Fundic gland polyps related to diverse aetiologies show subtle morphological differences: a multicentre retrospective study

Kővári, Bence; Naili, Reima El; Pereira, Daniela Vinha; Kumarasinghe, Priyanthi; Boer, W. Bastiaan de; Jiang, Kun; Pimiento, José M.; Fukuda, Masahide; Misdraji, Joseph; Kushima, Ryoji; Lauwers, Gregory Y.

doi:10.1111/his.14623

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…Most recent studies compared a set of polyps from non-syndromic patients to syndromic FGPs such as FAP and GAPPS and evaluated histological features related to distinct subtypes of FGPs. 12 Although there are slight differences between FAP-associated or GAPPS-related FGP and non-syndromic FGPs, most have similar histologic features.…”

Section: Pathological Featuresmentioning

confidence: 99%

“…The finding was an accompanying neoplastic component in the form of a dysplasia‐adenomatous‐adenocarcinoma sequence in the development of the malignant phenotype of GAPPS. Most recent studies compared a set of polyps from non‐syndromic patients to syndromic FGPs such as FAP and GAPPS and evaluated histological features related to distinct subtypes of FGPs 12 . Although there are slight differences between FAP‐associated or GAPPS‐related FGP and non‐syndromic FGPs, most have similar histologic features.…”

Section: Diagnosismentioning

confidence: 99%

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The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment

Iwatsuki

Matsumoto

Mimori

et al. 2023

Annals of Gastroent Surgery

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Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) was first proposed by Wothley et al. in 2012 as a rare familial gastric cancer syndrome associated with an autosomal dominant form of inheritance. GAPPS is characterized by gastric basal gland polyposis from the hilum to the body of the stomach. Li et al. in 2016 showed that the cause of the disease is a point mutation in the promotor 1B region of the APC gene, and genetic testing was used to confirm the diagnosis. If the patient has already developed gastric cancer, treatment should be based on the usual treatment for gastric cancer. If no distant metastases exist, a good prognosis can be expected by performing a total gastrectomy. On the other hand, patients with distant metastasis have a poor prognosis. In the case of dysplasia, prophylactic total gastrectomy is recommended, but because it is highly invasive and postoperative postgastrectomy syndrome must be considered, the decision should be made with careful consideration of the patient's background. Therefore, there are no guidelines for screening for GAPPS, the timing of prophylactic total gastrectomy, or methods of endoscopic surveillance. Because GAPPS is a rare disease, its natural history is still unclear. Further case series are needed to elucidate the molecular biology and clinicopathological features of GAPPS and to establish clinical management, including diagnosis, treatment, and surveillance. In this review, we provide an overview of GAPPS, its clinical management, and its problems, which will be useful for the treatment of GAPPS.

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Section: Pathological Featuresmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment

Iwatsuki

Matsumoto

Mimori

et al. 2023

Annals of Gastroent Surgery

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“…The presence of specific histopathological characteristics of FGP associated with FAP in a previous study [19] prompted us to analyze whether these…”

Section: Fgp In Fap Patients Showed Specific Histopathological Featuresmentioning

confidence: 99%

“…Histological features of fundic gland polyps (FGP) in our cohort evaluated according to Kővári et al[19] …”

mentioning

confidence: 99%

Gastric Polyps in Familial Adenomatous Polyposis Portuguese Patients: The First Western Cohort with Asian Features

Baptista,

Fernandes,

Garrido

et al. 2023

Pathobiology

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Introduction: Chronic atrophic gastritis may contribute to gastric polyps (GP) phenotype in familial adenomatous polyposis (FAP). Considering the high prevalence of Helicobacter-pylori (HP) infection in Portugal, we aim to characterise GP in a series of Portuguese patients. Methods: In a retrospectively-selected series of 53 FAP patients, clinical data and histopathological features of GP and background gastric mucosa were studied. SPSS (27.0) was used for statistical analysis. Results: Thirteen patients (24.5%) developed fundic gland polyps (FGP), seven (13.2%) gastric adenomas (GA) and ten (18.9%) both FGP and GA. Out of 100 GP, four were hyperplastic polyps, 58 FGP (24 with dysplasia), 35 intestinal-type GA (intGA) and three foveolar-type GA (fovGA). IntGA were larger (60% >7mm, p=0.03), occurred predominantly in the distal stomach (66.7%, p=0.024), in patients harbouring gastric intestinal metaplasia (IM) (86.7%, p<0.001) and duodenal adenomas (86.7%, p<0.001) Conclusion: This is the first Western series showing high prevalence of intGA in FAP patients, comparable to Asian cohorts. HP infection and chronic atrophic gastritis/intestinal metaplasia are likely responsible for this difference, with risk of neoplastic transformation and management implications. Biopsy/excision of GP >7mm, in the distal stomach, and in patients harbouring gastric intestinal metaplasia/duodenal adenomas should be considered.

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“…Although recently Kővári et al . 13 described subtle differences between sporadic, FAP‐associated, and GAAPS‐associated FGPs, so far the only difference between the histology of fundic polyps has been in the frequency of dysplasia, which is rare in sporadic FGPs (1%), frequent in FAP‐associated polyps (30–50%), and almost universal in GAAPS‐associated polyps.…”

Section: Figurementioning

confidence: 99%

Multidinous fundic gland polyps: An yet‐underscribed association

et al. 2022

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Dear Editor, We read with great interest the paper by Lam and Lau, 1 which recently appeared on your journal. In their paper, the authors report about two patients with a large number (52 and 147, respectively) of fundic gland polyps (FGPs) without any known association with previous therapies or genetic familial syndromes, which they aptly named "idiopathic" (literally "without known cause") multidinous FGPs.FGPs are small sessile polyps (2-3 mm), usually multiple, of the acid-secreting gastric mucosa. They are characterized by shortened gastric pits and cystic dilations, both superficial and deep, bordered by columnar mucous, chief, and parietal cells. They are almost always negative for Helicobacter pylori colonization. 2 Although they show the same histology, they have been described as sporadic, 3 associated with familial adenomatous polyposis (FAP), 4 attenuated FAP, 5 Zollinger-Ellison syndrome, 6,7,8 MUTYH-associated polyposis, 9 gastric adenocarcinoma and proximal polyposis of the stomach (GAAPS), 10,11 and absorptive hypercalciuria 12 (Fig. 1). Although recently K} ov ari et al. 13 described subtle differences between sporadic, FAP-associated, and GAAPS-associated FGPs, so far the only difference between the histology of fundic polyps has been in the frequency of dysplasia, which is rare in sporadic FGPs (1%), frequent in FAP-associated polyps (30-50%), and almost universal in GAAPS-associated polyps.Lam and Lau 1 were clearly faced with a management dilemma-how to treat such unusual patients. They never received a long-term treatment with proton pump inhibitors (if such a treatment promotes polyps at all), nor had a positive family history for genetic syndromes with a known risk for FGP development. In absence of clear guidelines for such a situation, the authors decided to endoscopically remove all polyps and to submit them to histologic examination. Quite surprisingly, not a single polyp showed dysplasia.Given such results, we would suggest to Lam and Lau to submit their polyps to molecular biology examination, in a search for possible new mechanisms driving such an exceptional multidinous polyposis.

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Fundic gland polyps related to diverse aetiologies show subtle morphological differences: a multicentre retrospective study

Cited by 5 publications

References 23 publications

The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment

The comprehensive review of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) from diagnosis and treatment

Gastric Polyps in Familial Adenomatous Polyposis Portuguese Patients: The First Western Cohort with Asian Features

Multidinous fundic gland polyps: An yet‐underscribed association

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