Table of ContentsDefinition / general | Essential features | Terminology | Sites | Etiology | Clinical features | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Molecular / cytogenetics description | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1
Cite this page: Assarzadegan N, Gonzalez RS. Fundic gland polyp. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachfundicgland.html. Accessed January 17th, 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 for these polyps (Mod Path 2002;15:718)
- Can be sporadic, associated with familial adenomatous polyposis (FAP) or arise as part of a familial condition confined to the stomach without polyposis coli
- Also known as Elster glandular cysts and cystic hamartomatus epithelial polyps
- Typically restricted to the fundus and body of the stomach
- 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
- 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
- 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)
Microscopic (histologic) images
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.
Board review style question #1
- Which of the following statements is true about fundic polyps?
- Alterations of APC beta catenin pathway is seen in both sporadic and syndromic fundic gland polyps
- Dysplasia is a common finding in fundic gland polyps
- Only familial forms are associated with alteration in APC beta catenin pathway
- They are unequivocally benign and nonneoplastic