ИСТИНА

Objective: Gastric hyperplastic polyps (GHP) are detected during 1-6% of upper gastrointestinal endoscopies. Only a small percentage (< 2-3%) of GHPs, usually the larger ones (> 1-2 cm), show features of focal intraepithelial neoplasia (IEN) or cancer. Method: We describe the case of focal adenocarcinoma developed in GHP. Results: A 56-year-old man presented with abdominal pain. Endoscopic study detected large polyp of the antrum, 5,5х4,5х2,5 cm in size, with brown granular surface, lobular structure, pedunculated (Yamada type IV). Endoscopic polypectomy was impossible due to high risk of postoperative complications. Thus laparoscopic antrum resection of the stomach was performed. On histological examination the polyp was identified as GHP with focal high grade IEN of the surface epithelium and two independent focuses of well differentiated tubular adenocarcinoma: 3,5х3 mm and 4x2 mm. No signs of stalk invasion were detected. Immunohistochemical study revealed elevated expression of Claudin-3, Ki67 in cancer glands and nuclear expression of Claudin-3 in dysplastic glands. Strong expression of CDX-2 detected in adenocarcinoma and IEN confirmed intestinal type of differentiation. Expression levels of Claudin-1, Claudin-4 and β-catenin did not differ between adenocarcinoma and GHP-areas. Conclusion: The polyp was removed radically. There were no signs of progression or relapse 3 month later.