Polypoid Lesions Focal Hyperplasia and Chronic Erosions

■ Focal Hyperplasia

Focal hyperplasias are a pathogenetically diverse group of polypoid mucosal changes that many authors do not classify as polyps (Fig. 3.100). They are found in association with chronic erosions, scars, and anastomoses. They are not considered a precursor of gastric cancer. H. pylori-associated gastritis is usually present.

■ Chronic Erosions

Chronic erosions are usually found in the antrum and less commonly in the gastric body. Reportedly, they can persist for months without change. Occasionally they are found in association with other morphological signs of gastritis but may also occur in asymptomatic patients with otherwise normal gastric mucosa. The endoscopic appearance is very typical.

Endoscopic diagnostic criteria (Fig. 3.100)

► Predominantly in the antrum

► "String of beads" configuration

► Central depression

Differential diagnosis

► Chronic erosions

Checklist for endoscopic evaluation

Additional Studies

Endoscopic diagnostic criteria (Fig. 3.101)

► Size: 5-10 mm; circumscribed, resemble sessile polyps

► Central depression, usually fibrin-coated, rarely with traces of hematin

► Inflammatory border, thickened gastric folds in some cases

► Single, multiple, or numerous

► Occasional "string of beads" arrangement tracking toward the pylorus: "varioliform gastritis"

Differential diagnosis

► Specific lesions

- Eroded polyps

- Metastases

- Lymphoma

- Ectopic pancreatic tissue

- Early gastric carcinoma

- Crohn disease

Fig. 3.100 Focal hyperplasia. Polypoid outgrowth of mucosa in gastritis

Checklist for endoscopic evaluation

Additional Studies

► Unnecessary in most cases

► Biopsy if doubt exists

Fig. 3.101 Chronic erosions a Chronic erosions in the antrum

b "String of beads" erosions directed toward the pylorus

c Chronic erosion

Fig. 3.101 Chronic erosions a Chronic erosions in the antrum b "String of beads" erosions directed toward the pylorus c Chronic erosion

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