21

Case 21


History



An 80-year-old gentleman with a past history of diabetes, hypertension, hyperlipidaemia and chronic kidney disease is admitted with symptoms of epigastric pain. On further enquiry, he also reveals a history of prophylactic colectomy for familial adenomatous polyposis.


Physical examination


Afebrile, pulse 64 bpm, BP 135/60mmHg, SaO2 98-100% on RA.


Hydration is good.


Examination of the hands reveals no clubbing and normal-appearing palmar creases.


Head and neck examination is unremarkable.


Cardiovascular: HS dual, no murmur.


His chest is clear on auscultation.


Abdominal examination reveals a soft abdomen, with a midline laparotomy scar noted.


No signs of oedema.


Investigations


CBC:


WBC 7.2 x 109/L;


haemoglobin 10.9g/dL;


platelets 191 x 109/L.


Creatinine 123μmol/L.


Liver function tests are normal.


Clotting profile is normal.


What would you do next?


An oesophagogastroduodenoscopy (OGD) should be performed (Figures 21.1 and 21.2).






images






images


Please describe what you see


There are multiple, small 2-4mm, sessile polyps with a smooth surface throughout the entire stomach, mainly concentrated at the fundus and body upon retroflexion of the endoscope.


What is your differential diagnosis?


Fundic gland polyp.


Hyperplastic polyp.


Hamartomatous polyp.


Adenomatous polyp.


How would you proceed?


Biopsy the lesions.


Drug history — any long-term use of proton pump inhibitors.


The biopsy results show some dilated fundic glands lined by an attenuated layer of chief and parietal cells with no features of dysplasia or malignancy, in keeping with the diagnosis of fundic gland polyps.


Clinical pearls


Fundic gland polyps (FGP) are one of the most commonly found polyps in the stomach. They are reported to be found in 0.8-23% of endoscopies 1.


They are observed in three clinical contexts:


sporadic;


proton pump inhibitor use 2;


syndromic:


familial adenomatous polyposis (FAP) or attenuated FAP;


Zollinger-Ellison syndrome.

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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 21
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