Polypoid Lesions Adenoma and Rare Findings

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While relatively rare, gastric adenomas have a tendency to undergo malignant change. The frequency of the adenoma-to-carcinoma sequence is uncertain, however. Reportedly, carcinoma develops in up to 40% of patients with gastric adenomas larger than 2 cm.

Endoscopic diagnostic criteria (Fig. 3.102)

► Most commonly located in the prepyloric antrum or near the cardia

► Surface irregular, septated, erythematous

► May show erosion or ulceration

► Mucosal erythema

Differential diagnosis

► In particular: hyperplastic polyps

Checklist for endoscopic evaluation

Additional Studies

Comments

Gastric adenoma is a precancerous lesion. Endoscopic biopsy surveillance is adequate for lesions smaller than 1 cm. Lesions larger than 1 cm should be removed.

■ Heterotopic Brunner Glands

This is a rare condition seen predominantly in the gastric antrum (Fig. 3.103a, b). The lesions are usually small (< 1 cm).

Carcinoids may present as polypoid lesions. Occurrence in the stomach is very rare.

■ Heterotopic Pancreatic Tissue

Heterotopic pancreas is very rare and is found only in the antrum. The lesion is moderately large, occasionally exceeding 1 cm in size.

■ Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome is an autosomal dominant condition characterized by perioral melanin pigmentation and intestinal polyposis. The polyps occur mainly in the small bowel and colon but may also be found in the stomach (Fig. 3.103 c). Histologi-cally, the lesions are submucosal hamartomas that are usually 1-2 cm in size but may grow considerably larger. There is no risk of malignant transformation, but the risk of colon cancer is increased due to a greater frequency of adenoma occurrence.

b Gastric polyp. Histology: adenoma

Fig. 3.102 Adenomas a Pedunculated gastric polyp. Histology: adenoma b Gastric polyp. Histology: adenoma

Fig. 3.103 Rare benign tumors of the stomach a, b Heterotopic Brunner glands

Fig. 3.103 Rare benign tumors of the stomach a, b Heterotopic Brunner glands

Fig. 3.102 Adenomas a Pedunculated gastric polyp. Histology: adenoma

Gastric polyposis in Peutz-Jeghers syndrome

■ Treatment and Follow-Up

For polyps smaller than 1 cm, further management is contingent upon biopsy findings (Figs. 3.104, 3.105). Complete removal is indicated for polyps larger than 1 cm.

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