Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics

Figure 1 A case of sporadic fundic gland polyp without dysplasia. A: White light endoscopic view. A 47-year-old man with a complaint of heartburn underwent esophagogastroduodenoscopy. He had no medical history of receiving long-term proton pump inhibitor therapy and no family history of familial adenomatous polyposis (FAP). White light endoscopy identified several fundic gland polyp-like lesions in the body of the stomach without atrophic mucosa, suggesting a Helicobacter pylori-uninfected setting. Among them, a 3 mm isochromatic sessile polyp with a smooth surface structure was detected in the middle body; B: Magnifying narrow-band imaging (NBI) endoscopic view. Magnifying NBI endoscopy revealed regularly arranged, white, dot-shaped crypt openings resembling surrounding mucosa; C: Chromoendoscopic view. Chromoendoscopy using indigo carmine dye revealed less irregularity of the lesion surface. This lesion was endoscopically diagnosed as a fundic gland polyp without dysplasia and was biopsied; D and E: Histopathological view. The histopathological examination revealed a non-dysplastic fundic gland polyp with hyperplastic proliferation of the oxyntic glands and several cystically dilated glands. Colonoscopy did not reveal indications for FAP.

Figure 2 A case of sporadic fundic gland polyp with carcinoma. A: White light endoscopic view. A 73-year-old woman with a complaint of upper abdominal discomfort underwent esophagogastroduodenoscopy. She had received long-term proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease. White light endoscopy identified several fundic gland polyp-like lesions in the body and fundus of the stomach without atrophic mucosa, suggesting a Helicobacter pylori (H. pylori)-uninfected setting. Among them, a 6 mm isochromatic sessile polyp with a slightly irregular surface structure was detected in the fundus; B: Magnifying narrow-band imaging (NBI) endoscopic view. Magnifying NBI endoscopy revealed irregular microvessels on the lesion surface; C: Chromoendoscopic view. Chromoendoscopy using indigo carmine dye more clearly revealed the irregularity of the lesion surface. This lesion was endoscopically diagnosed as a fundic gland polyp with dysplasia or carcinoma and was removed by the endoscopic mucosal resection technique; D: Histopathological view (low magnification). The histopathological examination revealed a fundic gland polyp with prominent dilated cystic glands often observed in patients receiving PPI therapy; E-G: Histopathological view (higher magnification of D). This lesion coexisted with epithelial dysplasia and intramucosal well-differentiated adenocarcinoma. Serological examination confirmed that she was negative for H. pylori infection. Colonoscopy as well as her family history showed no familial adenomatous polyposis.

Figure 3 Proposal of a management algorithm for sporadic fundic gland polyps. ¹If multiple fundic gland polyps are detected in patients receiving proton pump inhibitor therapy, reducing or discontinuing proton pump inhibitor therapy or switching to H2-receptor antagonists is recommended. NBI: Narrow-band imaging.