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ADENOCARCINOMA ARISING IN HYPERPLASTIC POLYPS OF THE GE JUNCTION
MP Dupré1, RF Perini2, C Nash2, SJ Urbanski1
1Department of Pathology and Lab Medicine, University of Calgary and Calgary lab Services; 2Department of Medicine, Division of Gastroenterology, University of Calgary
BACKGROUND: Hyperplastic polyps of the gastroesophageal junction (GEJ) are rare benign neoplasms, accounting for less than 1% of esophageal epithelial tumors. They are believed to arise secondary to gastroesophageal reflux and have been described to occur in association with Barrett’s esophagus. Based on a single previous report which demonstrated low-grade dysplasia in only 1 of 30 polyps, the conclusion was that these polyps are benign and are of limited clinical significance. This has led some to believe they are purely inflammatory in nature. Since then, two additional examples of low-grade dysplasia in hyperplastic polyps of GEJ have been published. High-grade dysplasia and adenocarcinoma have not been reported to arise in hyperplastic polyps of the GEJ.
Case reports: We report two cases of hyperplastic polyps of the GEJ which harboured high-grade dysplasia and intramucosal carcinoma. Both cases were identified endoscopically as benign GEJ polyps in adults undergoing upper endoscopy for reflux symptoms. Barrett’s esophagus was not identified endoscopically in either case. The lesions were staged with endoscopic ultrasound and resection was managed by endoscopic mucosal resection using the Duette kit. Photodynamic therapy will be performed to ensure complete ablation of the lesions. Clinical and pathologic findings of these cases and current literature are reviewed.
CONCLUSION: These cases demonstrate that hyperplastic polyps of the GEJ may contain foci of high-grade dysplasia and even adenocarcinoma. Clinicians should be aware of this association These polyps should be adequately biopsied and endoscopic resection techniques considered to completely remove these lesions.