Malignant transformation of a gastric hyperplastic polyp in a context of Helicobacter pylori-negative autoimmune gastritis: a case report

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Background:
Gastric foveolar hyperplastic polyps (GFHPs) are common findings in clinical practice. GFHPs commonly arise in a background of chronic atrophic gastritis, including autoimmune gastritis (type A gastritis), and have a potential risk of malignant transformation.

Case presentation:
In 2005, a 55-year-old Japanese woman underwent upper endoscopy at another hospital and was found to have a pedunculated polyp (10 mm in diameter) on the greater curvature of the lower gastric body. On biopsy, the polyp was diagnosed as a GFHP. Nine years later, the polyp had grown to 20 mm in diameter, and the biopsy specimen taken at this time showed tubular adenocarcinoma. On admission to our hospital, the serum Helicobacter Pylori (H. pylori) immunoglobulin G antibody and stool H. pylori antigen were both negative. Anti-gastric parietal cell antibody was positive, as was the anti-intrinsic factor antibody, and the fasting serum gastrin level was markedly increased. In 2014, en bloc resection of the pedunculated polyp was performed by endoscopic submucosal dissection. The final histological diagnosis was adenocarcinoma of the stomach with submucosal and lymphatic invasion. Subsequently, additional radical distal gastrectomy was performed. At the latest follow-up (12 months postoperatively), no recurrence was noted.

Conclusions:
We here reported a rare case of malignant transformation of GFHP arising in a context of type A gastritis. To our knowledge, there are no previous reports on malignant transformation of GFHP with submucosal and lymphatic invasion arising in a background of type A gastritis in the English literature. Further, there is currently no effective treatment other than endoscopic or surgical treatment for such cases. Given the potential risk of malignant transformation due to hypergastrinemia, we consider that endoscopic treatment should be considered as a first-line therapy when a malignant growth is suspected.

Keywords:
Gastric hyperplastic foveolar polyp, Autoimmune gastritis, Helicobacter pylori, Gastric carcinoma, Case report

Autoři: Kenichi Yamanaka ^1*; Hiroyuki Miyatani ¹; Yukio Yoshida ¹; Takehiro Ishii ¹; Shinichi Asabe ¹; Osamu Takada ²; Mitsuhiro Nokubi ³; Hirosato Mashima ¹
Působiště autorů: Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 0-850 , Japan. ¹; Department of Surgery, Jichi Medical University, Saitama Medical Center, Saitama 0-850 , Japan. ²; Department of Pathology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan. ³
Vyšlo v časopise: BMC Gastroenterology 2016, 16:130
Kategorie: Case report
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12876-016-0537-x

© 2016 The Author(s).

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The electronic version of this article is the complete one and can be found online at: http://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0537-x

Souhrn

Keywords:
Gastric hyperplastic foveolar polyp, Autoimmune gastritis, Helicobacter pylori, Gastric carcinoma, Case report

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