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Gastric inverted hyperplastic polyp with typical endoscopic feature

  • Lang Yang
    Affiliations
    Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China

    Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
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  • Jing Li
    Affiliations
    Department of Pathology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
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  • Peng Jin
    Correspondence
    Corresponding author: Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China.
    Affiliations
    Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China

    Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
    Search for articles by this author
Published:January 21, 2023DOI:https://doi.org/10.1016/j.dld.2023.01.150
      A 37-year-old woman received gastroscopy for compliant of upper abdominal discomfort for six months. A polyp with size in 10 mm was found in the upper third of stomach. The polyp with a papilla-like depression in the top and smooth surface similar to surrounding non-atrophic mucosal characterized by regular arrangement of collective veins (Fig. 1A and B). Endoscopic ultrasound showed the lesion was hypo –equal echo in the mucosal layer, displayed expansive growth nature and oppressing submucosal layer (Fig. 1C). Histology of biopsy showed inflamed mucosa with submucosal atypic oxyntic gland, considering histological diagnosis of ectopic gastric glands with atypia, but adenocarcinoma of fundic gland type cannot be ruled out (Fig. 1D and E). Thus, the polyp was removed by endoscopic submucosal dissection for accurate histological diagnosis. The histology showed the benign hyperplastic glands with inverted growth manner with communication with mucosal at the top, the surround area was covered by normal oxyntic mucosa (Fig. 2), and diagnosed as gastric inverted hyperplastic polyp (GIHP). GIHPs are rare gastric polyps and typically appeared as rounded subepithelial lesions with normal overlying mucosa, more than half of cases with surface erosion, depression, or orifice exuding mucin [
      • Kim JY
      • Ahn S
      • Kim KM
      • et al.
      Gastric inverted polyps—distinctive subepithelial lesions of the stomach: clinicopathologic analysis of 12 cases with an emphasis on neoplastic potential.
      ]. GIHPs had the potential to develop adenocarcinoma, but histological diagnosis based on biopsy is challenging, endoscopic resection may be a wise choice for accurate diagnosis.
      Fig 1
      Fig. 1Endoscopic images and histology based on biopsy. (A) distant view; (B) close view; (C) endoscopic ultrasound (arrow); (D) histology of biopsy at low magnification(40x); (E) some glands with atypia at high magnification(200x).
      Fig 2
      Fig. 2Histology based on the resected specimen. (A) Scanning image of the lesion showed inverted growth manner; (B) Hyperplastic glands without dysplasia at high magnification.
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      Reference

        • Kim JY
        • Ahn S
        • Kim KM
        • et al.
        Gastric inverted polyps—distinctive subepithelial lesions of the stomach: clinicopathologic analysis of 12 cases with an emphasis on neoplastic potential.
        Am J Surg Pathol. 2021 May 1; 45: 680-689