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Gastric Adenoma

Adenoma of Stomach


Presentation

Most gastric polyps are incidentally detected during endoscopic procedures, and this also applies to GA. They may grow in any part of the stomach and measure a few millimeters or several centimeters in diameter. Their designation as polyps implies that these tumors rise above the stomach lining. Indeed, the majority of GA are exophytic neoplasms, but about one in ten tumors is depressed relative to the surrounding mucosa [6]. GA typically possess a velvety surface and don't tend to bleed upon contact. They are most frequently solitary, while distinct gastric polyps without malignant potential as well as carcinoids and metastases are more likely to present as multiple lesions [3]. Furthermore, the presence of a pedicle as well as the absence of redness and surface erosions may imply a benign lesion, but these are not reliable parameters.

The vast majority of patients remains asymptomatic. Occasionally, GA may ulcerate and bleed, and patients may develop anemia. In rare cases, GA may provoke outflow obstructions and delayed gastric emptying [7].

Asymptomatic
  • The vast majority of patients remains asymptomatic. Occasionally, GA may ulcerate and bleed, and patients may develop anemia. In rare cases, GA may provoke outflow obstructions and delayed gastric emptying.[symptoma.com]
  • Adenomas are usually seen to arise in a background of chronic atrophic gastritis and intestinal metaplasia. [1] , [2] They usually remain asymptomatic, but have a significant risk for malignant change wherein underlies their importance.[jdeonline.in]
  • They are almost always asymptomatic and are usually discovered as an incidental finding at an endoscopic examination. Gastric polyp at the cardias. The video clip displays a gastric carcinoma at the corpus and fundus a polyp is observed.[gastrointestinalatlas.com]
  • Polyps are generally asymptomatic but may occasionally ulcerate and bleed; uncommonly, they may result in obstruction if very large.[emedicine.medscape.com]
Dyspepsia
  • It often produces no specific symptoms when it is superficial and potentially surgically curable, although up to 50% of patients may have nonspecific gastrointestinal complaints such as dyspepsia 2 .[radiopaedia.org]
  • […] code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Polyp, polypus stomach K31.7 duodenum K31.7 ICD-10-CM Codes Adjacent To K31.7 K30 Functional dyspepsia[icd10data.com]
  • "Proton Pump Inhibitor or Testing for Helicobacter pylori as the First Step for Patients Presenting with Dyspepsia? A Cluster-Randomized Trial". The American Journal of Gastroenterology . 101 (6): 1200–1208. doi : 10.1111/j.1572-0241.2006.00673.x .[en.wikipedia.org]
  • Palabras clave: Gastric tumors, pyloric gland adenoma, gastric polyps, dyspepsia, upper gastrointestinal endoscopy, Mexico Texto Completo ?? Introduction Gastric adenomas are characterized by polypoid projections of dysplastic epithelium.[revistagastroenterologiamexico.org]
  • Large GISTs may produce symptoms of gastric outlet obstruction or present with pain/dyspepsia, early satiety and nausea. Pathology Gastric GISTs are highly cellular and tend to be of either spindle cell or epithelioid subtypes.[atlasgeneticsoncology.org]
Gastropathy
  • Gastric antral vascular ectasia Reactive gastropathy Autoimmune metaplastic atrophic gastritis AKA autoimmune gastritis .[librepathology.org]
  • Considered to be analogous to colonic dysplasia-associated masses arising in setting of chronic inflammatory bowel disease, as they arise in a background of atrophic gastritis (metaplastic or autoimmune) Only rarely associated with reactive / chemical gastropathy[pathologyoutlines.com]
Hematemesis
  • Hyperplaginous polyp that caused hematemesis. Gastric polyp that was removed with the diathermy snare. (polypectomy).[gastrointestinalatlas.com]
Erythema
  • […] al. [ 15 ] ESD LGD 195 LGD HGD 15 HGD, depression, HGD 87 LGD CA 23 surface redness, HGD CA 48 size 2 cm Choi et al. [ 17 ] ESD LGD 218 LGD HGD 14 Surface redness, LGD CA 24 surface nodularity, size 1 cm Kim et al. [ 18 ] EMR, ESD LGD 285 LGD HGD 22 Erythema[ekjm.org]

