Hyperplastic polyps of the esophagus and esophagogastric junction - Histologic and clinicopathologic findings

Hyperplastic polyps of the esophagus and esophagogastric junction region (E GJ) are uncommon lesions characterized by hyperplastic epithelium (foveolar -type, squamous, or both) with variable amounts of inflamed stroma. They ha ve been reported almost exclusively in the radiologic and clinical literatu re as occurring predominantly in association with gastroesophageal reflux d isease (GERD). Comprehensive histologic and clinicopathologic evaluation of these polyps, their association with background mucosal pathology, and the ir association with Barrett's esophagus has not been previously performed. We studied 30 hyperplastic polyps from 27 patients and characterized the hi stologic, endoscopic, and clinical features of both the polyps and the back ground esophagus. Hyperplastic polyps were most common in the region of the EGJ (67%), followed by the distal esophagus (30%) and mid-esophagus (3%). Most (80%) were composed of predominantly cardiac-type mucosa, predominantl y squamous mucosa (17%), or an admixture (3%). Intestinal metaplasia of the polyp was present in only 7% and low-grade dysplasia in only 3%. In the ma jority of cases (67%) hyperplastic polyps were associated with concurrent o r recent ulcers or erosive esophagitis. In most cases (48%) esophageal inju ry was associated with GERD, but other potential etiologies included medica tions, infection, anastomotic or polypectomy sites, vomiting, and photodyna mic therapy. Four patients (15%) had Barrett's esophagus, three of whom had or developed dysplastic Barrett's mucosa. These results underscore the pat hogenesis of esophageal/EGJ region hyperplastic polyps as a mucosal regener ative response to surrounding mucosal injury. Careful clinical history and biopsy of the nonpolypoid mucosa are essential for determining the clinicop athologic context in which the polyps have developed.