Difference between revisions of "Fundic gland polyp"

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Fundic gland polyp (view source)

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#redirect [[Stomach#Fundic_gland_polyp]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Fundic gland polyp (1).jpg
| Width      =
| Caption    = Fundic gland polyp. [[H&E stain]].
| Micro      = polypoid shape (epithelium on three sides), dilated gastric glands (flatted epithelial lining consisting of normal foveolar epithelium), lack of foveolar hyperplasia
| Subtypes  =
| LMDDx      = [[hyperplastic polyp of the stomach]], [[gastric columnar dysplasia]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = polyp - usu. fundus, may be in body of stomach
| Grossing  =
| Site      = [[stomach]] - usually fundus
| Assdx      = [[gastroesophageal reflux disease]] - thus PPI use
| Syndromes  = [[familial adenomatous polyposis]], [[gastric adenocarcinoma and proximal polyposis of the stomach]]
| Clinicalhx =
| Signs      =
| Symptoms  = usu. asymptomatic
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  = polyps
| Prognosis  = benign
| Other      =
| ClinDDx    = [[gastric adenoma]], [[hyperplastic polyp of the stomach]]
}}
'''Fundic gland polyp''', abbreviated '''FGP''', is a relatively common pathology of the [[stomach]]. It is associated with [[familial adenomatous polyposis]] and proton pump inhibitor use.


==General==
*Most common stomach polyp.<ref name=pmid20567540/>
*''Fundic'' location usually.
**May be in the body.<ref name=pmid20567540>{{Cite journal  | last1 = Spiegel | first1 = A. | last2 = Stein | first2 = P. | last3 = Patel | first3 = M. | last4 = Patel | first4 = R. | last5 = Lebovics | first5 = E. | title = A report of gastric fundic gland polyps. | journal = Gastroenterol Hepatol  (N Y) | volume = 6 | issue = 1 | pages = 45-8 | month = Jan | year = 2010 | doi =  | PMID = 20567540 }}</ref>
===Clinical significance===
*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>
**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:
*Animal studies suggested PPIs cause [[neuroendocrine tumour]]s -- but this has not been found in humans.<ref>{{cite journal |author=Masaoka T, Suzuki H, Hibi T |title=Gastric epithelial cell modality and proton pump inhibitor |journal=J Clin Biochem Nutr |volume=42 |issue=3 |pages=191-6 |year=2008 |month=May |pmid=18545640 |pmc=2386521 |doi=10.3164/jcbn.2008028 |url=}}</ref>
==Gross==
*Polyp - usuallly in fundus, may be in body of stomach.
===Images===
<gallery>
Image:Endoscopic_view_of_fundic_gland_polyps.jpg | FGPs on endoscopy. (WC)
</gallery>
==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>
*Polypoid shape (may not be appreciated on microscopy).
*Dilated gastric glands.
**Flatted epithelial lining (consisting of normal foveolar epithelium) - '''key feature'''.
Notes:
*The presence of dysplastic changes should prompt consideration of ''FAP''.
DDx:
*[[Hyperplastic polyp of the stomach]] - has foveolar hyperplasia, gland dilation may be present.
*[[Gastric columnar dysplasia]] - esp. in the context of FAP.
===Images===
<gallery>
Image:Fundic gland polyp (1).jpg | FGP - low mag. (WC)
Image:Fundic_gland_polyp_(2).jpg | FGP - high mag. (WC)
</gallery>
www:
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm Fundic gland polyp (ouhsc.edu)].
==Sign out==
<pre>
POLYP, STOMACH, BIOPSY:
- FUNDIC GLAND POLYP.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- 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>
==See also==
*[[Stomach]].
*[[Neuroendocrine tumours]].
*[[Gastric columnar dysplasia]].
*[[Hyperplastic polyp of the stomach]].
*[[Hyperplastic polyp]] of the colon and rectum.
==References==
{{Reflist|2}}
[[Category:Stomach]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
Michael
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