Diagnosis

A confident diagnosis cannot be made from endoscopic findings alone. While it is often possible to make a diagnosis without histological evaluation, a biopsy should always be obtained if there is any doubt.

Polyps can be classified more accurately than intramural masses by their morphology, location, size, and number (see Checklist for endoscopic evaluation, p. 106).

Differential diagnosis of polyps and polypoid lesions based on morphological criteria

► Mucosa intact

- Small hyperplastic polyp (Fig. 3.94)

- Small adenoma

► Mucosa altered, fragile, fissured

- Adenoma

- Carcinoma

- Large hyperplastic polyp

► Glassy, glistening mucosa

- Elster glandular cyst

► Hemispherical with depressed center

- Focal hyperplasia

- Chronic erosion

- Hyperplastic polyp with central erosion

- Early carcinoma

- Lymphoma

- Heterotopic pancreatic tissue

- Crohn disease

- Metastases

Differential Diagnosis of Polyps Based on their Location

Polyp location as a criterion for differential diagnosis

Cardia and prepyloric antrum - Adenoma (less common at other sites)

Cardia and prepyloric antrum - Adenoma (less common at other sites)

Body

- Elster glandular cysts (almost always in the body, rarely in the fundus)

- Hyperplastic polyp

Fig. 3.95 Polyp location as a criterion for differential diagnosis

Fig. 3.96 Chronic erosions in the gastric antrum

Body

- Elster glandular cysts (almost always in the body, rarely in the fundus)

- Hyperplastic polyp

Antrum

- Hyperplastic polyp

- Focal hyperplasia and chronic erosion (Fig. 3.96)

- Heterotopic Brunner glands

- Heterotopic pancreatic tissue (only in the antrum)

Fig. 3.95 Polyp location as a criterion for differential diagnosis

Fig. 3.97 Elster glandular cysts in the gastric body

Differential Diagnosis of Polyps Based on their Size (Table 3.18)

Table 3.18 Polyp size as a criterion for differential diagnosis

Always < 1 cm

Usually < 1 cm

Focal hyperplasia

Chronic erosion

Elster glandular cyst

Ectopic Brunner glands

Often > 1 cm

Very often > 1cm

Carcinoid Hyperplastic polyp

Ectopic pancreatic tissue Adenoma

Hyperplastic polyp Peutz-Jeghers polyp

Carcinoid Hyperplastic polyp

Ectopic pancreatic tissue Adenoma

Hyperplastic polyp Peutz-Jeghers polyp

Differential Diagnosis of Polyps Based on their Number

► Almost always solitary

- Adenoma

► Rarely multiple

- Heterotopic Brunner glands

- Heterotopic pancreatic tissue

- Carcinoid

► Frequently multiple

- Hyperplastic polyp

► Almost always multiple

- Elster glandular cysts (Fig. 3.97)

- Focal hyperplasia

- Chronic erosions (Fig. 3.96)

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