Stomach adenoma
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Stomach adenoma, also gastric adenoma, is a precursor to adenocarcinoma of the stomach.
Gastric columnar dysplasia and tubular adenoma of the stomach direct here.
General
- Lesions that protrude into the lumen and are macroscopically apparent are known as: adenomas.[1]
- Polypoid forms are grouped various ways.[2]
Grading
Like in the colon - they are divided into:
- Low grade.
- High grade.
Subclassification
One subclassification:[3]
- Intestinal: goblet cells or Paneth cells.
- Not associated with FAP.
- Gastric: foveolar epithelium.
- Associated with familial adenomatous polyposis (FAP).
Microscopic
- Histologic criteria similar to columnar dysplasia in the esophagus.
- The threshold is much lower than in the colon and rectum.
Foveolar type
Features:
- Hyperchromasia at the surface - key feature.
- Cytoplasm with (shortened) champagne flute-like luminal aspect (apical mucin caps).
- Nuclear changes:
- Hyperchromasia.
- Enlargement.
- No intestinal metaplasia.
DDx:
Intestinal type
Features - intestinal:
- Intestinal metaplasia.
- Hyperchromasia of cytoplasm.
- Nuclear changes:
- Loss of nuclear polarity.
- Increased NC ratio.
- Elongation of nucleus and pseudostratification.
DDx:
Images
Gastric adenoma. (WC/KGH)
Gastric adenoma. (WC/KGH)
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www:
- Gastric polyps - several images (sciencedirect.com).
- Gastric polyps - several images (achivesofpathology.org).
Grading
Low-grade gastric dysplasia
Features:
- Nuclear changes:
- Nuclear crowding/pseudostratification with hyperchromasia.
- Elongation of nuclei (cigar-shaped nuclei).
- Nuclear stratification intact; nuclei close to the basement membrane.
- Architecture:
- Focal irregularities in the glandular contours.
Negatives:
- No desmoplasia.
- No necrosis.
- No surface maturation.
DDx:
- Indefinite for dysplasia.
- High-grade gastric columnar dysplasia - see below.
- The threshold is much lower than in the colon and rectum!
Images:
- Low-grade gastric columnar dysplasia - several images (upmc.edu).
- Gastric low-grade dysplasia (nih.gov).[4]
High-grade gastric dysplasia
Features:
- Nuclear changes:
- Round hyperchromatic nuclei.
- Loss of normal nuclear stratification.
- Architecture:
- Irregularities in the glandular contours.
- Back-to-back glands.
- +/-Cribriforming of the glands.
- +/-Necrosis.
Negatives:
- No desmoplasia.
DDx:
- Low-grade gastric columnar dysplasia.
- Gastric adenocarcinoma.
Images
High grade gastric dysplasia - low mag. (WC/Nephron)
High grade gastric dysplasia - very high mag. (WC/Nephron)
www:
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Indefinite for dypslasia
STOMACH, ANTRUM, BIOPSIES: - ANTRAL-TYPE MUCOSA INDEFINITE FOR DYSPLASIA WITH MODERATE CHRONIC INFLAMMATION. - EXTENSIVE INTESTINAL METAPLASIA. - NEGATIVE FOR HELICOBACTER-LIKE ORGANSIMS. - NEGATIVE FOR MALIGNANCY.
Intestinal type
STOMACH, ANTRUM, BIOPSIES: - ANTRAL-TYPE MUCOSA WITH FOCUS OF LOW-GRADE DYSPLASIA (INTESTINAL TYPE). - EXTENSIVE INTESTINAL METAPLASIA. - MODERATE CHRONIC INFLAMMATION. - NEGATIVE FOR HELICOBACTER-LIKE ORGANSIMS. - NEGATIVE FOR MALIGNANCY.
Foveolar type
STOMACH POLYP, EXCISION: - ADENOMATOUS POLYP, FOVEOLAR TYPE. - NEGATIVE FOR HIGH-GRADE DYSPLASIA. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
Foveolar type with high-grade dysplasia
STOMACH POLYP, EXCISION: - LARGE ADENOMATOUS POLYP (FOVEOLAR TYPE) WITH HIGH-GRADE DYSPLASIA. - NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Rugge, M.; Correa, P.; Dixon, MF.; Hattori, T.; Leandro, G.; Lewin, K.; Riddell, RH.; Sipponen, P. et al. (Feb 2000). "Gastric dysplasia: the Padova international classification.". Am J Surg Pathol 24 (2): 167-76. PMID 10680883.
- ↑ Park, do Y.; Lauwers, GY. (Apr 2008). "Gastric polyps: classification and management.". Arch Pathol Lab Med 132 (4): 633-40. doi:10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2. PMID 18384215. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132%5B633:GPCAM%5D2.0.CO;2.
- ↑ URL: http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html. Accessed on: 18 December 2012.
- ↑ 4.0 4.1 Kushima, R.; Kim, KM. (Sep 2011). "Interobserver Variation in the Diagnosis of Gastric Epithelial Dysplasia and Carcinoma between Two Pathologists in Japan and Korea.". J Gastric Cancer 11 (3): 141-5. doi:10.5230/jgc.2011.11.3.141. PMID 22076218.
- ↑ Correa, P.; Piazuelo, MB. (Jan 2012). "The gastric precancerous cascade.". J Dig Dis 13 (1): 2-9. doi:10.1111/j.1751-2980.2011.00550.x. PMID 22188910.