, Sun Hee Sung, Hea Soo Koo, Woon Sup Han, Ok Kyong Kim Gastric polyp is histologically very diverse and its classification is still unsettled. The purpose of the article is to classify the endoscopically diagnosed polypoid lesions and to evaluate their malignant potential.
A retrospective study was done on 142 cases of endoscopically diagnosed gastric polypoid lesions from September 1993 to May 1996. We investigated their clinical findings, histopathology, and nuclear gradings of PCNA by immunohistochemistry.
1) The mean age is 57.9 and sex ratio os 0.8:1
2) The most prevalent location is antrum(57.7%).
3) Morphologically, Yamada type II is the most frequent(35.9%).
4) Histologically, lesions are classified as true polyps and reactive lesions. True polyps are subclassified as hyperplastic polyp(61.2%), adenomatous polyp(19.4%), mixed adenomatous and hyperplastic polyp(10.2%), fundic gland polyp(2.0%), and adenocarcinoma(7.1%). Reactive lesions are subclassified as chronic superficial gastritis(68.2%), mucosal hyperplasia(15.9%), edema of lamina propria(9.1%), xanthoma(4.5%), and ectopic pancreas(2.3%).
5) Atypical changes is accompanied in 12 cases(20%) of hyperplastic polyps.
6) Adenocarcinoma arising from adenomatous polyp is noted in 6 cases. In hyperplastic polyp one case is combined with adenocarcinoma.
7) Among the true polyps single lesions are 127 cases(89.4%), and multiple lesions, 15 cases(10.6%)
8) Immunohistochemical staining for proliferating cell nuclear antigen(PCNA) reveals that hyperplastic polyps show focal positive rection in the area of pit and fundus, and adenomatous polyps show diffuse positive reaction. Dysplastic foci in both adenomatous and hyperplastic polyps shows diffuse positive reaction of PCNA.
Endoscopically diagnosed polypoid lesions show variable histologic findings ranging from chronic superficial gastritis to adenocarcinoma. They are mainly subclassified as histologically true polyps and reactive lesions. Some of true polyps have atypical changes of varing dgree in not only adenomatous polyps but also hyperplastic polyps.
Endometrial hyperplasia(EH) and endometrial carcinoma(EC) very in their biologic potential, which may be correlated with the histologic grade. Evaluation of cellular kinetics, which may prove to be another measure of predicting biologic behavior. Accessments of AgNORs and PCNA(proliferative cell nuclear antigen) indeces in 33 cases of EH including 16 cases of simple hyperplasia(SH), 8 of complex hyperplasia(CH), and 9 of atypical hyperplasia(AH), and 28 of EC including 7 of grade I, 12 of grade II, and 6 of grade III were performed. The results were as follows :I, 12 of grade II, and 6 of grade III were performed. The results were as follows : 1. AgNOR counts per glandular cells(Mean SD) were 2.7±0.2 in normal proliferative and 2.3±0.2 in secretory endometrium, and increased to 3.2±0.3 in SH, 3.5±0.3 in CH, to 5.4±0.4 in AH, and finally 6.9±0.5 in endometrioid carcinoma(grade I: 5.8±0.7, grade II: 6.7±0.6, grade III: 8.4±0.9). 2. PCNA indeces(percentages of nuclear positive cells of total cells of glands) were 16±14.2 in normal proliferative endometrium and 12±8.1 in secretory endometrium, and increased to 18.4±14.7 in SH, 21.6±17.8 in CH, 36.4±27.4 in AH, and finally 42.1±31.3 in EC(grade I: 38.3±23.2,grade II: 39.4±25.4, and grade III: 58.4±35.3). 3. DNA aneuploidy was detected in 4 cases of EC(40%), and tended to be more frequently found in poorer histologic grade. This data suggest that cell kinetic evaluation of EH and EC using AgNORs and PCNA is well correlated with histologic grade. And with the aspect of biologic potential, AH could be regarded as well differentiated EC.
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