Giant hyperplastic gastric polyp: A diagnostic dilemma!!

Gastric hyperplastic polyps (GHP) account for a majority of benign gastric polyps. Most of the GHPs are <2 cm, asymptomatic, and incidentally detected on endoscopy or radiologically. With increasing size, these polyps manifest as upper gastrointestinal bleeding, iron deficiency anemia, and gastric outlet obstruction (GOO). We report an unusual case of giant GHP simulating gastric carcinoma and posing as a diagnostic challenge for the surgeons emphasizing the diagnostic role of histopathology. A 46-year-old female presented with clinical features of progressive GOO for 1 year. Endoscopy revealed an eccentric proliferative lesion in the antrum. Computed tomography showed a polypoidal, enhancing mural thickening involving distal body and antro-pyloric region measuring 8.4 cm × 6.6 cm × 1.8 cm. Subtotal gastrectomy was done in view of clinical features of GOO and having a clinical suspicion of malignancy. Gross examination showed a giant sessile hyperplastic polyp with lobulated surface. Microscopy revealed features of a large, sessile hyperplastic polyp without any evidence of dysplasia. The patient was symptomatically relieved and is on follow-up. To conclude, giant GHPs can mimic gastric carcinoma on endoscopy and radiology. The possibility of giant GHP should be kept in mind in the presence of an intensely contrast-enhancing polypoidal lesion in the gastric antrum. Long-term endoscopic follow-up is recommended.

Heterotopia pancreática en pólipo gástrico. Presentación de caso / A case of heterotopic pancreas in a gastric polyp

Resumen La heterotopia pancreática es un hallazgo poco frecuente, en ocasiones accidental, que se puede observar en cualquier nivel del tracto digestivo e inclusive fuera del mismo; es congénita y su patogenia está en discusión. Aunque su forma de presentación es lenta y progresiva y su comportamiento benigno y asintomático, en ocasiones puede originar manifestaciones obstructivas, hemorrágicas, inflamatorias y neoplásicas. En este último caso es imprescindible el diagnóstico histopatológico. Se presenta el caso de un paciente sintomático con heterotopia pancreática a nivel del píloro gástrico cuya localización es bastante infrecuente.

Abstract Pancreatic heterotopia is rare and is sometimes found accidentally. It can occur anywhere in the digestive tract and even outside of it. Heterotopic pancreas is congenital, but its pathogenesis is under discussion. Although it develops slowly and progressively, its behavior is benign and asymptomatic. Nevertheless, it can manifest in obstructions, hemorrhaging, inflammation and neoplasia. In the latter case, histopathological diagnosis is essential. We present the case of a symptomatic patient with pancreatic heterotopia at the gastric pylorus, a very uncommon location.

Effect of Helicobacter pylori eradication on the regression of gastric polyps in National Cancer Screening Program

BACKGROUND/AIMS: Western guidelines recommend Helicobacter pylori eradication in H. pylori-associated gastric polyps; however, there is no standard guideline in Korea. The aim of this study is to assess the effect of H. pylori eradication on the regression of gastric hyperplastic polyps in National Cancer Screening Cohort, representative of general population. METHODS: Among participants in National Cancer Screening Program, subjects who had H. pylori positive gastric hyperplastic polyps less than 10 mm and underwent follow-up endoscopy and H. pylori testing were enrolled. The effect of H. pylori eradication on hyperplastic gastric polyps was estimated using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 183 H. pylori infected subjects with hyperplastic polyp at baseline underwent follow-up endoscopy and H. pylori test after mean of 2.2 years. Successful H. pylori eradication markedly induced the disappearance of hyperplastic polyps comparing to non-eradication group (83.7% vs. 34.1%, p = 0.001). Successful eradication increased the possibility of disappearance of hyperplastic polyps (adjusted OR, 5.56; 95% CI, 2.63 to 11.11). Polyp size was inversely related with the disappearance of hyperplastic polyps (adjusted OR, 59; 95% CI, 0.48 to 0.71). CONCLUSIONS: Eradication of H. pylori infection may induce disappearance of gastric hyperplastic polyps in National Cancer Screening Cohort.

Menetrier's Disease: Its Mimickers and Pathogenesis

Menetrier's disease is a rare protein-losing hypertrophic gastropathy. Histologically, it can be mistaken for other disorders showing hypertrophic gastropathy. The pathogenesis of Menetrier's disease is not fully understood; however, it appears that the epidermal growth factor receptor (EGFR) ligand, transforming growth factor alpha, contributes to the pathogenesis of this disorder. In this review, we will discuss disease entities that can mimic Menetrier's disease and the role of EGFR signaling in Menetrier's disease.

