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Difference between revisions of "Fundic gland polyp"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Fundic gland polyp (1).jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Fundic gland polyp. [[H&E stain]]. | ||
| Micro = | | Micro = polypoid shape (epithelium on three sides), dilated gastric glands (flatted epithelial lining consisting of normal foveolar epithelium), lack of foveolar hyperplasia | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[hyperplastic polyp of the stomach]] | | LMDDx = [[hyperplastic polyp of the stomach]], [[gastric columnar dysplasia]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 12: | Line 12: | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = | | Gross = polyp - usu. fundus, may be in body of stomach | ||
| Grossing = | | Grossing = | ||
| Site = [[stomach]] - usually fundus | | Site = [[stomach]] - usually fundus | ||
| Assdx = [[gastroesophageal reflux disease]] - thus PPI use | | Assdx = [[gastroesophageal reflux disease]] - thus PPI use | ||
| Syndromes = [[familial adenomatous polyposis]] | | Syndromes = [[familial adenomatous polyposis]], [[gastric adenocarcinoma and proximal polyposis of the stomach]] | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = usu. asymptomatic | ||
| Prevalence = common | | Prevalence = common | ||
| Bloodwork = | | Bloodwork = | ||
| Line 38: | Line 38: | ||
*Weak association with FAP ([[familial adenomatous polyposis]]).<ref name=pmid20567540/><ref name=pmid18322941>{{cite journal |author=Freeman HJ |title=Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis |journal=World J. Gastroenterol. |volume=14 |issue=9 |pages=1318-20 |year=2008 |month=March |pmid=18322941 |doi= |url=http://www.wjgnet.com/1007-9327/14/1318.asp}}</ref> | *Weak association with FAP ([[familial adenomatous polyposis]]).<ref name=pmid20567540/><ref name=pmid18322941>{{cite journal |author=Freeman HJ |title=Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis |journal=World J. Gastroenterol. |volume=14 |issue=9 |pages=1318-20 |year=2008 |month=March |pmid=18322941 |doi= |url=http://www.wjgnet.com/1007-9327/14/1318.asp}}</ref> | ||
*Associated with chronic proton pump inhibitors (PPI) use -- approximately 4x risk.<ref>{{cite journal |author=Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH |title=Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy |journal=Aliment. Pharmacol. Ther. |volume=24 |issue=9 |pages=1341-8 |year=2006 |month=November |pmid=17059515 |doi=10.1111/j.1365-2036.2006.03127.x |url=}}</ref> | *Associated with chronic proton pump inhibitors (PPI) use -- approximately 4x risk.<ref>{{cite journal |author=Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH |title=Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy |journal=Aliment. Pharmacol. Ther. |volume=24 |issue=9 |pages=1341-8 |year=2006 |month=November |pmid=17059515 |doi=10.1111/j.1365-2036.2006.03127.x |url=}}</ref> | ||
**PPIs may cause ''fundic gland polyposis'' - extremely rare (two reported cases as of 2012).<ref name=pmid22348851>{{Cite journal | last1 = Hegedus | first1 = I. | last2 = Csizmadia | first2 = C. | last3 = Lomb | first3 = Z. | last4 = Cseke | first4 = L. | last5 = Enkh-Amar | first5 = Y. | last6 = Pajor | first6 = L. | last7 = Bogner | first7 = B. | title = [Massive fundic gland polyposis caused by chronic proton pump inhibitor therapy]. | journal = Orv Hetil | volume = 153 | issue = 9 | pages = 351-6 | month = Mar | year = 2012 | doi = 10.1556/OH.2012.29313 | PMID = 22348851 }}</ref> | |||
*[[Gastric adenocarcinoma and proximal polyposis of the stomach]].<ref name=pmid21813476>{{Cite journal | last1 = Worthley | first1 = DL. | last2 = Phillips | first2 = KD. | last3 = Wayte | first3 = N. | last4 = Schrader | first4 = KA. | last5 = Healey | first5 = S. | last6 = Kaurah | first6 = P. | last7 = Shulkes | first7 = A. | last8 = Grimpen | first8 = F. | last9 = Clouston | first9 = A. | title = Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS): a new autosomal dominant syndrome. | journal = Gut | volume = 61 | issue = 5 | pages = 774-9 | month = May | year = 2012 | doi = 10.1136/gutjnl-2011-300348 | PMID = 21813476 }}</ref> | |||
