Stomach
Polyps
Fundic gland polyp


Topic Completed: 15 February 2021

Minor changes: 15 February 2021

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PubMed Search: Stomach [title] fundic gland polyp "loattrfree full text"[sb]

Naziheh Assarzadegan, M.D.
Raul S. Gonzalez, M.D.
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Cite this page: Assarzadegan N, Gonzalez RS. Fundic gland polyp. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachfundicgland.html. Accessed April 12th, 2021.
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 of 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 hamartomatous 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 and are usually solitary but may be multiple (Hum Pathol 2000;31:684)
  • 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)
  • 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
Case reports
Treatment
  • Current guidelines do not recommend polypectomy or surveillance endoscopy for sporadic cases
  • Findings of multiple fundic gland polyps in a younger patient or fundic gland polyp with dysplasia should prompt colonic investigation for the possibility of familial adenomatous polyposis
  • In GAPPS, gastrectomy may be indicated
Clinical images

Images hosted on other servers:

Pedunculated lesion

Multiple polyps

Gross description
  • Typically small and sessile, with a glassy surface, usually less than a centimeter
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)
  • May harbor dysplasia
Microscopic (histologic) images

Contributed by Naziheh Assarzadegan, M.D.
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Cystically dilated glands

Missing Image

Fundic gland polyp with dysplasia



Case #389

Specialized gastric mucosa

Scattered dilated fundic type glands

Nuclear enlargement, hyperchromasia and stratification


Fundic gland polyp with dysplasia

Positive stains
Molecular / cytogenetics description
  • Associated with APC beta catenin alteration in both sporadic and syndromic cases
Sample pathology report
  • Stomach, fundus, polypectomy:
    • Fundic gland polyp
  • Stomach, fundus, resection:
    • Portion of stomach with numerous fundic gland polyps, some with focal low grade dysplasia (see comment)
    • Negative for high grade dysplasia or malignancy
    • Margins of resection unremarkable
    • Comment: Multiple fundic gland polyps can arise in several settings, including proton pump inhibitor use, familial adenomatous polyposis and gastric adenocarcinoma and proximal polyposis of the stomach.
Differential diagnosis
Board review style question #1

    Which of the following statements is true about gastric fundic gland 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 style answer #1
A. Alterations of APC beta catenin pathway is seen in both sporadic and syndromic fundic gland polyps

Comment Here

Reference: Fundic gland polyp
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