Histology of endoscopic core-biopsies are not sufficient for differentation between hyperplastic and adenomatosus polyps in stomach

Based on literature, hyperplastic ventricular polyps could show the same stepvise colon polyp like transformation. To recognise the malignant changes as early as possible the most important deal is to obtain histological confirmation of hyperplastic and adenomatous polyps found at endoscopy.

Our aims were to find correlation between the histological results of core biopsy and polypectomy and to detect the transformation of hyperplastic alterations to adenomatous polyps in the stomach as well as in the colon.

Results were analyzed retrospectively. In the period of 1999–2003 15466 gastroscopies were performed and 87 polypectomies were done in 73 pts. In 39 21 of them showed the same cases biopsies were taken before polypectomy histology as the polypectomies, in 18 cases the results were different with 12 adenomas not verified with core biopsy. Among the 87 polypectomies 24 adenomas were found but in 8 cases (4 pts) with hyperplastic polyps repeated polypectomies revealed adenomatous transformation. Altogether 4 villous, 6 tubular, 4 tubulovillous, 4 hyperplastic, 5 unspecified adenomas and one planocell carcinoma were the defined histologically. With long term follow-up one malignant transformation in a tubulovillosus adenoma and in another case a metachrone hyperplastic adenomatosus change was detected and 11 control gastroscopies were tumor negative, 10 pts have no repeated examination yet. Among 55 cases of gastric polypectomies colonoscopy verified adenoma or cancer at 30 endoscopies.

Conclusion: Transformation of ventricular hyperplastic polyps to adenomas is not rare even malignant development can occur similarly to the colon. For definitive differentiation between hyperplastic and adenomatosus polyps polypectomy is necessary.