Gastric epithelial polyps. A 10-year study

We have reviewed the 10-year experience of a community teaching hospital with gastric epithelial polyps and have analyzed 121 polyps removed from 35 patients. Hyperplastic polyps constituted nearly 75% of the polyps examined; fundic gland polyps constituted 17%, and adenomatous polyps were infrequent (8.6%). No clinical or endoscopic finding distinguished the variants of polyp before histologic examination. The majority of hyperplastic and fundic gland polyps were multiple. Whenever there were multiple polyps, all polyps were of the same histologic type. In no case did adenocarcinoma originate within a benign polyp. In only a single case was there an associated adenocarcinoma elsewhere in the stomach. None of the adenomatous polyps was linked with gastric adenocarcinoma.     

胃息肉的临床病理特征和内镜治疗随访观察

背景：胃息肉是一种常见病,病因不明且有癌变的可能。目的：分析胃息肉的临床、内镜、病理特征和内镜治疗效果。方法：对2006年7月1日～2009年7月1日于空军总医院接受胃镜检查,诊断为增生性息肉、腺瘤性息肉和胃底腺息肉的患者进行回顾性分析。结果：共检出三种常见类型的胃息肉392例,检出率为3.4％,单发283例,多发109例。61．5％的患者位于30～59岁年龄段．53．1％的患者息肉形态为山田Ⅱ型,64．0％的患者息肉最大径≤0．5cm。365例行病理检查者中,增生性、腺瘤性和胃底腺息肉分别占63．6％、5．5％和31．0％,前两者好发于胃窦部,后者好发于胃体、胃底部。383例患者成功接受内镜治疗。75例有随访资料者中20例复发,其中13例为多发息肉。结论：胃息肉内镜下多为山田Ⅱ型,直径较小,多为单发．病理类型上以增生性息肉和胃底腺息肉多见。多发息肉治疗后易复发。     

A case of gastric adenocarcinoma arising from a fundic gland polyp

A rare case of gastric adenocarcinoma arising on the surface of a fundic gland polyp is reported. A 36-year-old Japanese woman was referred to our hospital for examination and treatment of a polyp that had been detected in another hospital. She did not have a history of familial adenomatous polyposis (FAP). Endoscopic examination revealed a 10-mm-diameter fundic gland polyp in the body of the stomach. The polyp had an irregular depression on its top, suggesting the presence of malignancy. Endoscopic mucosal resection was done to make a histological diagnosis. This revealed a fundic gland polyp with a tiny superficial adenocarcinoma. Atrophic changes of the gastric mucosa were mild, although Helicobacter pylori infection was positive. It is suggested that fundic gland polyps have the potential for malignant transformation.     

Solitary pedunculated polypoid gastric gland heterotopia

A solitary pedunculated gastric polyp in the gastric fundus was removed from an asymptomatic 36-year-old woman with normal gastric acid secretion and a normal serum gastrin level. This lesion exhibited distinctive histological features including prominent proliferation of pseudopyloric glands, fundic glands, foveolar epithelium and a fibromuscular stroma. Moreover, its surface was entirely covered by a layer of normal gastric epithelium. Biopsies of the background mucosa taken from the gastric fundus revealed only mild superficial gastritis. A gastric gland heterotopia was diagnosed because of its unique morphology.     

Ectopic gastric mucosa of the gallbladder: comparison with metaplastic polyp of the gallbladder

We report a case of ectopic gastric mucosa of the gallbladder in a 44-yr-old man. A sessile polypoid lesion 1.0 cm in diameter was seen in the body of the gallbladder, without gallstones. The polypoid lesion consisted of gastric pyloric glands and fundic glands. The surrounding mucosa consisted of ordinary gallbladder epithelium without any metaplastic change. To elucidate the characteristics of this lesion, a clinicopathological comparison was made with metaplastic polyp of the gallbladder.     

Unusual gastric polyp showing submucosal proliferation of glands: Case report and literature review

We report an unusual pedunculated polyp in the stomach in a 41-year-old woman. She was hos-pitalized because of epigastric discomfort. Endoscopy revealed a polyp with a long stalk in the fundus of the stomach. The polypectomyzed polyp measured 23 × 18 × 9 mm and was characterized by submucosal proliferation of glands and cystic dilatation. The surface of the polyp was covered with gastric mucosa of fundic or pyloric gland type. The glandular structures consisted of various types of lining cells, including pyloric or mucous-neck cell type, surface mucous (foveolar) cell type, parietal-like cells, and somatostatin-positive cells. The submucosal glandular or cystic elements were connected with the overlying gastric mucosa through a defect of the muscularis mucosa, suggesting that this polyp may have been formed by the heterotopic inverted downgrowth of mucous glands into the submucosa. We discuss the histogenesis of this rare polyp and present a review of the literature. Received June 18, 1997; accepted Feb. 27, 1998     

Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies

BACKGROUND: Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM: To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS: One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS: The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5%; adenomatous polyps - 73,6%; fundic gland polyps - 72%). Hyperplastic polyps were the most frequent and accounted for 71.3% of the cases, whereas fundic gland polyps accounted for 16.3% and adenomatous polyps for 12.4%. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9%) and in two adenomatous polyps (10.5%). High grade dysplastic foci were found in four adenomatous polyps (21%). CONCLUSIONS: The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologist's aid, once the conduct to be adopted will depend on the result of the biopsy.     

SPORADIC FUNDIC GLAND POLYP‐RELATED ADENOMAS OCCURRED IN NON‐ATROPHIC GASTRIC MUCOSA WITHOUT HELICOBACTER PYLORI INFECTION

We report three cases of adenoma associated with sporadic fundic gland polyp (FGP) in the non‐atrophic fundic gland mucosa without Helicobacter pylori (HP) infection, which was verified with both serological and histopathological examinations. Gastric tubular adenoma (flat adenoma) is common and focal cancers occurring in the hyperplastic polyp of foveolar cell type are also sometimes experienced. However, adenomas occurring in sporadic FGP are valuable, as they are very rare, in upper gastrointestinal endoscopy. Whether or not these adenoma lesions of three sporadic FGP cases may become the background of protruded gastric cancers without HP infection remains unclear. Therefore, we emphasize the importance of histological examination on fundic gland polyps that are >5 mm in size to accumulate new similar cases. Follow‐up studies of these lesions are also needed to evaluate their outcomes.     

Heterotopic gastric mucosa in gallbladder associated with kidney agenesis and congenital hip dysplasia

Heterotopic gastric tissue in the gallbladder is an extremely rare condition. There is not any specific clinical or laboratory finding and correct diagnosis is not possible before histopathological examination. Preoperative diagnosis usually resembles a polypoid Lesion or a fixed gallstone. We reported a 34-year-old female patient with heterotopic gastric mucosa in the gallbladder associated with congenital hip dysplasia and kidney agenesis. Laparoscopic cholecystectomy was performed and histopathology of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundic type. Some cases of heterotopia in the gallbladder come from metaplasia, and may be one of the causes of gall bladder cancer. We discussed the clinical and histologic features of heterotopic gastric tissues and reviewed reported cases in the literature.     

Hemorrhagic polyps formed like fundic gland polyps during long-term proton pump inhibitor administration

We report a rare case of hemorrhagic gastric polyps resulting in anemia during long-term proton pump inhibitor (PPI) administration that endoscopically looked like a fundic gland polyp (FGP). A 44-year-old man presented complaining of anemia and tarry stools. Esophagogastroduodenoscopy (EGD) demonstrated multiple white edematous polyps in the corpus and antrum, which were considered to be FGPs. We attempted endoscopic hemostasis but hemorrhaging increased because of hemorrhagic polyps and vulnerable gastric mucosa. Re-bleeding occurred several times. Polyp resection was performed at 24 polyp sites. We also ceased the administration of PPI. Microscopically, polyps showed characteristics of hyperplasia in the foveolar epithelium, extensions of fundic glands, and edema of the stroma. The proliferation of parietal and chief cells was also observed. Immunohistochemically, aquaporin-4 (AQP4) and KCNQ1-positive parietal cells and dilated mucous glands were found from the basal side to the apical side of the mucosa. These findings were compatible with the development of lesions associated with the long-term administration of PPI. EGD revealed an improvement in the vulnerability of gastric mucosa and the development of polyps, with no further gastric polyps observed 1 year after discharge. Bleeding from polyps resembling FGPs is generally rare, with indications that long-term PPI administration may induce such bleeding.     

