Fundic Gland Polyps with Dysplasia: Prevalence and Risk Factors
Dianne Torrence, Maya Balakrishnan, Rhonda Yantiss, Suzanne Lagarde, Joanna Gibson, Dhanpat Jain. Yale School of Medicine, New Haven, CT; Weill Medical College of Cornell University, New York, NY; Yale New Haven Hospital, New Haven, CT
Background: Dysplasia in fundic gland polyps (FGP) is uncommon and has been previously recognized in familial polyposis syndrome (FAP). However, the prevalence and significance of dysplasia in sporadic FGP have not been well studied. The goal of the study was to estimate the prevalence of and characterize the histologic features of dysplasia in sporadic FGPs and identify any risk factors, such as proton pump inhibitors (PPI) and non-steroidal anti-inflammatory drugs (NSAID).
Design: The institutional pathology database was searched for FGPs with dysplasia (FGP-D) diagnosed between 1994-2012. Detailed histopathologic assessment was performed, including evaluation of the morphologic features of dysplasia, background gastric mucosal changes, H. pylori status and presence of intestinal metaplasia. Duration of medication use, including PPI and NSAID, was recorded, when available. Similar number of age and gender matched patients who had FGPs without dysplasia was also evaluated. Patients with FAP were excluded.
Results: A total of 28 FGP-D were identified during the study period, out of a total of 1934 FGPs, in 28 patients. Patient mean age was 55.1 years and 9/28 were men. 3/28 (10.7%) patients were diagnosed before and 25/28 (89.3%) after the year 2000. Histologically, the dysplasia resembled the recently described foveolar-type dysplasia and was characterized by the presence of nuclear hyperchromasia, enlargement and crowding, as well as increased mitoses and minimal to no surface maturation. None of the FGP-D showed intestinal metaplasia, H. pylori, intestinal type or high grade dysplasia or carcinoma. Three patients (10.7%) with FGP-D had documented use of PPI (n=3) and NSAID (n=2).
Conclusions: Dysplasia in FGPs is uncommon, occurs in 1.4% of FGPs, and is morphologically characterized by low grade foveolar dysplasia-type histology. The increase of FGP-D is attributable at least in part due to increasing number of endoscopies and biopsies performed. Use of PPIs has been associated with increased incidence of FGPs, but evidence linking PPIs and/or NSAIDs to dysplasia is lacking. Although there is no evidence so far to suggest that FGP-D increases risk of gastric cancer, the relationship of FGP, with or without dysplasia, to fundic gland carcinoma, a recently described unique gastric carcinoma variant, remains unknown and needs further study.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 80, Wednesday Afternoon