ABSTRACT
OBJECTIVES: Juvenile polyps involving the stomach are uncommon. Massive gastric juvenile polyposis is even rarer. METHODS: We describe the clinicopathologic features of nine cases of massive gastric juvenile polyposis. RESULTS: All patients had anemia; four had hypoalbuminemia. The polyps were composed predominantly of dilated crypts lined by columnar epithelium and abundant edematous stroma with mixed inflammatory infiltrates. One patient had a poorly differentiated adenocarcinoma, arising in juvenile polyp-associated intraepithelial neoplasia. A second patient had a well-differentiated intramucosal adenocarcinoma arising in a juvenile polyp with high-grade dysplasia. Three of our cases had polyposis restricted to the stomach. Six (66.6%) had loss of SMAD4 immunoreactivity, making them subject to severe bleeding and hypoproteinemia, as well as developing severe dysplasia or adenocarcinoma. CONCLUSIONS: SMAD4 immunohistochemstry is a helpful ancillary diagnostic test in cases of suspected juvenile polyposis syndrome involving the stomach.
Subject(s)
Adenocarcinoma/pathology , Adenomatous Polyps/pathology , Intestinal Polyposis/congenital , Neoplastic Syndromes, Hereditary/pathology , Smad4 Protein/metabolism , Stomach Neoplasms/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/genetics , Adenomatous Polyps/diagnosis , Adenomatous Polyps/genetics , Adult , DNA Mutational Analysis , Epithelium/metabolism , Epithelium/pathology , Female , Gastric Mucosa/metabolism , Humans , Immunohistochemistry , Intestinal Polyposis/diagnosis , Intestinal Polyposis/genetics , Intestinal Polyposis/pathology , Male , Middle Aged , Mutation , Neoplastic Syndromes, Hereditary/diagnosis , Neoplastic Syndromes, Hereditary/genetics , Retrospective Studies , Smad4 Protein/genetics , Stomach/pathology , Stomach Neoplasms/diagnosis , Stomach Neoplasms/genetics , Young AdultABSTRACT
Gastric hyperplastic polyps in organ transplant recipients have been recently described; however, the clinical significance of hyperplastic polyps in this setting remains unclear. The aim of this study is to further characterize the clinical presentation and histopathology of gastric hyperplastic polyps in organ transplant recipients as compared to hyperplastic polyps in non-transplant individuals. All gastric hyperplastic polyps diagnosed in our institute from 1999 to 2005 were retrieved. Clinical data including endoscopic findings were reviewed. Twenty cases without history of transplantation were randomly selected for a control population. Hematoxylin and eosin and Genta stains were reviewed. 104 cases of gastric hyperplastic polyps were identified. Sixteen (15%) had a history of solid organ (one liver/kidney, four livers, one lung, one kidney, one kidney/pancreas, three hearts) or bone marrow transplantation (five). The average time after transplantation was 28 months. Signs/symptoms leading to endoscopy were more frequently nausea/vomiting in transplant patients as compared to bleeding/hematemesis/anemia in non-transplant patients. The transplant patients tended to be younger with a reversed M:F ratio, but age was the only demographic factor that was statistically significant. There was no difference in polyp size, location and number. Histologically, no difference was observed in the frequency of active inflammation, Helicobacter pylori infection or intestinal metaplasia. Dysplasia was not present in any of the cases. None of the patients had a history of polyposis syndrome. In conclusion, a significant percentage of gastric hyperplastic polyps (15%) were from organ transplant patients, further suggesting a strong association of gastric hyperplastic polyps with transplantation. The younger age in the transplant group may be explained by the nature of the cohort qualified for transplantation. While no statistically significant differences in histopathologic features were found between transplant and non-transplant groups, analysis was limited by small case numbers. Overall, gastric hyperplastic polyps in the post transplant setting is a common, but under-recognized entity and merits further clinicopathologic analysis.