Gastric polyps: Association with Helicobacter pylori status and the pathology of the surrounding mucosa,a cross sectional study

aim:To assess the endoscopic characteristics of gastric polyps and their association with Helicobacter pylori(H.pylori)status in a predominantly Hispanic population.m ETHODS:We conducted a retrospective study of all esophagogastroduodenoscopies performed at our institution.Demographic,endoscopic and histopathological data were reviewed.Categorization of patients into Hispanic and Non-Hispanic was based on selfidentification.Patients without resection/biopsy were not included in the analysis.Identification of polyps type was based on histological examination.One way analysis of variance was used to compare continuousvariables among different polyp types and Fisher’s exact test was used compare categorical variables among polyp types.Unadjusted and adjusted comparisons of demographic and clinical characteristics were performed according to the H.pylori status and polyp type using logistic regressions.RESULTS:Of 7090 patients who had upper endoscopy,335 patients had gastric polyps(4.7%).Resection or biopsy of gastric polyps was performed in 296 patients(88.4%)with a total of 442 polyps removed or biopsied.Of 296 patients,87(29%)had hyperplastic polyps,82(28%)had fundic gland polyps and 5(1.7%)had adenomatous polyps.Hyperplastic polyps were significantly associated with positive H.pylori status compared with fundic gland polyps(OR=4.621;95%CI:1.92-11.13,P=0.001).Hyperplastic polyps were also found to be significantly associated with portal hypertensive gastropathy compared with fundic gland polyps(OR=6.903;95%CI:1.41-33.93,P=0.0174).Out of 296 patients,30(10.1%)had a followup endoscopy with a mean duration of 26±16.3 mo.Interval development of cancer was not noted in any of the patients during follow up period.CONCLUSi ON:Gastric hyperplastic polyps were significantly associated with positive H.pylori status and portal hypertensive gastropathy as compared with fundic gland polyps.     

Incidence and risk factor of fundic gland polyp and hyperplastic polyp in long-term proton pump inhibitor therapy: a prospective study in Japan

Goal  

To investigate the development of fundic gland polyp (FGP) and gastric hyperplastic polyp (HPP) during long-term proton pump inhibitor (PPI) therapy and risk factors of each polyp via patient status in a multicenter prospective study.     

Acute pancreatitis from intussusception of a gastric polyp in a patient with Gardner's syndrome

Gastric polyps in Gardner's syndrome are usually benign small fundic gland neoplasms with little clinical significance. We report a case of gastroduodenal intussusception secondary to a large benign gastric polyp in a 44-year-old woman with Gardner's syndrome who presented with acute pancreatitis. The intussuscepted polyp caused obstruction of the ampulla of Vater with subsequent acute pancreatitis.     

Cell proliferation in three types of Barrett's epithelium

Barrett's epithelium is a columnar, possibly premalignant, metaplasia of the oesophagus. To study the pattern of epithelial renewal in this disorder, we localised the lower oesophageal sphincter by manometry in 12 patients with known Barrett's epithelium, obtained multiple suction biopsies above the sphincter, and organ cultured the biopsies over 3H-TdR-containing medium to label proliferating cells. Of 23 biopsies from the 12 patients, 13 were specialised columnar type, three were junctional type, and seven were fundic type. None of the patients showed clinical evidence of oesophageal carcinoma, and oesophageal cytological examinations were uniformly negative for neoplastic cells. When compared with control gastric fundic biopsies from normal volunteers, mean values for the labelling index and the proportion of the pit which was occupied by the proliferative zone in Barrett's biopsies were not significantly different. However, four individual Barrett's biopsies (three specialised columnar type and one junctional type) did have a proliferative zone which occupied a greater proportion of the pit than did the widest control zone. We propose that the pattern of epithelial proliferation in Barrett's epithelium in general is similar to that found in other gastrointestinal columnar epithelia. However, a minority of patients with Barrett's epithelium may have an expanded proliferative zone. The clinical implications of an expanded proliferative zone with regard to the subsequent development of oesophageal carcinoma require further investigation.     

Regression of fundic gland polyps following acquisition of Helicobacter pylori

The prevalence of Helicobacter pylori infection is very low in patients with fundic gland polyps (FGPs) of the stomach. We report here two cases with multiple FGPs that regressed following new H pylori acquisition. Patient Nos I and II had multiple FGPs in normal fundic mucosa without inflammatory changes or atrophy. Both were not infected with H pylori. Following acquisition of H pylori infection however, all FGPs in both patients completely disappeared except for one FGP in patient No I. Although the size of the remaining polyp in patient No I was greatly reduced after H pylori acquisition, it became enlarged again after eradication. Interestingly, in the remaining polyp, we found an activating beta-catenin gene mutation whereas no such mutations were detected in FGPs of patient No II. Thus H pylori infection may have an inhibitory effect on the development of FGPs.     

Oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor: A case report

Gastric adenocarcinoma is one of the most common malignancies worldwide.Histochemical and immunohistologic analyses classify the phenotypes of gastric adenocarcinoma into several groups based on the variable clinical and pathologic features.A new and rare variant of gastric adenocarcinoma with chief cell differentiation(GA-CCD)has recently been recognized.Studies reporting the distinct clinicopathologic characteristics proposed the term oxyntic gland polyp/adenoma because of the benign nature of the GACCD.Typically,GA-CCD is a solitary mucosal lesion that develops either in the gastric cardia or fundus.Histologically,this lesion is characterized by tightly clustered glands and anastomosing cords of chief cells.Immunohistochemically,GA-CCD is diffusely positive for mucin(MUC)6 and negative for MUC2and MUC5AC.However,other gastric tumors such as a gastric neuroendocrine tumor or fundic gland polyp have been difficult to exclude.Because GA-CCD tends to be endoscopically misdiagnosed as a neuroendocrine tumor or fundic gland polyp,comprehensive assessment and observation by an endoscopist are strongly recommended.Herein,we report a rare case of oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor that was successfully removed by endoscopic mucosal resection.     

A family with attenuated familial adenomatous polyposis identified because of fundic gland polyposis

We report a 41-year-old woman who had fundic gland polyposis without a colorectal polyp. Because her father had colon cancer, multiple colorectal polyps and the gastric polyposis, we suspected AFAP and researched the APC gene. There was 1 base pair deletion of guanine at codon 99-100 in exon 3 of the APC gene, and its frame shift mutation made stop codon at codon 124. It was proved that the gene carrier of AFAP can be discovered based on the family-history and the presence of fundic gland polyposis, even when no colorectal polyps exist.     

Giant sporadic fundic gland polyp： Endoscopic and endosonographic features and management

Fundic gland polyps are the most common gastric polyps. They are usually small in size, sporadic and asymptomatic. We present a case of giant fundic gland polyp. Our case is particular because of the clinical presentation, the endoscopic and endosonographic documented findings, and the treatment otpions followed.     

Benign gastric polyps: morphological and functional origin

The most common types of benign gastric polyps are fundic gland polyps, hyperplastic polyps, and adenomas. The aim of this study was to determine on which morphological and functional background benign gastric polyps develop. The study includes 85 consecutive patients with gastric polyps and sex- and age-matched controls without polyps selected at random from a general population sample. The type of polyp was hyperplastic in 52 (61%), fundic gland in 18 (21%), adenoma in 10 (12%), carcinoid in 2 (2%), hamartoma in 2 (2%), and inflammatory fibroid in 1 (1%) of the cases. Routine biopsies from the gastric corpus and antrum were examined for presence of gastritis and H. pylori. Blood samples were analyzed for H. pylori antibodies, H⁺,K⁺-ATPase antibodies, gastrin, and pepsinogen I. Patients with hyperplastic polyps had increased P-gastrin concentrations and S-H⁺,K⁺-ATPase antibody titers and decreased S-pepsinogen I concentrations with a high prevalence of atrophic corpus gastritis or pangastritis. A similar pattern was observed among patients with adenomas, whereas patients with fundic gland polyps had normal serology and a lower prevalence of gastritis and H. pylori infection than controls. In conclusion, hyperplastic polyps and adenomas are generally associated with atrophic gastritis. Patients with fundic gland polyps seem to have a sounder mucosa than controls. Whereas the risk of malignant gastric neoplasia is increased in patients with hyperplastic polyps or adenomas, this does not seem to be the case in patients with fundic gland polyps.     

Natural history of fundic gland polyposis in patients with familial adenomatosis coli/Gardner's syndrome

In order to study the natural history of fundic gland polyposis, 23 patients with familial adenomatosis coli/Gardner's syndrome were examined over a follow-up period ranging from 17 mo to 13 yr (average 6 yr). Examinations included gastric radiography and endoscopy with biopsy. Fundic gland polyps were found in 10 individuals. The size and number of polyps varied considerably. During the follow-up period, there was an increase in number or size of polyps, or both, in 5 patients (aged 8-27 yr), a decrease or disappearance in 2 patients (aged 36 and 41 yr), an initial decrease or disappearance followed by a late-occurring increase in 2 patients (aged 28 and 35 yr), In addition, malignant or adenomatous changes of fundic gland polyps were not observed in any patient. Therefore, fundic gland polyposis in patients with familial adenomatosis coli/Gardner's syndrome may appear as early as 8 yr of age. In some patients there is a gradual increase in number and size of polyps, whereas in others, polyp proliferation ceases and polyps may even decrease in number and size. Our findings indicate that the fundic gland polyposis does not require prophylactic surgery and that careful periodic follow-up should suffice.