Gastric hamartomatous inverted polyp:A clinicopathological analysis and review of literature

CHEN Weihua; LIU Xia

doi:10.3969/j.issn.1007-8096.2025.11.1468

Abstract：Objective To investigate the diagnostic criteria and differential diagnosis of gastric hamartomatous inverted polyp(GHIP)and to conduct a literature review.Methods The clinical data and pathological specimens of three patients with GHIP from the Second Affiliated Hospital of Xuzhou Medical University and the First People's Hospital of Xuzhou from 2019 to 2024 were collected,and HE and immunohistochemical sections were prepared,and morphological observation and analysis were performed.Results There were 2 females and 1 male,and the age of onset was 52～63 years(mean 57 years).The site was located in the gastric body in 2 cases,the fundus in 1 case;the pedunculated polypoid bulge in 1 case under endoscope,juvenile polypoid manifestation in 1 case,and the bulge(mass)of the sessile submucosal mass in 1 case.The pathological features under light microscope were mainly lesions located in the submucosa,the surface was covered with normal gastric mucosa,lobulated/clustered gastric glandular epithelium(fundus gland,pyloric gland,foveolar epithelium)could be seen in the submucosa;some glands were significantly cystic dilated,some glands were disorderly distributed,lacking normal gastric gland differentiation,but cells were not atypical,lobulated/clusters of hyperplastic glands were surrounded by smooth muscle tissue with varying degrees of hyperplasia,disordered arrangement,and inverted growth to the submucosa.Immunohistochemistry showed that the glands expressed MUC5AC,MUC6,pepsinogen I,H/K ATPaseβ and smooth muscle markers were positive.Conclusion GHIP is a rare gastric polyposis lesion with a special morphology of hyperplastic mucosal inversion to submucosa,which is easy to cause misdiagnosis or overdiagnosis by clinicians and pathologists due to its extremely low incidence.It should be pathologically distinguished from gastritis cystica profunda(GCP),juvenile polyps,Peutz-Jeghers polyps,gastric adenomyomas,and gastric well-differentiated tubular adenocarcinoma.