Workup

Gastric polyps are detected endoscopically, but additional therapeutic measures are necessary to determine their nature. Histopathological analyses of tissue specimens may reveal whether a gastric polyp does indeed correspond to GA, and if so, which cell type prevails in this benign neoplasm. GA consist of dysplastic epithelium and contain goblet cells and/or Paneth cells - these tumors are defined as intestinal-type GA - or foveolar cells, which form gastric-type GA [3]. The former are more common and are more likely to harbor adenocarcinoma. Other classification systems consider the differentiation of low-grade tumors and high-grade GA [8] [9]. Parameters considered to this end comprise mitotic activity, nuclear anomalies like hyperchromasia, and architectural changes. Additionally, patients diagnosed with GA frequently suffer from gastric atrophy and intestinal metaplasia, and these conditions may also be confirmed histopathologically. In case of multiple lesions, it is strongly recommended to examine several tissue samples since different types of gastric polyps are known to coincide [10].

Pneumoperitoneum
  • One case each of pneumoperitoneum and Mallory-Weiss tearing occurred and could be managed with conservative care. One case of overt bleeding occurred after 2 weeks and was treated with APC.[ncbi.nlm.nih.gov]
Nephrolithiasis
  • Her past medical history revealed nephrolithiasis and a urinary tract surgery. Physical examination of the patient was unremarkable. Serum calcium, phosphate and parathormone levels were 13 mg/dL, 3 mg/dL, and 410 pg/mL, respectively.[turkjem.org]
Gastric Lesion
  • At present, there are no established guidelines for either surveillance or treatment of gastric lesions in FAP patients.[austinpublishinggroup.com]
  • For Case 1, with early oesophageal cancer and gastric adenoma with SEA in the body of stomach, a laparotomy and local resection of the gastric lesion were carried out prior to thoracotomy in order to determine the safest reconstructive method after measuring[ncbi.nlm.nih.gov]
  • Forty-nine consecutive gastric lesions were diagnosed as adenomas by conventional endoscopy with forceps biopsy and finally resected by endoscopic submucosal dissection.[ncbi.nlm.nih.gov]
  • lesions scattered evenly in other regions 15% in extra-gastric sites usually in patches of gastric heterotopic epithelium Duodenum, bile duct, gall bladder Oxyntic gland polyp/adenoma (proposed entity, Singhi 2012) Clustered glands and cords of oxyntic[surgpathcriteria.stanford.edu]
  • Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection. See comment in PubMed Commons belowSurg Endosc 2013; 27:1211–1218. 27.[ekjm.org]
Lymphocytic Infiltrate
  • Eight patients (6.8%) had gastritis with typical features of an earlier H pylori infection; that is, the presence of lymphoid aggregates, moderate lymphocytic infiltrate, but no detectable organisms (fig 2).[jcp.bmj.com]

Treatment

  • Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma.[ncbi.nlm.nih.gov]
  • After treatment of gastric adenoma, meticulous follow-up endoscopy is recommended for detection of metachronous lesions.[ncbi.nlm.nih.gov]
  • The materials were 93 lesions that required differential diagnosis between gastric adenoma and well-differentiated adenocarcinoma among the gastric epithelial tumors for which endoscopic treatment was planned at three facilities during the 14 months between[ncbi.nlm.nih.gov]
  • We included 210 patients with gastric adenoma, who underwent treatment with either APC (97 patients) or ESD (113 patients).[ncbi.nlm.nih.gov]
  • A nonrandomized trial of Helicobacter pylori eradication was conducted in patients with endoscopically diagnosed gastric adenoma to determine the long-term effect of antimicrobial treatment on progression of the adenoma.[ncbi.nlm.nih.gov]