Inflammatory fibroid polyp (Vanek’s polyp): a case report and literature review / Pólipo fibroide inflamatório (pólipo de Vanek): relato de caso e revisão da literatura

Inflammatory fibroid polyp (IFP) is a benign uncommon lesion (1%-4% of gastric benign lesions), originated from the submucosa of the gastrointestinal tract. Its origin is controversial and immunohistochemical studies of lesions have largely refuted the possible vascular, neural or smooth muscle origin. Recent studies suggest a neoplastic etiology due to a mutation, in some cases, in the alpha-type platelet-derived growth factor receptor gene (PDGFRa). Our objective is to report the case of a patient aged 70 years, with gastric IFP, comparing her immunohistochemical profile with those of other studies, and a brief review of the literature.

Pólipo fibroide inflamatório (PFI) é uma lesão benigna, pouco frequente (1%-4% das lesões benignas gástricas), originada na submucosa do trato gastrointestinal. Sua origem é controversa e vários estudos imuno-histoquímicos da lesão refutaram uma possível origem vascular, neural ou muscular lisa. Recentes estudos sugerem etiologia neoplásica devida à mutação, em alguns casos, no gene receptor tipo alfa para fator de crescimento derivado de plaquetas (PDGFRa). Nosso objetivo é relatar o caso de uma paciente de 70 anos de idade, com PFI gástrico, comparando seu perfil imuno-histoquímico com o de outros estudos, além de breve revisão da literatura.

A Case of Aggravated Hyperplastic Gastric Polyps after Treatment with Long-term Proton Pump Inhibitors / 영남의대학술지

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.

A Case of Multiple Tumors Located in Structures Other than the Colon in a Patient with Familial Adenomatous Polyposis / 대한내과학회지

Most patients with familial adenomatous polyposis (FAP) undergo prophylactic colectomy. As a result, extracolonic manifestations including benign and malignant tumors are more common in patients with FAP, and duodenal cancer is now the main cause of death. However, duodenal adenomas and carcinomas are detected less frequently in Korea and Japan than in Western countries, and gastric cancer is more prevalent than in Western countries. In the present case, a 63-year-old man, who had undergone a total colectomy and an ileostomy 14 years previously, presented at our outpatient clinic complaining of discomfort at the ileostomy site. The patient had adenomas in the gallbladder and ileum, and adenocarcinomas in the duodenum and stomach. The interval between development of duodenal cancer and stomach cancer was only 4 months. Therefore, we suggest that more frequent endoscopic surveillance may be needed for these cases.

Tumor de Vanek o pólipo fibroide inflamatorio gástrico. Presentación de dos casos en Medellín / Presentation of two cases of Vanek's tumor (inflammatory fibroid polyp) in Medellín

Se reportan dos casos de pólipo fibroide inflamatorio (PFI) o tumor de Vanek. El primero corresponde a una mujer de 63 años, con cuadro clínico de dolor abdominal. En la endoscopia digestiva se encuentra pólipo antral, que se reseca; el estudio anatomopatológico informa los hallazgos clásicos de un pólipo fibroide inflamatorio. El segundo caso es un paciente de sexo masculino, 63 años, que ingresa en choque hemorrágico por hematemesis masiva. En la endoscopia se evidencia una lesión de Dieulafoy en el cardias y una lesión polipoide en antro que se reseca. El estudio anatomopatológico informa una histología inusual que requiere estudio de inmunohistoquímica para confirmar el diagnóstico de PFI.

We report on two cases of inflammatory fibroid polyps in the stomach (Vanek's tumor). The first patient was a 63-year-old woman with abdominal pain for whom resection of an antral polypoid lesion was done. This polyp presented classical histopathology. The second case was a 63-year-old male patient who was admitted to the hospital with hemorrhagic shock due to hematemesis. During endoscopy a Dieulafoy's lesion was found in the cardia of the stomach and a polypoid lesion was found in the antrum. Unusual histopathology required that the diagnosis be confirmed by immunohistochemistry.

Manejo de pólipos gástricos / Management of gastric polyps

Most of gastric polyps are benign and do not need specific treatment. However, some types have significant malignant potential that can lead to gastric cancer if they are not managed appropriately. The malignant potential depends on the histological type of the polyp, therefore it is important to sample and make biopsies.

La mayoría de los pólipos gástricos son benignos y no requieren tratamiento específico; no obstante, algunos de ellos pueden malignizarse. Si estos pólipos no son tratados pueden ser causa de cáncer gástrico. El potencial maligno depende del tipo histológico del pólipo, por lo que estas lesiones debieran ser siempre biopsiadas.

