title: A white opaque substance-positive gastric hyperplastic polyp with dysplasia.
abstract: The endoscopic findings of gastric hyperplastic polyps (HPs) with dysplasia have not been well-defined, and the clinical significance of these lesions, including their malignant potential, is unclear. In this report, we describe a case of a white opaque substance (WOS)-positive gastric HP with dysplasia. A 76-year-old woman 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. The whitish part was diagnosed as a WOS using conventional and magnifying endoscopy with narrow band imaging. An examination of the biopsy specimen indicated that the lesion was a typical gastric HP. However, because of its color and the presence of a WOS, we suspected that this lesion was an atypical gastric HP. Therefore, we performed a polypectomy. Histopathologically, diffuse low- to high-grade dysplasia was found on the surface of the polyp. We performed immunohistochemical staining using a monoclonal antibody specific for adipophilin as a marker of lipid droplets (LDs). LDs were detected in approximately all of the neoplastic cells, especially in the surface epithelium of the intervening apical parts and were located in the subnuclear cytoplasm of the neoplastic cells. According to endoscopic and histopathological findings, the WOS-positive epithelium indicated dysplasia of the gastrointestinal phenotype, which could absorb lipids. The presence of a WOS in a gastric HP may be considered an endoscopic finding that is predictive of the neoplastic transformation of a gastric HP. We suggest that a WOS-positive gastric HP should be resected endoscopically to investigate its neoplastic transformation.
authors.affiliation: Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan. psyro@juntendo.ac.jp
authors.forename: Hiroya
authors.initials: H
authors.lastname: Ueyama
authors.forename: Kenshi
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Akihito
authors.initials: A
authors.lastname: Nagahara
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Gushima
authors.forename: Takuo
authors.initials: T
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Yao
authors.forename: Sumio
authors.initials: S
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D005773:Gastroscopy; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D008055:Lipids / Q000032:analysis; D008565:Membrane Proteins / Q000032:analysis; D062048:Narrow Band Imaging; D000070780:Perilipin-2; D011127:Polyps / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D013272:Stomach Diseases / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D008055:Lipids; D008565:Membrane Proteins; C000602982:PLIN2 protein, human; D000070780:Perilipin-2
keywords: Adipophilin; Gastric hyperplastic polyp with dysplasia; Lipid droplet; Narrow band imaging; White opaque substance