BRAF Mutation Is Associated with Hyperplastic Polyp-Associated Gastric Cancer

Gastric hyperplastic polyps (GHP) are frequently found to be benign polyps and have been considered to have a low carcinogenic potential. The characteristics of the hyperplastic polyp-associated gastric cancer (HPAGC) remain unclear. Therefore, we analyzed samples from 102 GHP patients and identified 20 low-grade atypical GHPs (19.6%), 7 high-grade atypical GHPs (6.9%), and 5 intramucosal cancer samples (4.9%). GHP atypia was more common in the elderly and increased with increasing polyp size. In particular, polyps larger than 1 cm were associated with a higher grade and cancer. Furthermore, mucus production decreased with increasing atypia. Although no correlation was found between atypia and Helicobacter pylori infection or intestinal metaplasia, enhanced proliferative ability (Ki-67) did correlate with atypia, as did nuclear 8-hydroxy-2’-deoxyguanosine levels. Interestingly, 4-hydroxynonenal levels in granulation tissue and the area ratio of granulation tissue within polyps also correlated with GHP atypia. In five cases of HPAGC, three cases exhibited caudal type homeobox transcription factor (CDX2)-positive cells and a mixed mucin phenotype, which is considered to be related to H. pylori infection. By contrast, two cases were CDX2 negative, with a gastric mucin phenotype, and H. pylori infection was not observed in the tumor or the surrounding mucosa. In these cases, a v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation (V600E) was detected. All cancer samples showed high stemness and p53 protein accumulation, but no KRAS mutations. The molecular and phenotypic characteristics of the cases characterized by BRAF mutations may represent a novel subtype of HPAGC, reflecting a conserved pathway to oncogenesis that does not involve H. pylori infection. These findings are worthy of further investigation in a large-scale study with a substantial cohort of HPAGC patients to establish their clinical significance.

A case of osseous metaplasia in a gastric hyperplastic polyp: An unexpected finding in a common polyp

Introduction/Objective Foveolar hyperplastic polyp is a common gastric polyp characterized by foveolar hyperplasia with erosion, acute and chronic inflammation, granulation tissue formation, and smooth muscle strands extending from the muscularis mucosae. Although foveolar hyperplastic polyps may rarely contain foci of dysplasia or invasive carcinoma, osseous metaplasia/heterotopic bone formation in foveolar hyperplastic polyps of the stomach is extremely rare with a few case reports. Methods/Case Report A 63-year-old female with a history of hypertension, sick sinus syndrome, and Hashimoto’s thyroiditis was referred to our facility for evaluation of a mass in segment eight of the liver. The liver biopsy showed a moderately differentiated adenocarcinoma, most consistent with intrahepatic cholangiocarcinoma. A screening gastrointestinal endoscopy revealed a 7-mm sessile polyp in the antrum. The polyp was removed with a cold snare. No other abnormalities were identified in the stomach. Sections of the polyp showed fragments of antral-type gastric mucosa with foveolar hyperplasia, erosion, acute and chronic inflammation, and focal granulation tissue formation. In addition, multiple foci of woven bone formation without bone marrow surrounding dilated gastric foveolae were identified. No Helicobacter infection, intestinal metaplasia, dysplasia or malignancy was identified histologically. Osseous metaplasia/heterotopic bone formation is a well-known finding reported in various neoplastic and non- neoplastic conditions. However, osseous metaplasia in foveolar hyperplastic polyps of the stomach is extremely rare. There have been only four previous case reports published in English language. Our current case shows clinicopathologic features similar to those of the previous case reports including the findings of small-sized polyp found incidentally in middle-aged patients with no clinical history of hypercalcemia or any other abnormalities causing heterotopic bone formation. Results (if a Case Study enter NA) N/A Conclusion Although the pathogenesis of osseous metaplasia in a gastric hyperplastic polyp remains unknown, the finding of osseous metaplasia in a gastric hyperplastic polyp is very intriguing.

Changes of Gastric Juice Microenvironment in Patients with Fundic Gland Polyp and Hyperplastic Polyp

<b><i>Introduction:</i></b> The aim of this study was to study the relationship between the formation of gastric fundic gland polyp and gastric hyperplastic polyp (HP) and the changes of gastric juice microenvironment. <b><i>Methods:</i></b> The proton-pump inhibitor (PPI) applications to patients were recorded. Gastric juices and biopsy polyps were collected for pathological examination, <i>H. pylori</i> tests, biomarkers, and <i>MUC1</i>, <i>MUC2</i>, <i>MUC5AC expression</i> measurement. <b><i>Results:</i></b> Among 34,892 patients, the detection rate of gastric fundic gland polyps was significantly higher than that of gastric HPs (<i>p</i> &#x3c; 0.01). The incidence rate of gastric fundic gland polyp and gastric HP in PPI users (<i>n</i> = 3,886) was higher than that of non-PPI users (<i>p</i> &#x3c; 0.01). The occurrence of polyp was positively related to the duration of PPI application and the <i>H. pylori</i>-positive rate. The bile reflux rate between fundic gland polys group (17.61%) and HPs (28.67%) was significantly different (<i>p</i> &#x3c; 0.01). The levels of gastric juice Gastrin-17, epidermal growth factor (EGF) and MUC₂ from patients with gastric fundic gland polyps and gastric HPs were higher than those in the control group (<i>p</i> &#x3c; 0.01). However, patients with gastric fundic gland polyps and HPs had significantly lower gastric juice PGE₂ and MUC5AC (<i>p</i> &#x3c; 0.01). <b><i>Conclusion:</i></b> PPI application, <i>H. pylori</i> infection, and bile reflux are the potential risk factors for formation of fundic gland polyps and HPs. The potential mechanism of polyps’ formation can be related to the levels of Gastrin-17, EGF, MUC₂, PGE₂, and MUC5AC in gastric juice.

BİR EĞİTİM ARAŞTIRMA HASTANESİNDE ALT GASTROİNTESTİNAL SİSTEM BULGULARININ DEĞERLENDİRİLMESİ

Patients with complaints about colorectal region refer to general surgery, gastroenterology and other outpatient clinics with an increasing frequency. Rectal bleeding, abdominal pain, unexplained anemia, changes in bowel habit, occult blood positivity in stool can be a sign of serious colon disease. In this study, patients under the age of 65 who underwent AGIS endoscopy in the endoscopy unit of the Research and Application Hospital in Central Anatolia Region between 2015 and 2018 were examined. The data were reviewed retrospectively. 214 patients under the age of 65 were included in the study. Colitis in 37 (17.29%), hyperplastic polyp in 38 (17.76%), tubular adenoma in 86 (40.19%), tubular adenoma in 40 (18.69%), Adenocarcinoma was detected in 13 (6.7%) of results. Tubular adenoma, tubulovillose adenoma and adenocarcinomas were more common at the age of fifties, with colitis and hyperplastic polyps detected in the mean age of forties. Adenocarcinomas were found to be more common in female sex, unlike other results. Lower gis endoscopy has an important place in the diagnosis and treatment of colorectal cancer. In our study, in which the results of AGIS endoscopy were examined, tubular adenoma was high in individuals under 65 years of age. Keywords: Tubulovillous Adenoma, Colitis, Hyperplastic Polyp