-08-31_0001.jpgAuthor: Dr Tim Bracey |
(1) This is small bowel mucosa. There is a regular crypt and villous architecture with an intact brush border. There is no evidence of inflammation, coeliac disease, parasitic infection or dysplasia.
(2 & 3) This is antral-type gastric mucosa showing an irregular architecture with marked foveolar hyperplasia with infolding of the mucosa. There is mild active chronic inflammation and granulation tissue containing bizarre fibroblasts is seen. Intestinal metaplasia, Helicobacter or atrophy are not seen. There are regenerative changes but no evidence of dysplasia.
The appearances for both bopsies are those of a regenerative polyps. In specimen 2 (pylorus) there is some nuclear atypia which is most probably regenerative in nature. However interpretation can be difficult in the context of inflammation and therefore early re-biopsy is recommended.
Diagnostic Summary
(1) Duodenal biopsies - Normal.
Stomach
Polyps
Hyperplastic polyp
Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 8 August 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.
General
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● Also called inflammatory, regenerative polyps
● Different from colonic hyperplastic polyps but similar to colonic inflammatory pseudopolyps
● Non-neoplastic, represents about 75% of all gastric polyps
● Associated with background mucosal disease in 85% of cases, particularly chronic gastritis with glandular atrophy and intestinal metaplasia; H. pylori gastritis, chemical (reactive) gastropathy, thus, endoscopists should also biopsy surrounding mucosa to evaluate underlying gastric abnormalities
● Also associated with hypochlorhydria and hypergastrinemia
● Multiple polyps associated with autoimmune gastritis
● Usually age 50+
● Rare/no malignant potential by itself, although present in 20% of stomachs resected for carcinoma (chronically inflamed and atrophic mucosa tends to form hyperplastic polyps and to degenerate into malignancy)
● Hyperplastic polyps with even low grade dysplasia may have significant risk for associated carcinoma (Hum Pathol 2002;33:1016)
Gross description
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● Small (mean 1.4 cm, range 0.5 to 2 cm), sessile, multiple (20%), 60% in antrum
● Smooth or slightly lobulated
● Central umbilication common, more proximal when associated with autoimmune gastritis
Micro description
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● Elongated, tortuous or dilated gastric foveola with pyloric or fundic glands (Am J Surg Pathol 2001;25:500)
● Lamina propria has inflammatory cells, scattered smooth muscle bundles, edema, patchy necrosis
● Associated with chronic, active (H. pylori), reactive gastritis, and atrophic autoimmune gastritis
● Rarely foamy macrophages
● Surface mucosa may be regenerative, but dysplasia in only 4%
● Focal intestinal metaplasia in 16%
● May regress when H. pylori gastritis is treated
Micro images
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