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WHO Classification of Tumours
Adenoma, NOS
Stomach


Definition

Adenoma is a non-invasive, benign neoplasm arising from the epithelium. The neoplastic cells may display moderate cellular atypia or dysplasia.

> Adenomatous polyps of the stomach
Adenomatous polyps usually show evidence of intestinal-type differentiation (absorptive cells, goblet cells, endocrine cells, or even Paneth cells), express intestinal markers (MUC2 and CD10), and are negative for gastric mucins (MUC5AC and MUC6)

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Kushima R, Vieth M, Borchard F, Stolte M, Mukaisho K, Hattori T (2006)
Gastric-type well-differentiated adenocarcinoma and pyloric gland adenoma of the stomach.
Gastric Cancer 9: 177-84




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Park do Y, Lauwers GY (2008)
Gastric polyps: classification and management.
Arch Pathol Lab Med 132: 633-40



. The risk of malignant transformation is related to size (>2cm) and presence of high-grade dysplasia
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Park DI, Rhee PL, Kim JE, Hyun JG, Kim YH, Son HJ, Kim JJ, Paik SW, Rhee JC, Choi KW, Oh YL (2001)
Risk factors suggesting malignant transformation of gastric adenoma: univariate and multivariate analysis.
Endoscopy 33: 501-6



. However, the importance of the phenotype (intestinal-type versus gastric) is debated
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Abraham SC, Montgomery EA, Singh VK, Yardley JH, Wu TT (2002)
Gastric adenomas: intestinal-type and gastric-type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology.
Am J Surg Pathol 26: 1276-85




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Park do Y, Srivastava A, Kim GH, Mino-Kenudson M, Deshpande V, Zukerberg LR, Song GA, Lauwers GY (2008)
Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia.
Am J Surg Pathol 32: 524-33



. Gastric-type adenomas include:

Pyloric-gland adenoma is a rare neoplasm with gastric epithelial differentiation characterized by closely packed pyloric gland-type tubules with a monolayer of cuboidal to low columnar epithelial cells containing round nuclei and pale to eosinophilic cytoplasm

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Chen ZM, Scudiere JR, Abraham SC, Montgomery E (2009)
Pyloric gland adenoma: an entity distinct from gastric foveolar type adenoma.
Am J Surg Pathol 33: 186-93




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Kushima R, Vieth M, Borchard F, Stolte M, Mukaisho K, Hattori T (2006)
Gastric-type well-differentiated adenocarcinoma and pyloric gland adenoma of the stomach.
Gastric Cancer 9: 177-84




Click to access Pubmed
Park do Y, Lauwers GY (2008)
Gastric polyps: classification and management.
Arch Pathol Lab Med 132: 633-40



.

Foveolar-type adenomas are rare in general but more common in patients with familial adenomatous polyposis (FAP)

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Abraham SC, Montgomery EA, Singh VK, Yardley JH, Wu TT (2002)
Gastric adenomas: intestinal-type and gastric-type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology.
Am J Surg Pathol 26: 1276-85




Click to access Pubmed
Kushima R, Vieth M, Borchard F, Stolte M, Mukaisho K, Hattori T (2006)
Gastric-type well-differentiated adenocarcinoma and pyloric gland adenoma of the stomach.
Gastric Cancer 9: 177-84



, and predominantly express MUC5AC without MUC6
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Chen ZM, Scudiere JR, Abraham SC, Montgomery E (2009)
Pyloric gland adenoma: an entity distinct from gastric foveolar type adenoma.
Am J Surg Pathol 33: 186-93



. Whether they are low-risk lesions or not is debated
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Abraham SC, Montgomery EA, Singh VK, Yardley JH, Wu TT (2002)
Gastric adenomas: intestinal-type and gastric-type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology.
Am J Surg Pathol 26: 1276-85




Click to access Pubmed
Park do Y, Srivastava A, Kim GH, Mino-Kenudson M, Deshpande V, Zukerberg LR, Song GA, Lauwers GY (2008)
Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia.
Am J Surg Pathol 32: 524-33





> Fundic-gland polyps
Fundic-gland polyps may occur sporadically, in patients with familial adenomatous polyposis of the colon (FAP)

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Park do Y, Lauwers GY (2008)
Gastric polyps: classification and management.
Arch Pathol Lab Med 132: 633-40



, or as a familial condition confined to the stomach without polyposis coli
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Tsuchikame N, Ishimaru Y, Ohshima S, Takahashi M (1993)
Three familial cases of fundic gland polyposis without polyposis coli.
Virchows Arch A Pathol Anat Histopathol 422: 337-40



and also affect patients receiving long-term treatment with proton-pump inhibitors
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Ally MR, Veerappan GR, Maydonovitch CL, Duncan TJ, Perry JL, Osgard EM, Wong RK (2009)
Chronic proton pump inhibitor therapy associated with increased development of fundic gland polyps.
Dig Dis Sci 54: 2617-22




