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The Korean Journal of Pathology 1984;18(4): 382-397.
위장관 용종에 관한 병리조직학적 연구
Histopathological Study of the Gastrointestinal Polyps
ABSTRACT
The present study is aimed to evaluate the relationship be tween the histologic type and malignant potential of gastrointestinal polyps. The material consists of polyps obtained from 256 patients and examined at the Department of Pathology, Yonsei University College of Medicine from January, 1968 through December, 1982. After the classification of polyps by the histologic type, age and sex of the patients, size and shape of polyps, site, clinical symptoms, and dysplastic change were reviewed. Special stains such as periodic acid-Schiff, alcian blue pH 2.5 and 1.0, and Spicer's high iron b diamine method were applied for the demonstration of the amount and the character of mucin. Results obtained were as follows: 1) The cases consist of 46 gastric polyps and 211 colonic polyps. Terminal ileum was involved by a case of familial multiple polyposis. The multiplicity rate was 4.84. The hyperplastic polyp was the predominant histologic type among gastric polyps and the retention polyps. Seven cases of familial multiple polyposis and two cases of Peutz-Jeghers syndrome were observed. 2) The overall male to female ratio was 1.39 : 1. The hyperplastic polyp was distributed evenly from the 3rd decade of life. The tubular adenoma was predominant in the 5th and 6th decades, the villous adenoma in older age than the tubular adenoma, the retention polyp in the 1st decade, and the familial multiple polyposis in the 4th decade. 3) The size of polyps was than 1.5㎝ in diameter in most of the hyperplastic polyps. Otherwise the tubular and the villous adnomas had significant number of larger size. The retention polyps were variable in their size. 4) By Yamada's criteria of gross type the hyperplastic polyp and the tubular adenoma belonged to the type III, the villous adenoma type I, and the retention polyp type IV. 5) The large majority of gastric polyps arose in the antrum with the highest incidence in hyperplastic polyps. The large majority of colonic polyps arose in the rectum and sigmoid with the highest incidence in villous adenomas at rectum. 6) The patients with gastric polyps complained of epigastric pain or discomfort and the patients with colonic polyps, rectal bleeding. The average duration was within 6 months. 7) Fifteen cases of polyps were associated with carcinoma, which consisted of 14 adenocarcinomas and 1 epidermoid carcinoma. 8) About 30% of gastric and colonic polyps showed dysplastic change. The histologic types such as the tubular adenoma, villous adenoma, and familial multiple polyposis only showed dysplasia, which is milder in tubular adeonma and more severe in villous adenoma. Highest incidence of malignant change was associated with polyps of Yamada type I. 9) Special stains showed normal mucosal mucous pattern in the hyperplastic and retention polyps. The number of goblet cells and the amount of mucus were slightly decreased in the tubular and villous adenomas and markedly decreased in polyps with dysplasia, i.e.; gastric polyps showed decrease in neutral mucin and colonic polyps decrease in sulfomucin. And these were directly related to the degree of dysplasia.