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Presented by Ralph Hruban, M.D. and prepared by Shien Micchelli, M.D.
Case 2: This 70 some year-old woman of European descent underwent partial gastrectomy.
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1. Question
Week 288: Case 2
This 70 some year-old woman of European descent underwent partial gastrectomy.images/10_30_06_2a.jpg
images/10_30_06_2b.jpg
images/10_30_06_2c.jpgCorrect
Answer: Fundic gland polyp with PPi effect
Histology: Two lesions are present. The background stomach show numerous enlarged and hyperplastic parietal cells. In addition, several polyps composed of oxyntic mucosa with dilated fundic glands are present.
Discussion: Proton pump inhibitors (PPI) block the H+K+ ATPase producing a low acid environment in the stomach. This, in turn, stimulates gastrin which has a trophic effect on parietal cells giving them a “juicy” appearance. This patient also has benign gastric polyps. These polyps are composed of a proliferating oxyntic mucous producing dilated fundic glands. Fundic gland polyps can be sporadic or they can arise in patients with familial adenomatous polyposis. Fundic gland polyps are benign and do not have significant malignant potential. In young patients the finding of fundic gland polyps may warrant clinical testing for familial adenomatous polyposis. This patient was elderly and lacked a family history.Proton pump inhibitors (PPI) block the H+K+ ATPase producing a low acid environment in the stomach. This, in turn, stimulates gastrin which has a trophic effect on paneth cells giving them a “juicy” appearance. This patient also has benign gastric polyps. These polyps are composed of a proliferating oxyntic mucous producing dilated fundic glands. Fundic gland polyps can be sporadic or they can arise in patients with familial adenomatous polyposis. Fundic gland polyps are benign and do not have significant malignant potential. In young patients the finding of fundic gland polyps may warrant clinical testing for familial adenomatous polyposis. This patient was elderly and lacked a family history.
Incorrect
Answer: Fundic gland polyp with PPi effect
Histology: Two lesions are present. The background stomach show numerous enlarged and hyperplastic parietal cells. In addition, several polyps composed of oxyntic mucosa with dilated fundic glands are present.
Discussion: Proton pump inhibitors (PPI) block the H+K+ ATPase producing a low acid environment in the stomach. This, in turn, stimulates gastrin which has a trophic effect on parietal cells giving them a “juicy” appearance. This patient also has benign gastric polyps. These polyps are composed of a proliferating oxyntic mucous producing dilated fundic glands. Fundic gland polyps can be sporadic or they can arise in patients with familial adenomatous polyposis. Fundic gland polyps are benign and do not have significant malignant potential. In young patients the finding of fundic gland polyps may warrant clinical testing for familial adenomatous polyposis. This patient was elderly and lacked a family history.Proton pump inhibitors (PPI) block the H+K+ ATPase producing a low acid environment in the stomach. This, in turn, stimulates gastrin which has a trophic effect on paneth cells giving them a “juicy” appearance. This patient also has benign gastric polyps. These polyps are composed of a proliferating oxyntic mucous producing dilated fundic glands. Fundic gland polyps can be sporadic or they can arise in patients with familial adenomatous polyposis. Fundic gland polyps are benign and do not have significant malignant potential. In young patients the finding of fundic gland polyps may warrant clinical testing for familial adenomatous polyposis. This patient was elderly and lacked a family history.