Gastric Involvement in Autoimmune Pancreatitis / 대한소화기내시경학회지

Autoimmune pancreatitis is now considered to be a systemic fibroinflammatory disease that can involve multiple organs. As it is associated with IgG4-positive plasma cells by an autoimmune mechanism, extrapancreatic organs as well as the pancreas could be affected with a lymphoplasmacytic infiltrate. The proximal bile duct, the salivary gland, the retroperitoneum and the kidney are well known to be involved with, but less is known about the involvement of hollow viscus which is pathologically associated with autoimmune pancreatitis. We report here on a case of gastric involvement in a 53-year-old man with autoimmune pancreatitis.

Regression of Hyperplastic Gastric Polyp after Helicobacter pylori Eradication / 대한소화기내시경학회지

BACKGROUND/AIMS: Recent studies have suggested that the eradication of Helicobacter pylori (Hp) may lead to the regression of hyperplastic polyps (HPPs) in the stomach. We evaluated the sizes of HPPs after Hp eradication and we also compared the clinical parameters between the regression and non-regression groups. METHODS: We enrolled 187 patients who had HPPs in the stomach. The polyps were measured by using biopsy forceps, and the endoscopically observed changes of the polyps were assessed by two endoscopists. RESULTS: Total regression was observed in 68 patients of the eradicated group and in 6 patients in the non-eradicated group (42.5% vs. 22.2%, respectively, p<0.05). The non regression rate was significantly higher for the non-eradicated group than that for the eradicated group (33% vs. 10%, respectively, p<0.05). Comparing between the regression and non-regression groups, the incidence of polyps that were smaller than 10 mm in size and sessile was significantly higher in the regression group. Hp eradication was the only significant predictor of regression. CONCLUSIONS: Hp eradication could be a therapeutic option for Hp positive-hyperplastic gastric polyps, and especially for those that are less than 10 mm in size and sessile.

Clinical characteristics of 365 gastric polyps / 中国综合临床

Objective To analyze the clinical characteristics of gastric polyps in different histopathological types. Methods Based on histopathological difference, gastric polyps were categorized into fundic gland polyps, hyperplastic polyps, inflammatory polyps, adenomatous polyps, etc; Different types of polyps in the aspects of distribution, Helicobacter pylori (H. pylori) infection, the relationship between the proton pump inhibitors (PPI) and the occurrence of gastric polyps to provide guidance on treatment Results 365 cases of gastric polyps were diagnosed in 10 197 patients who underwent gastroscopy. The prevalence was 3. 6%. The histopathological type of the polyps were fundic gland polyps (61. 1%), hyperplastic polyps (23. 3%) , inflammatory polyps (12. 3%) , adenomatous polyps (2. 2%). 289 cases showed single polyps, which was the majoriry across all types of gastric polyps. Majority of the gastric polyps were located in gastric body and fundus, followed by gastric antrum and cardia Most of the fundic gland polyps were located in gastric body and fundus; Majority of the hyperplastic polyps and adenomatous polyps were located in gastric antrum; The main locations of inflammatory polyps were cardia and gastric body and fundus. A higher percent (51. 6%) of fundic gland polyps patients used PPI. The difference was statistically significant compared with the hyperplastic polyps(8. 2%)and inflammatory polyps group(8.9%) (x2 = 48. 31,27. 63 ,P <0. 01). The H. pylori infection rate of hyperplastic polyps and inflammatory polyps were 72.4% and 74.4% ,respectively, both of which were higher than that of fundic gland polyps(20. 2%)(x2 =46. 50,35. 04, P < 0. 01) . One year after the H. pylori eradication, the recurrence cases of hyperplastic polyps and inflammatory polyps were 1/41 and 0/19,respectively. Conclusions The main histopathological type of gastric polyps is fundic gland polyps followed by hyperplastic polyps. The main location of the gastric polyps is gastric body and fundus, followed by gastric antrum and cardia. The distribution of different types of gastric polyps has some characteristics. Long-time usage of PPI may increase the risk of fundic gland polyps. The occurrence of hyperplastic polyps and inflammatory polyps may be related to H. pylori infection. The H. pylori eradication helps preventing the recurrence of hyperplastic and inflammatory gastric polyps.

