Fundic gland polyp

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Fundic gland polyp
Diagnosis in short

Fundic gland polyp. H&E stain.

LM polypoid shape (epithelium on three sides), dilated gastric glands (flatted epithelial lining consisting of normal foveolar epithelium), lack of foveolar hyperplasia
LM DDx hyperplastic polyp of the stomach, gastric columnar dysplasia
Gross polyp - usu. fundus, may be in body of stomach
Site stomach - usually fundus

Associated Dx gastroesophageal reflux disease - thus PPI use
Syndromes familial adenomatous polyposis

Symptoms usu. asymptomatic
Prevalence common
Endoscopy polyps
Prognosis benign
Clin. DDx 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.[1]
  • Fundic location usually.
    • May be in the body.[1]

Clinical significance

  • Weak association with FAP (familial adenomatous polyposis).[1][2]
  • Associated with chronic proton pump inhibitors (PPI) use -- approximately 4x risk.[3]
    • PPIs may cause fundic gland polyposis - extremely rare (two reported cases as of 2012).[4]

Notes:

Gross

  • Polyp - usuallly in fundus, may be in body of stomach.

Images

Microscopic

Features:[6]

  • 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:

Images

www:

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POLYP, STOMACH, BIOPSY:
- FUNDIC GLAND POLYP.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Multiple polyps with PPI use

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) 
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 should be 
considered clinically.

Polyposis

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 and in
association with familial adenomatous polyposis (FAP). The possibility of FAP should be
investigated.

Block letters

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 and in
association with familial adenomatous polyposis (FAP). The possibility of FAP should be
investigated.

See also

References

  1. 1.0 1.1 1.2 Spiegel, A.; Stein, P.; Patel, M.; Patel, R.; Lebovics, E. (Jan 2010). "A report of gastric fundic gland polyps.". Gastroenterol Hepatol (N Y) 6 (1): 45-8. PMID 20567540.
  2. Freeman HJ (March 2008). "Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis". World J. Gastroenterol. 14 (9): 1318-20. PMID 18322941. http://www.wjgnet.com/1007-9327/14/1318.asp.
  3. Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH (November 2006). "Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy". Aliment. Pharmacol. Ther. 24 (9): 1341-8. doi:10.1111/j.1365-2036.2006.03127.x. PMID 17059515.
  4. Hegedus, I.; Csizmadia, C.; Lomb, Z.; Cseke, L.; Enkh-Amar, Y.; Pajor, L.; Bogner, B. (Mar 2012). "[Massive fundic gland polyposis caused by chronic proton pump inhibitor therapy].". Orv Hetil 153 (9): 351-6. doi:10.1556/OH.2012.29313. PMID 22348851.
  5. Masaoka T, Suzuki H, Hibi T (May 2008). "Gastric epithelial cell modality and proton pump inhibitor". J Clin Biochem Nutr 42 (3): 191-6. doi:10.3164/jcbn.2008028. PMC 2386521. PMID 18545640. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2386521/.
  6. URL: http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm. Accessed on: 19 October 2010.