A White Opaque Substance-positive Gastric Hyperplastic Polyp with Dysplasia Hiroya Ueyama 1 , Takashi Yao 2 , Kenshi Matsumoto 1 , Atsushi Ikeda 1 , Noboru Yatagai 1 , Hiroyuki Komori 1 , Yoichi Akazawa 1 , Tsutomu Takeda 1 , Kohei Matsumoto 1 , Takuo Hayashi 2 , Mariko Hojo 1 , Akihito Nagahara 1 1Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo 2Department of Human Pathology, Juntendo University, School of Medicine, Tokyo Keyword: 胃過形成性ポリープ , 癌化 , WOS , NBI , 腸型 pp.1522-1528
Published Date 2018/10/25
DOI https://doi.org/10.11477/mf.1403201503
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 To date, the endoscopic findings of gastric HPs(hyperplastic polyps)with dysplasia remain partially defined, and, thus, the clinical significance of these lesions, including their malignant potential, remains unclear. This report aims to describe a case of a WOS(white opaque substance)-positive gastric HP with dysplasia. A 76-year-old female was referred to our hospital for endoscopic resection of a gastric HP. Upper endoscopy revealed a 25-mm whitish and reddish polypoid lesion on the greater curvature in the lower third of the stomach. Conventional and magnifying endoscopy with narrow band imaging diagnosed the whitish part as a WOS. The assessment of the biopsy specimen revealed that the lesion was a typical gastric HP. However, we suspected that the lesion an atypical gastric HP because of its color and the presence of a WOS. Thus, we performed a polypectomy. Histopathologically, diffuse low- to high-grade dysplasia was observed on the surface of the polyp. Accordingly, we performed immunohistochemical staining using a monoclonal antibody specific for adipophilin as a marker of LDs(lipid droplets). LDs were detected in approximately all neoplastic cells, especially in the surface epithelium of intervening apical parts and were located in the subnuclear cytoplasm of neoplastic cells. Based on endoscopic and histopathological findings, the WOS-positive epithelium suggested dysplasia of the gastrointestinal phenotype, which could absorb lipids. In addition, the presence of a WOS in a gastric HP could be considered an endoscopic finding predictive of the neoplastic transformation of a gastric HP. This report suggests that a WOS-positive gastric HP should be resected endoscopically to assess its neoplastic transformation.

〔World J Gastroenterol 19:4262-4266, 2013〕

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