Notes: | Notes: | ||
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==Gross== | ==Gross== | ||
* | *Polyp - usuallly in fundus, may be in body of stomach. | ||
===Images=== | |||
<gallery> | <gallery> | ||
Image:Endoscopic_view_of_fundic_gland_polyps.jpg | | Image:Endoscopic_view_of_fundic_gland_polyps.jpg | FGPs on endoscopy. (WC) | ||
</gallery> | </gallery> | ||
==Microscopic== | ==Microscopic== | ||
Features:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref> | Features:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref> | ||
| Line 60: | Line 63: | ||
DDx: | DDx: | ||
*[[Hyperplastic polyp of the stomach]] - has foveolar hyperplasia, gland dilation may be present. | *[[Hyperplastic polyp of the stomach]] - has foveolar hyperplasia, gland dilation may be present. | ||
*[[Gastric columnar dysplasia]] - esp. in the context of FAP. | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
| Line 75: | Line 80: | ||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | ||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | ||
</pre> | |||
===Multiple polyps with PPI use=== | |||
<pre> | |||
POLYPS, STOMACH, POLYPECTOMY: | |||
- FUNDIC GLAND POLYP (x3). | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
Several fundic gland polyps were removed previously. Fundic gland | |||
polyps are associated with familial adenomatous polyposis (FAP), | |||
gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), | |||
and proton pump inhibitor (PPI) use. | |||
PPI use appears to be the most likely explanation in this case, | |||
in the context of the provided history; however, FAP and GAPPS should be | |||
considered clinically. | |||
</pre> | |||
===Polyposis=== | |||
<pre> | |||
Partial Stomach, Sleeve Gastrectomy: | |||
- Fundic gland polyposis, see comment. | |||
- NEGATIVE for intestinal metaplasia. | |||
- NEGATIVE for Helicobacter-like organisms. | |||
- NEGATIVE for dysplasia and negative for malignancy. | |||
Comment: | |||
Sixteen fundic gland polyps are identified on microscopy. At least forty polypoid lesions | |||
were seen at the time of grossing. | |||
Fundic gland polyps are reported in association with proton pump inhibitor use, familial | |||
adenomatous polyposis (FAP), and gastric adenocarcinoma and proximal polyposis of the | |||
stomach (GAPPS). The possibility of FAP and GAPPS should be considered. | |||
</pre> | |||
====Block letters==== | |||
<pre> | |||
STOMACH, GREATER CURVE, SLEEVE GASTRECTOMY: | |||
- FUNDIC GLAND POLYPOSIS, SEE COMMENT. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
Sixteen fundic gland polyps are identified on microscopy. At least forty polypoid lesions | |||
were seen at the time of grossing. | |||
Fundic gland polyps are reported in association with proton pump inhibitor use, familial | |||
adenomatous polyposis (FAP), and gastric adenocarcinoma and proximal polyposis of the | |||
stomach (GAPPS). The possibility of FAP and GAPPS should be considered. | |||
</pre> | </pre> | ||
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*[[Neuroendocrine tumours]]. | *[[Neuroendocrine tumours]]. | ||
*[[Gastric columnar dysplasia]]. | *[[Gastric columnar dysplasia]]. | ||
*[[Hyperplastic polyp of the stomach]]. | |||
*[[Hyperplastic polyp]] of the colon and rectum. | |||
==References== | ==References== | ||