Orlowska J, Jarosz D, Pachlewski J, Butruk E
Department of Gastroenterology, Medical Center of Postgraduate Education, Warsaw, Poland.
Am J Gastroenterol. 1995 Dec;90(12):2152-9.
To compare the malignant potential of hyperplastic polyps and adenomas in relation to different histological classifications and to try to follow the natural history of the BEGP-carcinoma sequence.
During a 13-yr period (1981-1993), 811 BEGP were discovered in 432 patients in consecutive esophagogastroscopic examinations in our department. Adequate endoscopic biopsies or polypectomy specimens were histologically diagnosed as hyperplastic polyp in 751 (92.6%) and adenoma in 60 (7.4%) of the lesions, according to WHO classification. Hyperplastic lesions were further divided into two subgroups: 268 were polypoid foveolar hyperplasia (FH) and 483 were typical hyperplastic polyps (HP), according to Elster's classification. Special attention was paid to focal malignancy at the first examination or malignant transformation of BEGP during follow-up. Ninety-six patients with 220 BEGP were followed for 1-11 yr, with an average of 2 yr and 8 months.
According to Elster's classification, there were 10/483 (2.1%) HP and 6/60 (10.0%) adenomas with focal carcinoma. Moreover, in 19/265 patients (7.1%) with HP and in 4/30 patients (13.3%) with adenomas, carcinoma was found elsewhere in the stomach. During our follow-up, 5/131 HP showed different steps of histological transformation: focal intestinal metaplasia in two, focal dysplasia in one, and focal carcinoma in two of them, which is 1.6%, 0.8%, and 1.6%, respectively. In 1/23 adenomas, focal carcinoma developed after 1 yr of observation (4.3%). Separate gastric carcinomas developed outside polyps during follow-up in 2/58 (3.5%) patients with hyperplastic polyps only. None of those with FH had focal carcinoma either at primary biopsy or during long-term observation. All proportions concerning gradual transformation of hyperplastic polyps classified as only one group according to WHO were lower.
In contrast to hitherto existing opinions, our results give support to the idea that gastric HP, like adenomas, are susceptible to malignant transformation. It seems sensible to separate a subgroup of FH from HP, since FH have no malignant potential until they change their histology to HP. The treatment of FH and HP as one group is the main reason why the malignant potential of hyperplastic polyps is still underestimated.
比较增生性息肉和腺瘤的恶性潜能与不同组织学分类的关系，并试图追踪胃食管交界部息肉-癌序列的自然病程。
在13年期间（1981 - 1993年），我科连续进行的食管胃镜检查中，432例患者发现了811个胃食管交界部息肉。根据世界卫生组织分类，751个病变（92.6%）的充分内镜活检或息肉切除标本经组织学诊断为增生性息肉，60个病变（7.4%）为腺瘤。根据埃尔斯特分类，增生性病变进一步分为两个亚组：268个为息肉样小凹增生（FH），483个为典型增生性息肉（HP）。特别关注首次检查时的局灶性恶性病变或随访期间胃食管交界部息肉的恶变情况。96例患者的220个胃食管交界部息肉接受了1 - 11年的随访，平均为2年8个月。
根据埃尔斯特分类，483个HP中有10个（2.1%）、60个腺瘤中有6个（10.0%）存在局灶性癌。此外，483例HP患者中有19例（7.1%）、30例腺瘤患者中有4例（13.3%）在胃的其他部位发现癌。在我们的随访中，131个HP中有5个出现了不同阶段的组织学转变：2个出现局灶性肠化生，1个出现局灶性发育异常，其中2个出现局灶性癌，分别占1.6%、0.8%和1.6%。23个腺瘤中有1个在观察1年后出现局灶性癌（4.3%）。仅增生性息肉患者中，2/58（3.5%）在随访期间息肉外发生了独立的胃癌。FH患者在初次活检时或长期观察中均无局灶性癌。根据世界卫生组织分类归为一组的增生性息肉逐渐转变的所有比例均较低。
与迄今已有的观点相反，我们的结果支持这样一种观点，即胃HP与腺瘤一样，易于发生恶变。将FH亚组与HP区分开来似乎是合理的，因为FH在组织学转变为HP之前没有恶变潜能。将FH和HP视为一组进行治疗是增生性息肉恶变潜能仍被低估的主要原因。