A Case of a Gastric Hyperplastic Polyp with a Signet Ring Cell Carcinoma / 대한소화기내시경학회지

Gastric polyps can be categorized as hyperplastic or adenomatous. Hyperplastic gastric polyps account for 28~77% of gastric polyps. Adenomatous polyps are recommended for removal due to their premalignant potential. However, there is no consensus on treatment and endoscopic surveillance of hyperplastic gastric polyps. The incidence of malignant neoplasms found in hyperplastic polyps has been reported to be about 2.1%; most of the reported cases of hyperplastic gastric polyps with malignant transformation were histologically well differentiated. We report a rare case of a gastric hyperplastic polyp with a signet ring cell carcinoma, with a review of the literature.

A Case of a Y-shaped Pedunculated Gastric Polyp Presenting as an Upper Gastrointestinal Bleeding in a Patient with Chronic Renal Failure / 대한소화기내시경학회지

Upper gastrointestinal bleeding is one of the most common complications in patients with chronic renal failure. Common causes are peptic ulcer, gastritis, duodenitis, esophagitis, Mallory-Weiss tear, and angiodysplasia. However, gastric polyp is a rare cause of upper gastrointestinal bleeding. We diagnosed a bleeding hyperplastic polyp in chronic renal failure patient with melena. He had a bleeding polyp with a Y-shaped stalk. This polyp was treated effectively by endoscopic snare polypectomy.

A Case of a Y-shaped Pedunculated Gastric Polyp Presenting as an Upper Gastrointestinal Bleeding in a Patient with Chronic Renal Failure / 대한소화기내시경학회지

Upper gastrointestinal bleeding is one of the most common complications in patients with chronic renal failure. Common causes are peptic ulcer, gastritis, duodenitis, esophagitis, Mallory-Weiss tear, and angiodysplasia. However, gastric polyp is a rare cause of upper gastrointestinal bleeding. We diagnosed a bleeding hyperplastic polyp in chronic renal failure patient with melena. He had a bleeding polyp with a Y-shaped stalk. This polyp was treated effectively by endoscopic snare polypectomy.

H.pylori infection,mucosal inflammation and atrophy in different histological types of gastric polyp / 中华消化内镜杂志

Objective To study H.pylori infection and the changes of muco sal inflammation， atrophy and intestinal metaplasia in the different histolog ical types of gastric polyps. Methods Two hundred and seventy－ eight cases of gastric polyps(12.6％ ) from 2 203 gastric mucosal biopsy cases were histologic ally classified and examined for the presence of Helicobacter pylori,for degree and type of inflammation,mucosal atrophy and intestinal metaplasia. Results 53. 9％ gastric polyps were infected with H.pylori,in which faveolar polyp was the highest with an infective rate of 73.1％ .The changes of active inflammation,atr ophy and metaplaisa in gastric mucosa were frequently accompanied with H.pylori positive faveolar polyps almost as same as those in adenoma.The fundic gland pol yps were usually with low rate of H.pylori infection,and the changes of mucosal active inflammation,atrophy and metaplasia were seldom observed. Conclusions Fav eolar polyps,which are different from fundic gland polyp,may caused by H.pylori infection and are usually with the changes of mucosal active inflammation,atroph y and metaplasia.

Three Cases of Gastric Polyps Producing Intermittent Gastric Outlet Obstruction / 대한소화기내시경학회지

The manifestations of gastric polyps vary, including abdominal pain, nausea, and vomiting or gastrointestinal bleeding. Sometimes large polyp of the stomach causes intermittent outlet obstruction. Most of gastric polyps that prolapse through the pylorus are pedunculated adenomatous polyps located in the antral and prepyloric regions. Even though the polyps has no evidence of malignancy, the polyps producing pyloric obstruction should be removed by polypectomy or surgery. Herein we describe 3 cases of a large, benign, and pedunculated gastric polyp that led to intermittent gastric outlet obstruction with review of literatures.

Clinicopathologic Evaluation of 290 Cases Involving Endoscopic Gastric Polypectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric polyps are recommended to be removed due to their premalignant potential. Endoscopic polypectomy has long been considered a safe and effective method for removal of gastric polyps. METHODS: The authors diagnosed and treated 290 gastric polyps using endoscopy on 210 patients who had been admitted to Chungnam National University Hospital from January, 1990 to August, 1996. The clinical endoscopic and pathologic findings were evaluated.

Cardiac Arrest due to Unsuspected pheochromocytoma Presenting during Gastric Polyp Operation / 대한마취과학회지

The anesthetic management of patient with pheochromocytoma is often difficult even when a clear-cut preoperative diagnosis has been made. We experienced a patient with a gastric polyp and an unsuspected pheochromocytoma which presented with transient hypertension during general anesthesia for an elective subtotal gastrectomy. The patient developed severe hypertension and arrhythmia leading to cardiac arrest just after the skin incision. This case illustrate the value of preoperative evaluation in a patient with transient hypertension.