Inverted Hyperplastic Polyp in Stomach: A Case Report and Literature Review

Yeon Ho Lee; Moon Kyung Joo; Beom Jae Lee; Ji-Ae Lee; Taehyun Kim; Jin Gu Yoon; Jung Min Lee; Jong-Jae Park

doi:10.4166/kjg.2016.67.2.98

Journal List > Korean J Gastroenterol > v.67(2) > 1007541

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Lee, Joo, Lee, Lee, Kim, Yoon, Lee, and Park: Inverted Hyperplastic Polyp in Stomach: A Case Report and Literature Review

Case Report

Korean J Gastroenterol 2016;67(2):98-102.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.2.98

Inverted Hyperplastic Polyp in Stomach: A Case Report and Literature Review

Yeon Ho Lee, Moon Kyung Joo, Beom Jae Lee, Ji-Ae Lee, Taehyun Kim, Jin Gu Yoon, Jung Min Lee, Jong-Jae Park

Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Correspondence to: Jong-Jae Park, Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea. Tel: +82-2-2626-1771, Fax: +82-2-2626-1019, E-mail: gi7pjj@korea.ac.kr

Received 7 October 2015 Revised 13 October 2015 Accepted 13 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.

Keywords: Inverted hyperplastic polyp, Stomach, Endoscopic submucosal dissection

References

1. Yamashita M, Hirokawa M, Nakasono M, et al. Gastric inverted hyperplastic polyp. Report of four cases and relation to gastritis cystica profunda. APMIS. 2002; 110:717–723.

2. Kamata Y, Kurotaki H, Onodera T, Nishida N. An unusual heterotopia of pyloric glands of the stomach with inverted downgrowth. Acta Pathol Jpn. 1993; 43:192–197.

3. Itoh K, Tsuchigame T, Matsukawa T, Takahashi M, Honma K, Ishimaru Y. Unusual gastric polyp showing submucosal proliferation of glands: case report and literature review. J Gastroenterol. 1998; 33:720–723.

4. Katz LB, Tenembaum MM, Kreel I. Gastric hamartomatous polyps in the absence of familial polyposis: report of two cases. Mt Sinai J Med. 1982; 49:426–429.

5. Hanada M, Takami M, Hirata K, Kishi T, Nakajima T. Hyperplastic fundic gland polyp of the stomach. Acta Pathol Jpn. 1983; 33:1269–1277.

6. Carfagna G, Pilato FP, Bordi C, Barsotti P, Riva C. Solitary polypoid hamartoma of the oxyntic mucosa of the stomach. Pathol Res Pract. 1987; 182:326–330.

7. Aoki M, Yoshida M, Saikawa Y, et al. Diagnosis and treatment of a gastric hamartomatous inverted polyp: report of a case. Surg Today. 2004; 34:532–536.

8. Kono T, Imai Y, Ichihara T, et al. Adenocarcinoma arising in gastric inverted hyperplastic polyp: a case report and review of the literature. Pathol Res Pract. 2007; 203:53–56.

9. Ono S, Kamoshida T, Hiroshima Y, et al. A case of early gastric cancer accompanied by a hamartomatous inverted polyp and successfully managed with endoscopic submucosal dissection. Endoscopy. 2007; 39(Suppl 1):E202.

10. Odashima M, Otaka M, Nanjo H, et al. Hamartomatous inverted polyp successfully treated by endoscopic submucosal dissection. Intern Med. 2008; 47:259–262.

11. Kim HS, Hwang EJ, Jang JY, Lee J, Kim YW. Multifocal adenocarcinomas arising within a gastric inverted hyperplastic polyp. Korean J Pathol. 2012; 46:387–391.

12. Lee SJ, Park JK, Seo HI, et al. A case of gastric inverted hyperplastic polyp found with gastritis cystica profunda and early gastric cancer. Clin Endosc. 2013; 46:568–571.

13. Jung M, Min KW, Ryu YJ. Gastric inverted hyperplasic polyp composed only of pyloric glands: a rare case report and review of the literature. Int J Surg Pathol. 2015; 23:313–316.

14. Choi MS, Jin SY, Kim DW, Lee DW, Park SM. A case of gastric inverted hyperplastic polyp associated with gastritis cystica profunda and early gastric carcinoma. Korean J Pathol. 2007; 41:55–58.

