Stomach
Polyps
Fundic gland polyp

Author: Naziheh Assarzadegan, M.D.
Editor: Raul S. Gonzalez, M.D.

Revised: 27 November 2017, last major update November 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Stomach [title] fundic gland polyp "loattrfree full text"[sb]
Cite this page: Assarzadegan, N. Fundic gland polyp. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachfundicgland.html. Accessed October 18th, 2018.
Definition / general
  • Benign cystic hyperplastic proliferation of oxyntic gland
  • Traditionally regarded as hamartomatous lesions; however, studies have shown alterations in the APC-beta catenin pathway in both sporadic and syndromic cases, supporting a neoplastic nature for these polyps (Mod Path 2002;15:718)
Essential features
  • Can be sporadic, associated with familial adenomatous polyposis (FAP) or arise as part of a familial condition confined to the stomach without polyposis coli
Terminology
  • Also known as Elster glandular cysts and cystic hamartomatus epithelial polyps
Sites
  • Typically restricted to the fundus and body of the stomach
Etiology
  • Sporadic cases are usually secondary to use of proton pump inhibitors (Hum Pathol 2000;31:684) and are usually solitary but may be multiple
  • Syndromic cases can arise from FAP or Gastric Adenocarcinoma and Proximal Polyposis of the Stomach (GAPPS) (Gut 2012;61:774)
Clinical features
  • Most commonly encountered form of gastric polyps
  • Peak incidence in fifth or sixth decade of life in sporadic cases and second and third decade in FAP patients
  • Sporadic cases rarely harbor dysplasia (Gasteroenterol Hepatol 2009;7:849); progression to carcinoma is vanishingly rare (Am Surg 2008;74:79)
  • FAP associated fundic gland polyps arise at younger ages, are more numerous and are more likely to show low grade dysplasia
  • Patients with GAPPS present with fundic gland polyposis and gastric adenocarcinoma at a young age
Treatment
  • Current guidelines do not recommend polypectomy or surveillance endoscopy for sporadic cases
  • Findings of multiple FGPs in a younger patient or FGP with dysplasia should prompt colonic investigation for the possibility of familial adenomatous polyposis
  • In GAPPS, gastrectomy may be indicated
Gross description
  • Typically small and sessile, with a glassy surface, usually less than a centimeter
Gross images

Images hosted on other servers:

50 year old woman
taking proton pump
inhibitors for 10 years
Microscopic (histologic) description
  • Cystically dilated glands lined by chief cells, parietal cells and mucinous foveolar cells
  • Hyperplastic parietal cells with apocrine snouting is seen in patients on proton pump inhibitors
  • May rarely contain squamous morules (Int J Clin Exp Pathol 2014;7:1241)
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by: Naziheh Assarzadegan, M.D.
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Fig 1: Low magnification

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Fig 2: High magnification

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Fig 3: Fundic gland polyp with dysplasia


Case of the Week #389:

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Contributed by Dr. Anne Herdman, PathGroup / Associated Pathologists, Tennessee (USA): fundic gland polyp with dysplasia

Positive stains
Molecular / cytogenetics description
  • Associated with APC beta catenin alteration in both sporadic and syndromic cases
Differential diagnosis
  • Oxyntic gland adenoma: anastomosing cords of oxyntic cells rather than dilated cysts; contain mucous neck cells rather than foveolar cells (Am J Surg Pathol 2012;36:1030)
Board review question #1
    Which of the following statements is true about fundic polyps?

  1. Alterations of APC beta catenin pathway is seen in both sporadic and syndromic fundic gland polyps
  2. Dysplasia is a common finding in fundic gland polyps
  3. Only familial forms are associated with alteration in APC beta catenin pathway
  4. They are unequivocally benign and nonneoplastic
Board review answer #1
A. Alterations of APC beta catenin pathway is seen in both sporadic and syndromic fundic gland polyps