Gastric Polyps

Published on 09/08/2015 by admin

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Last modified 09/08/2015

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 Hyperplastic, adenomatous, and hamartomatous

• Fundic gland polyps: Now most common type

image Associated with use of proton pump inhibitor (PPI) medication
image Sometimes considered a variant of hyperplastic polyps
• Hyperplastic polyps

image Virtually no malignant potential
image Typical: Small, multiple, sessile (< 1 cm)
image Location: Fundus and body
• Adenomatous polyps

image Less common (< 20% of benign polyps)
image Increased risk of malignant change
image Usually solitary, > 1 cm
• Hamartomatous polyps

image Peutz-Jeghers syndrome
image Can occur as isolated finding (sporadic)

TOP DIFFERENTIAL DIAGNOSES

• Retained food and pills
• Gastric carcinoma (polypoid type)
• Gastric metastases and lymphoma
• Gastric gastrointestinal stromal tumor
• Ectopic pancreatic tissue

CLINICAL ISSUES

• Prevalence of gastric polyps in patients who have upper endoscopy = 6% (2009 study)
• Fundic (77%), hyperplastic (17%), malignant (2%), adenomas (< 1%)
• Much higher percentage of fundic polyps than in earlier studies

image Caused by increased use of PPI medications
• Syndromic polyps have high association with cancer risk in stomach and other organs

image e.g., familial polyposis, Peutz-Jeghers syndrome
image
(Left) Graphic shows a pedunculated polyp in the gastric antrum, prone to prolapse through the pylorus with peristalsis. Any type of large polyp may prolapse in this fashion, including large hyperplastic, adenomatous, and even polypoid masses arising from the submucosa, such as lipomas.

image
(Right) Upper GI series shows a polypoid mass image in the duodenal bulb that is a prolapsed gastric antral polyp (adenoma).
image
(Left) Film from an upper GI series in a 57-year-old man shows multiple small, sessile polyps image in the gastric body. The appearance and age of the patient are typical for hyperplastic polyps.

image
(Right) Film from an upper GI series of adenomatous polyps in a patient with familial polyposis shows innumerable small polyps throughout the stomach. These are somewhat larger, more numerous, and more irregular in shape than most hyperplastic polyps.

TERMINOLOGY

Definitions

• Protruding, space-occupying lesion within stomach

image Encompass a broad spectrum of conditions that may originate in gastric mucosa or submucosa

IMAGING

General Features

• Best diagnostic clue

image Radiolucent filling defect, ring shadow, or contour defect on barium study
• Morphology

image Hyperplastic polyps: Smooth, sessile

– Fundic gland polyps: Always sessile, multiple, small
image Adenomatous polyps: Usually single with lobulated or cauliflower-like surface
image Hamartomas: Cluster of broad-based polyps
• Other general features

image Polyps classified  based on pathology
image Fundic gland polyps

– Variant of hyperplastic polyps (< 1 cm)
– Have become most common type of gastric polyp
– Associated with use of proton-pump inhibitor medication
image Hyperplastic polyps

– Virtually no malignant potential
– Typical: Small, multiple, sessile (< 1 cm)

image Location: Fundus and body
– Atypical large: Solitary, pedunculated (2-6 cm), location in body and antrum
– Atypical giant: Polyp (6-10 cm) multilobulated mass, location in body and antrum
image Adenomatous polyps

– Less common (< 20% of benign polyps); dysplastic lesions
– Increased risk of malignant change via adenoma-carcinoma sequence
– Usually solitary, occasionally multiple, > 1 cm

image Location: Mostly antrum > body
– Histologically: Tubular (75%), tubulovillous (15%), villous (10%)
– Gastric adenomatous polyps 30x less common than gastric cancer
– Carcinoma in situ and invasive carcinoma: Seen in 50% of adenomatous polyps > 2 cm
– 30-40% associated with atrophic gastritis, pernicious anemia, and cancer
– Higher risk of coexisting gastric cancer than risk of malignant change in polyp
image Polyposis syndromes involving stomach

– Familial adenomatous polyposis (FAP) syndrome 

image > 50% of patients have gastric adenomatous or fundic gland polyps
– Hamartomatous polyposis (e.g., Peutz-Jeghers syndrome [PJS])

image Have increased risk of gastric and other cancers
– Cronkhite-Canada, Cowden, etc.

image All rare but associated with gastric polyps

Fluoroscopic Findings

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