Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Am J Surg Pathol. 2011 Jul;35(7):1038-44. doi: 10.1097/PAS.0b013e3182189425.
Hyperplastic (inflammatory) polyps (HPs) of the gastric corpus and antrum typically develop in association with chronic gastritis. However, little is known regarding the etiology, pathologic features, and natural history of HPs of the gastroesophageal junction (GEJ). We have noted, anecdotally, that GEJ HPs often occur in patients without gastric pathology. The aim of this study was to evaluate the clinical, pathologic, and outcome features of patients with HPs of the GEJ, and to compare the data with a control group of individuals with HPs in the gastric corpus or antrum. One hundred thirty-four consecutive polyps of the GEJ were identified by a 5-year search through the pathology files of a major tertiary-care hospital. Of these, 46 (36%) polyps from 46 patients met the pathologic criteria for HPs and formed the basis of this study. The 46 study patients, and their polyps, were evaluated for a wide variety of clinical, endoscopic, and pathologic features including outcome on follow-up endoscopy. The findings were compared with 46 HPs from 46 patients of the distal stomach (antrum or corpus) that were obtained randomly from the same 5-year period. Compared with patients with gastric antral or corpus HPs, patients with HPs of the GEJ were significantly younger in age (mean age, 55.9 y vs. 63.0 y; P=0.04). Pathologically, GEJ HPs showed a significantly higher rate of multilayered epithelium (P=0.06) and association with Barrett esophagus (BE) (P=0.0001) compared with distal gastric HPs. All BE-associated GEJ HPs were associated with either ultrashort (<1 cm) or short segment (1 to 3 cm) BE. All other pathologic variables, including intestinal metaplasia, were similar to those of distal gastric HPs. In a subanalysis, BE-associated GEJ HPs (33% of all GEJ HPs) showed a higher male to female ratio and a higher rate of intestinal metaplasia compared with all other HPs. Furthermore, none of the BE-associated GEJ HPs were associated with chronic active gastritis versus the non-BE-associated GEJ HPs, although this was not statistically significant. Only 1 HP (from the GEJ) from both the study and control groups was associated with a neoplasm (signet-ring cell carcinoma). On follow-up, 1 patient with a GEJ HP and 4 with distal gastric HPs developed recurrent HPs and none of the patients from either patient group developed dysplasia or carcinoma. In conclusion, unlike HPs of the gastric corpus or antrum, a significant proportion of HPs of the GEJ arise in association with BE and without gastric pathology. In patients with BE, the columnar-lined segment is often ultrashort, and thus, an HP may be the first clinical/endoscopic manifestation of that disorder.
胃体和胃窦的增生性（炎症性）息肉（HPs）通常与慢性胃炎相关。然而，对于胃食管交界处（GEJ）的 HPs 的病因、病理特征和自然史知之甚少。我们偶然注意到，GEJ HPs 经常发生在没有胃病理学的患者中。本研究旨在评估 GEJ HPs 患者的临床、病理和结局特征，并将数据与胃体或胃窦 HPs 的对照组进行比较。通过对一家主要三级保健医院的病理档案进行 5 年的搜索，确定了 134 个连续的 GEJ 息肉。其中，46 个（36%）来自 46 名患者的息肉符合 HPs 的病理标准，并构成了本研究的基础。对这 46 名研究患者及其息肉进行了广泛的临床、内镜和病理特征评估，包括随访内镜的结果。并将这些发现与同一 5 年期间从远端胃（胃窦或胃体）随机获得的 46 名患者的 46 个胃窦 HPs 进行了比较。与胃窦或胃体 HPs 患者相比，GEJ HPs 患者的年龄明显更年轻（平均年龄，55.9 岁 vs. 63.0 岁；P=0.04）。病理上，GEJ HPs 显示出更高的多层上皮（P=0.06）和与 Barrett 食管（BE）的关联（P=0.0001），与远端胃 HPs 相比。所有与 BE 相关的 GEJ HPs 均与超短（<1cm）或短段（1-3cm）BE 相关。所有其他病理变量，包括肠上皮化生，与远端胃 HPs 相似。在亚分析中，与所有其他 HPs 相比，与 BE 相关的 GEJ HPs（所有 GEJ HPs 的 33%）显示出更高的男性与女性比例和更高的肠上皮化生率。此外，与 BE 相关的 GEJ HPs 中没有一个与慢性活动性胃炎相关，而非 BE 相关的 GEJ HPs 虽然这没有统计学意义。只有来自研究组和对照组的 1 个 HP（来自 GEJ）与肿瘤（印戒细胞癌）相关。在随访期间，1 名 GEJ HP 患者和 4 名远端胃 HPs 患者出现复发性 HPs，两组患者均未出现发育不良或癌。总之，与胃体或胃窦 HPs 不同，相当一部分 GEJ HPs 与 BE 相关且无胃病理学表现。在 BE 患者中，柱状上皮线通常很短，因此，HP 可能是该疾病的首次临床/内镜表现。
