Abstract
Aim
Dysplastic FGPs (d-FGPs) typically arise in patients with familial adenomatous polyposis (FAP) but may occur in nonsyndromic patients. They rarely develop malignancy, but their significance is unclear, especially in nonsyndromic patients. APC/β-catenin alterations have been implicated in their pathogenesis, and β-catenin immunohistochemistry (IHC) may show nuclear positivity.
Methods and results
We identified 124 FGPs with low-grade dysplasia (LGD) or high-grade dysplasia (HGD) or indefinite for dysplasia (IFD) from 66 patients (27 with FAP, 39 nonsyndromic). We recorded patient sex, age at first d-FGP, time until subsequent d-FGP (if any), history of non-gastric cancer (no patients had gastric cancer), proton-pump inhibitor (PPI) use, and presence of Helicobacter pylori. β-catenin IHC was performed on cases with available blocks. Mean age at d-FGP diagnosis was 31 years for FAP patients and 61 years for nonsyndromic patients (P<0.0001). Sixteen FAP patients (59%) developed at least one subsequent d-FGP, compared to 10 (27%) nonsyndromic patients (P=0.0099). Median time between d-FGP detection was 11.5 months in FAP patients and 7 months in nonsyndromic patients (P=0.82). Six FAP patients (22%) and 17 nonsyndromic patients (44%) had non-gastric malignancies (P=0.11). β-catenin IHC showed nuclear positivity in 14/112 (13%) d-FGPs: 12/94 with LGD, 2/3 with HGD, 0/15 IFD.
Conclusion
FAP patients develop d-FGPs earlier and more often develop additional ones than nonsyndromic patients. Dysplastic FGPs in FAP and nonsyndromic patients have similar low rates of β-catenin nuclear IHC positivity. FAP and nonsyndromic patients developed non-gastric cancers at similar rates, suggesting that d-FGPs may portend a general increased risk of carcinogenesis in nonsyndromic patients.
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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ssoCsI
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