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Fossmark R, Jianu CS, Martinsen TC, Qvigstad G, Syversen U, Waldum HL (2008)
Serum gastrin and chromogranin A levels in patients with fundic gland polyps caused by long-term proton-pump inhibition.
Scand J Gastroenterol 43: 20-4



. Sporadic fundic-gland polyps have very weak malignant potential, and the frequency of dysplasia is very low
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Jalving M, Koornstra JJ, Boersma-van Ek W, de Jong S, Karrenbeld A, Hollema H, de Vries EG, Kleibeuker JH (2003)
Dysplasia in fundic gland polyps is associated with nuclear beta-catenin expression and relatively high cell turnover rates.
Scand J Gastroenterol 38: 916-22




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Stolte M, Vieth M, Ebert MP (2003)
High-grade dysplasia in sporadic fundic gland polyps: clinically relevant or not?
Eur J Gastroenterol Hepatol 15: 1153-6



. Patients with FAP may develop dysplasia (in up to 48% of cases) in fundic-gland polyps, but carcinomas are extremely rare
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Abraham SC, Park SJ, Mugartegui L, Hamilton SR, Wu TT (2002)
Sporadic fundic gland polyps with epithelial dysplasia : evidence for preferential targeting for mutations in the adenomatous polyposis coli gene.
Am J Pathol 161: 1735-42




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Attard TM, Giardiello FM, Argani P, Cuffari C (2001)
Fundic gland polyposis with high-grade dysplasia in a child with attenuated familial adenomatous polyposis and familial gastric cancer.
J Pediatr Gastroenterol Nutr 32: 215-8



. The frequent finding of genetic alteration involving the APC/β-catenin pathway, either sporadic or arising in the setting of FAP, suggests that fundic-gland polyps may be neoplastic
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Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, Wu TT (2000)
Fundic gland polyps in familial adenomatous polyposis: neoplasms with frequent somatic adenomatous polyposis coli gene alterations.
Am J Pathol 157: 747-54




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Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, Wu TT (2001)
Sporadic fundic gland polyps: common gastric polyps arising through activating mutations in the beta-catenin gene.
Am J Pathol 158: 1005-10




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Torbenson M, Lee JH, Cruz-Correa M, Ravich W, Rastgar K, Abraham SC, Wu TT (2002)
Sporadic fundic gland polyposis: a clinical, histological, and molecular analysis.
Mod Pathol 15: 718-23



.

> Non-neoplastic polyps
Non-neoplastic polyps of the stomach encompass hyperplastic polyps, hamartomatous polyps (Peutz-Jeghers polyp, juvenile polyp, Cronkhite-Canada syndrome- associated polyp), and miscellaneous lesions with polypoid growth pattern

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Carmack SW, Genta RM, Graham DY, Lauwers GY (2009)
Management of gastric polyps: a pathology-based guide for gastroenterologists.
Nat Rev Gastroenterol Hepatol 6: 331-41




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Park do Y, Lauwers GY (2008)
Gastric polyps: classification and management.
Arch Pathol Lab Med 132: 633-40



).

Hyperplastic polyps
Hyperplastic polyps are the second most common gastric polyps and typically arise in previously damaged gastric mucosa

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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: 500-7




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Carmack SW, Genta RM, Graham DY, Lauwers GY (2009)
Management of gastric polyps: a pathology-based guide for gastroenterologists.
Nat Rev Gastroenterol Hepatol 6: 331-41




Click to access Pubmed
Park do Y, Lauwers GY (2008)
Gastric polyps: classification and management.
Arch Pathol Lab Med 132: 633-40



, arising in a back- ground of H. pylori gastritis or autoimmune gastritis. Malignant transformation, although rare, is well-documented
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Carneiro F, David L, Seruca R, Castedo S, Nesland JM, Sobrinho-Sim§es M (1993)
Hyperplastic polyposis and diffuse carcinoma of the stomach. A study of a family.
Cancer 72: 323-9




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Carneiro F, Sobrinho-Simˇes M (1996)
Signet ring cell carcinoma in hyperplastic polyp.
Scand J Gastroenterol 31: 95-6




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Stolte M (2001)
Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy.
Am J Surg Pathol 25: 1342-4




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Zea-Iriarte WL, Sekine I, Itsuno 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: 377-86



.

Polyposis syndromes
Peutz-Jeghers polyps , juvenile polyps , and Cowden polyps generally do not occur sporadically, but rather as part of hereditary polyposis syndromes. Some cases of juvenile polyposis may affect the stomach only

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Dunlop MG, , (2002)
Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polypolis, juvenile polyposis, and Peutz-Jeghers syndrome.
Gut 51 Suppl 5: V21-7



. Gastric Peutz-Jeghers polyps are characterized histologically by branching bands of smooth muscle derived from muscularis mucosae, and hyperplasia, elongation and cystic change of foveolar epithelium; the deeper glandular components tend to show atrophy. However, syndromic gastric polyps can be difficult to distinguish from hyperplastic polyps.