Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach

Abstract

Background/Aims:While the occurrence of multiple whitish flat elevated lesions (MWFL) was first reported in 2007, no studies on MWFL have been published to date. The present retrospective observational study aimed to clarify the endoscopic findings and clinicopathological features of MWFL. Methods:Subjects were consecutive patients who underwent upper gastrointestinal endoscopy as part of routine screening between April 2014 and March 2015. The conventional white-light, non-magnifying and magnifying narrow-band images were reviewed. Clinical features were compared between patients with and without MWFL. Results:The conventional endoscopic findings of MWFL include multiple whitish, flat, and slightly elevated lesions of various sizes, mainly located in the gastric body and fundus. Narrow-band imaging enhanced the contrast of MWFL and background mucosa, and magnifying narrow-band imaging depicted a uniformly long, narrow, and elliptical marginal crypt epithelium with an unclear microvascular pattern. Histopathological findings revealed hyperplastic changes of the foveolar epithelium, and parietal cell protrusions and oxyntic gland dilatations were observed in the fundic glands, without any intestinal metaplasia. The rate of acid-reducing drug use was significantly higher in patients with MWFL than in those without (100% [13/13] vs. 53.7% [88/164], p<0.001). Conclusions:The present study indicated a relationship between the presence and endoscopic features of MWFL and history of acidreducing drug use.

British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma

“…Histologically, the biopsy specimens from the MWFLs included fundic gland parietal cell protrusions and oxyntic gland dilatations. There was no evidence of intestinal metaplasia 279…”

Characteristics of non-neoplastic epithelium that appears within gastric cancer with and without Helicobacter pylori eradication: A retrospective study

“…Previous studies have shown that MUC5AC, which is specific for foveolar epithelium, was decreased by HP infection and increased by HP eradication [ 16 – 18 ]. Hyperplastic changes in the foveolar epithelium, such as multiple whitish flat elevated lesions (MWFL) [ 19 ], are frequently observed after HP-eradication [ 11 ]. In the present study, the frequency of WNM related to foveolar hyperplasia was significantly higher in HP-eradicated GCs than in HP-infected GCs.…”

Multiple White Flat Lesions of the Corpus: Subtype of Hyperplastic Polyps vs. Intestinal Metaplasia

“…In a current issue of Clinical Endoscopy , Hasegawa et al reported the ME-NBI and clinicopathologic findings of multiple whitish flat elevated lesions (MWFLs) extending from the gastric body to the fundus [7]. A previous study evaluating the endoscopic classification, using ME-NBI, of gastric precancerous and cancerous lesions proposed that lesions with tubular-villous mucosal and regular vascular patterns can be classified as IM [8,9].…”

“…The common histologic findings of these lesions included straight enlarged foveolar epithelium with atrophy of the fundic gland without cystic dilatation. Hasegawa et al also reported observing foveolar hyperplasia in 100% of 4 patients, and parietal cell protrusion and oxyntic gland dilatation in 75% of the patients [7]. Fundic gland and hyperplastic polyps induced by proton pump inhibitor use have different histologic features from those of MWFLs.…”

“…First, MWFLs present as whitish elevated patches in the upper corpus, whereas whitish elevated lesions on the antrum are usually IM. Second, this lesion can be observed without atrophic background because H. pylori infection, which causes atrophic gastritis, is present in 7.7%–31.7% of the patients [7,12]. IM, the replacement of the gastric mucosa by intestinal epithelium, usually develops after atrophic change.…”