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Abstract：
BACKGROUND: Gastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP.
METHODS: We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection.
RESULTS: GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective.
CONCLUSIONS: GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.
METHODS: We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection.
RESULTS: GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective.
CONCLUSIONS: GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.
摘要：
背景：胃错构瘤性倒置息肉（GHIP）没有很好的特征，并且由于罕见而在诊断上仍然具有挑战性。因此,本研究旨在探讨GHIP患者的临床病理和内镜特点。
方法：回顾性分析北京友谊医院2013年3月至2022年7月收治的10例GHIP患者的临床病理及内镜特点。所有患者均经内镜切除成功。
结果：GHIP通常无症状，在胃镜检查中偶然发现。它们可能是无柄的或有花梗的，有弥漫性或局部表面发红或侵蚀。在内窥镜超声检查中，无柄粘膜下肿瘤型GHIP表现出异质性病变，在胃壁的第三层具有囊性区域。组织学上,GHIP的特征是膀胱扩张的增生性胃腺的粘膜下倒置增生，并伴有平滑肌束的分支增生。在基质中观察到炎症细胞浸润，而只有一名患者并发腺体低度发育不良。对周围粘膜的评估表明，有6例患者（60％）患有萎缩性胃炎或幽门螺杆菌相关性胃炎，4例患者（40％）患有非特异性胃炎。内镜下切除是安全有效的。
结论：GHIP通常来自异常粘膜的背景，如萎缩性或幽门螺杆菌相关性胃炎。我们假设获得性炎症可能导致GHIP的发展。我们建议对背景粘膜和幽门螺杆菌感染状态进行全面评估，以评估潜在的胃粘膜异常，这可能是胃的肿瘤前状态。
方法：回顾性分析北京友谊医院2013年3月至2022年7月收治的10例GHIP患者的临床病理及内镜特点。所有患者均经内镜切除成功。
结果：GHIP通常无症状，在胃镜检查中偶然发现。它们可能是无柄的或有花梗的，有弥漫性或局部表面发红或侵蚀。在内窥镜超声检查中，无柄粘膜下肿瘤型GHIP表现出异质性病变，在胃壁的第三层具有囊性区域。组织学上,GHIP的特征是膀胱扩张的增生性胃腺的粘膜下倒置增生，并伴有平滑肌束的分支增生。在基质中观察到炎症细胞浸润，而只有一名患者并发腺体低度发育不良。对周围粘膜的评估表明，有6例患者（60％）患有萎缩性胃炎或幽门螺杆菌相关性胃炎，4例患者（40％）患有非特异性胃炎。内镜下切除是安全有效的。
结论：GHIP通常来自异常粘膜的背景，如萎缩性或幽门螺杆菌相关性胃炎。我们假设获得性炎症可能导致GHIP的发展。我们建议对背景粘膜和幽门螺杆菌感染状态进行全面评估，以评估潜在的胃粘膜异常，这可能是胃的肿瘤前状态。