Prognosis

  • Moreover, Pim-3 may be employed to predict the prognosis of gastric cancer patients. Distinct Pim-3 expression underlies the molecular mechanisms for the differentiation of intestinal-type and diffuse-type carcinomas.[ncbi.nlm.nih.gov]
  • Treatment and prognosis It is an aggressive tumour with a 5-year survival rate of less than 20%. Prognosis is correlated to the stage of the tumour at presentation.[radiopaedia.org]
  • PMID 18267927 Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Miettinen M, Lasota J. Arch Pathol Lab Med. 2006 Oct;130(10):1466-78.[atlasgeneticsoncology.org]
  • Type IV carcinoid may arise anywhere in the stomach and have a significantly worse prognosis.[gastroenterologyandhepatology.net]
  • Pagina 38 - Dukes CE, Bussey HJR, The spread of rectal cancer and its effect on prognosis. Br J Cancer 1958; 12: 309-20. ‎[books.google.ro]

Etiology

  • Etiologies: various - see amyloidosis . Gross/endoscopy Red/swollen gastric folds. [22] Endoscopic DDx: Stomach cancer . [23] [24] Microscopic Features: Lamina propria expanded by amorphous paucicellular material.[librepathology.org]
  • Disease Gastric adenocarcinoma Etiology Helicobacter pylori H. pylori is the single most important etiological agent in the pathogenesis of gastric cancer.[atlasgeneticsoncology.org]
  • In this context, associations of PGAs with autoimmune gastritis have been reported. 14,15 However, these findings are not present in all cases, and the influence of autoimmune gastritis in the etiology of PGAs has not been confirmed.[revistagastroenterologiamexico.org]
  • […] hyperplastic polyps are strongly associated with inflammatory disorders such as chronic gastritis, H pylori gastritis, pernicious anemia, and reactive or chemical gastritis. 11,25 As such, it is worthwhile to biopsy the background flat mucosa to identify any etiologic[gastroenterologyandhepatology.net]

Epidemiology

  • Although epidemiological studies strongly suggest an association between Helicobacter pylori infection and gastric carcinogenesis via a multistage process, a causal link between them has not been demonstrated.[ncbi.nlm.nih.gov]
  • Epidemiologic factors, molecular and biologic determinants, diagnostic/staging methods and treatment modalities are described for each organ site.[books.google.de]
  • The contents range widely, covering the entire field from epidemiology through screening methods, diagnostic approaches and therapy of both primary and secondary disease.[books.google.ro]
  • To determine the prevalence of epidemiologic factors related to gastric adenocarcinoma in patients with gastric adenocarcinoma and without gastric adenocarcinoma. Patients and Methods.[dspace.unitru.edu.pe]
Sex distribution
Age distribution

Pathophysiology

  • Further research is needed on the pathophysiology of this disease.[revistagastroenterologiamexico.org]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management . 6th ed. Philadelphia: WB Saunders; 1997. 467-71. Mandel JS, Bond JH, Church TR, et al.[emedicine.medscape.com]
  • This tumor has been associated with metaplasia and autoimmunity; nevertheless, additional studies are needed for both pathophysiology of the disease and its relation with other diseases.[karger.com]
  • Citation CrossRef TDM Supplementary Material E-Mail Print Share: METRICS 0 Crossref 6,081 View 256 Download Treatment of Severe Asthma 2018 April;93(2) Treatment of Iron-Deficiency Anemia 2015 July;89(1) Treatment of Allergic Rhinitis 2013 November;85(5) Pathophysiology[ekjm.org]

