Morphological factors aid in therapeutic decisions concerning gastric adenomas

The morphology of 73 gastric adenomas and 134 protruded early gastric carcinomas was studied. Most adenomas were less than 2 cm in diameter (76.7%), while protruded lesions larger than 2 cm were more frequently early cancers (P less than 0.01). Adenomas larger than 4 cm in diameter usually contained foci of adenocarcinoma (83.3%). Flat or depressed adenomas were rare (6.8%). Protruded adenomas were compared with protruded early cancers. The superficial elevated adenoma was common, and the combined superficial elevated and superficial depressed form (IIa + IIc) was frequent in early cancer (P less than 0.001). A smooth surface was more common in adenoma (P less than 0.05), and erosion or ulcer more frequent in early cancer (P less than 0.01). Pale color was more common in adenoma (P less than 0.001), while areas of red were more frequent in early cancer (P less than 0.001). Gastric adenomas more than 2 cm, especially those more than 4 cm, in diameter, with flat or depressed or IIa + IIc morphology, with surface erosion or ulcer, and/or areas of red are likely to contain to cancer and should be treated aggressively.