15. Lee KM, Kim JH. Endoscopic treatment of gastric adenoma with argon plasma coagulation. Pascu O, editor. Therapeutic gastrointestinal endoscopy. Rijeka, Croatia: InTech;2011. p. 33–56.

Fig. 1.

Pre-procedural findings. (A) An esophagogastroduodenoscopy shows a submucosal mass with central ulceration in high body, great curvature. (B) Endoscopic ultrasonography shows that the lesion is located in the submucosa and has inhomogeneous hypoechogenecity. (C) A computed tomography shows a 1.9 cm sized lesion in high body, posterior wall (arrow).

Fig. 2.

Endoscopic submucosal dissection for gastric subepithelial tumor (SET). (A) A large SET is found on the high body, greater curvature side. (B, C) Mucosal layer in the lower part of the tumor is removed using two-channel endoscopy to expose the base of the tumor. (D) Submucosal dissection is performed using insulated tip knife. (E) After resection of the tumor, grossly no remnant tissue is observed.

Fig. 3.

Microscopic findings of resected specimen (H&E). (A) Glandular proliferation with cystic dilatation and smooth muscle proliferation are found in submucosa (×12.5). (B) Submucosal lesion consists of foveola-type columnar epithelium (×100).

Table 1.

Case Review of Gastric Inverted Hyperplastic Polyp in English and Korean Literature

Author	Reported year	Age (yr)	Sex	Symptoms	Location	Gross ^a	^a Size (cm)	Associated findings	Treatment
Yamashita et al.¹	¹2002	69	M	Melena	Body	YI	1×0.9	AC, GCP	Surgery
Yamashita et al.¹	¹2002	58	M	Loss of appetite	Cardia	YII	2.6×2.2	−	Surgery
Yamashita et al.¹	¹2002	34	F	Asymptomatic	Body	YIII	3×3	−	Surgery
Yamashita et al.¹	¹2002	81	M	Vomiting,	Fundus	YI	0.5×0.5	AC, GCP	Surgery
				abdominal fullness
Kamata et al.²	1993	79	M	NA	Body	YII	2.5×1.5	AC	NA
Itoh et al.³	1998	41	F	Epigastric discomfort	Fundus	YIV	2.3×1.8×0.9	−	EP
Katz et al.⁴	1982	85	F	NA	Antrum	NA	11×5	NA	NA
Katz et al.⁴	1982	51	F	NA	Antrum	NA	6×4	NA	NA
Hanada et al.⁵	1983	47	F	NA	Fundus	YIV	1.3×0.9	NA	NA
Carfagna et al.⁶	1987	66	F	NA	Fundus	YIV	1.5×1.5	Atrophic gastritis	NA
Aoki et al.⁷	2004	43	F	Asymptomatic	Body	YIII	2.8×2.8	−	Surgery
Kono et al.⁸	2007	54	M	Asymptomatic	Antrum	YIV	4.5×3.5	AC, transition zone	Surgery
Ono et al.⁹	2007	59	M	Asymptomatic	Body	YIII	NA	AC	ESD
Odashima et al.¹	⁰2008	37	M	Asymptomatic	Fundus	YII	2.5×2.5	−	ESD
Kim et al.¹¹	2012	40	F	Epigastric discomfort	Body	YIII	3.5×3.2×1.8	AC, SC, transition zone	ESD
Lee et al.¹²	2013	77	M	Asymptomatic	Body	YI	4.5×3×0.5	AC, GCP	ESD
Jung et al.¹³	2015	70	M	Epigastric discomfort	Body	YI	1.6×1.5×0.4	−	ESD
Choi et al.¹⁴	2007	71	M	Epigastric discomfort,	Body	YI	3.5×3.5	AC, GCP	Surgery
				dyspepsia
Present case	−	41	M	Epigastric discomfort	Body	YII	2×2×1.3	−	ESD

NA, not applicable; AC, adenocarcinoma; GCP, gastritis cystica profunda; SC, signet ring cell carcinoma; EP, endoscopic polypectomy; ESD, endoscopic submucosal dissection.

^a Yamada classification.

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