Prevention

  • "Intravenous pantoprazole 40mg every 24 hours or 12 hours for two days after endoscopic resection were equally effective for the prevention of delayed bleeding," the authors write.[empr.com]
  • Korean Journal of Preventive Medicine 1994;27(4): 677-692. Serum Pepsinogen Levels as a Screening Test of Gastric Cancer and Adenoma in Korea.[jpmph.org]
  • The preferred citation for this PDQ summary is: PDQ Screening and Prevention Editorial Board. PDQ Stomach (Gastric) Cancer Prevention. Bethesda, MD: National Cancer Institute. Updated . Available at: . Accessed .[cancer.gov]
  • Talk to your doctor about how to prevent recognize and manage low blood sugar (hypoglycemia) high blood sugar Family dinners are more often than not an ordeal of nervou indigestion Find a translation for the psychosomatic definition in other languages[biobankcloud.eu]
  • Prevention Through Participation in a Registry The goal of the Inherited Colorectal Cancer Registries (ICCR) at Cleveland Clinic is to prevent needless deaths from colon cancer.[my.clevelandclinic.org]

Summary

While gastric polyps are rather common findings in endoscopic procedures, few gastric polyps correspond to gastric adenoma (GA), a benign neoplasm sometimes also referred to as gastric adenomatous polyp [1] [2]. The distinction between subtypes of gastric polyps is of major therapeutic and prognostic relevance, though, since polyps without malignant potential may resemble precancerous lesions like GA, carcinoids and metastases [3]. In detail, neither hyperplastic polyps nor inflammatory fibrinoid polyps or hamartomatous polyps are likely to undergo malignant transformation, whereas the presence of gastric metastases does indicate an underlying malignancy. GA are known to be associated with concomitant adenocarcinoma, and they may undergo malignant transformation, but to date, it is not possible to predict such developments. Estimates regarding a GA patient's risk to suffer from adenocarcinoma vary largely and range from 2.5 to 50% [2]. Therefore, all GA should be resected. Regular follow-ups are an essential part of GA therapy and after the successful removal of the tumor, patients should undergo periodic endoscopy [4].

Patients suffering from Lynch syndrome, familial adenomatous polyposis, or MUTYH-associated polyposis are at increased risks of developing GA [5].

References

Article

  1. Smith GV, Feakins R, Farthing MJ, Ballinger A. Cyclooxygenase 2, p53, beta-catenin, and APC protein expression in gastric adenomatous polyps. Am J Clin Pathol. 2005; 123(3):415-420.
  2. Abraham SC, Montgomery EA, Singh VK, Yardley JH, Wu TT. Gastric adenomas: intestinal-type and gastric-type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology. Am J Surg Pathol. 2002; 26(10):1276-1285.
  3. Jung JT. Gastric polyps and protruding type gastric cancer. Clin Endosc. 2013; 46(3):243-247.
  4. Kelly PJ, Lauwers GY. Clinical guidelines: Consensus for the management of patients with gastric polyps. Nat Rev Gastroenterol Hepatol. 2011; 8(1):7-8.
  5. Jasperson KW, Tuohy TM, Neklason DW, Burt RW. Hereditary and familial colon cancer. Gastroenterology. 2010; 138(6):2044-2058.
  6. Tamai N, Kaise M, Nakayoshi T, et al. Clinical and endoscopic characterization of depressed gastric adenoma. Endoscopy. 2006; 38(4):391-394.
  7. Park DY, Lauwers GY. Gastric polyps: classification and management. Arch Pathol Lab Med. 2008; 132(4):633-640.
  8. Rugge M, Correa P, Dixon MF, et al. Gastric dysplasia: the Padova international classification. Am J Surg Pathol. 2000; 24(2):167-176.
  9. Yamada H, Ikegami M, Shimoda T, Takagi N, Maruyama M. Long-term follow-up study of gastric adenoma/dysplasia. Endoscopy. 2004; 36(5):390-396.
  10. Sonnenberg A, Genta RM. Prevalence of benign gastric polyps in a large pathology database. Dig Liver Dis. 2015; 47(2):164-169.

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Last updated: 2017-08-09 16:36