Gastric polyps
Types
- Neoplastic – adenoma, fundic gland polyp
- Non-neoplastic – hyperplastic polyps, inflammatory polyp, hamartomatous polyp
Pathology
- Hyperplastic – associated with chronic inflammation caused by H. pylori
- <2cm, often multiple – little malignant potential
- >2cm – can harbour dysplasia or carcinoma in situ
- Fundic gland polyps – associated with PPI therapy
- Adenomatous polyps – premalignant
- More common in patients with familial adenomatous polyposis (FAP)
- >2cm, often single
- Most common in the antrum
- Hyperchromatic nucleus
Clinical features
- Can be asymptomatic
- Pain, hematemesis, gastric outlet obstruction
Investigations
- Biopsy is essential. MC type – metaplastic
Treatment
- Observation and monitoring for non-neopalstic polyps
- Endoscopy and resection – for neoplastic polyps
Gastric epithelial dysplasia
- When cells of the stomach change and become abnormal – can eventually become adenocarcinoma
- Pathology
- Low grade dysplasia – abnormal cell change and slow growing
- High grade dysplasia – abnormal cell change and rapid growing
- Risk factors
- Chronic atrophic gastritis due to H. pylori – lining of stomach atrophies due to long term inflammation
- Intestinal metaplasia – lining of stomach replaced by tissues normally found in the small intestine
- Pernicious anaemia
- Investigations – endoscopy and biopsy
- Treatment
- Low grade – surgery not needed, patient is monitored, upper GI endoscopy and biopsy once a year
- High grade – endomucosal resection
Gastritis
- Type A – autoimmune, formation of antiparietal cell antibodies
- Parietal cell dysfunction leads to achlorydia and vitamin B12 deficiency
- Formation of microadenoma of enterochromaffin like cells – predisposing factor for gastric cancer
- Type B – due to H. pylori infection
- Antrum affected
- Peptic ulcer common
- Helicobacter related pangastritis – can turn into gastric cancer
- Reflux gastritis – after gastric surgeries
- Erosive gastritis – due to disturbed gastric mucosal barrier (induced by NSAIDS/alcohol)
- Due to inhibition of COX-1 → decreased prostaglandin synthesis which is cytoprotective
Neurinoma (schwannoma)
- Tumour of neurilemma (peripheral nerve sheath)
- Most frequently occurs in the antrum, but can also occur in the body and cardia
- Slow growing
- Most are benign but rarely have malignant potential
- Clinical features – depend on size
- Discomfort, nausea and vomiting
- Pyloric stenosis (depending on position)
- Treatment – partial gastrectomy
Leiomyoma
- Rare, benign mesenchymal tumours, usually found incidentally
Pathology
- Originate from the muscular layer of the stomach lining
- Characterised by bundles of splindle cells
- They are usually firm – but if they become ulcerate there is a tendency to bleed
Clinical features
- Usually asymptomatic if <2cm
- Larger tumours >2cm can cause symptoms
- Bleeding, obstruction, pain
Investigations
- Immunohistochemistry – positive for desmin and actin
- CT
Treatment
- Resection