J Korean Soc Radiol.  2013 Jun;68(6):479-482. 10.3348/jksr.2013.68.6.479.

A Giant Hyperplastic Polyp of the Stomach Complicated by Intussusceptions and Intraepithelial Malignant Transformation

• Lee MH
• Chung DJ
• Kim U
• Hahn ST
• Lee JM

• KMID: 2002899
• DOI: http://doi.org/10.3348/jksr.2013.68.6.479

Abstract

Hyperplastic polyp is generally considered as a small, asymptomatic, benign natured polyp. Here, we present a rare case of a hyperplastic polyp, which is very large and induces gastric intussusceptions. In addition, after surgery, histopathologic examination confirmed hyperplastic polyp, which contains focal adenocarcinoma. Both the gastric intussuscepted condition itself and the leading tumor, intraepithelial adenocarcinoma arising in the hyperplastic polyp, are extremely exceptional. To the best of our knowledge, this is the first reported case of a giant hyperplastic polyp, which causes gastric intussusceptions, and harbored an intraepithelial adenocarcinoma.

MeSH Terms

Adenocarcinoma
Intussusception
Polyps
Stomach

Figure

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  Fig. 1 A 79-year-old woman who presented with gastric intussusceptions due to a giant hyperplastic polyp with intraepithelial malignant transformation. A, B. Initial contrast enhance CT, axial images in prone position (A) and in left lateral decubitus (B) show a lobulating mass (small arrow) protruding into the gastric lumen. Noted a stalk (large arrow) and feeding vessel arising from left gastric artery (arrowhead) on a left decubitus view. C. On initial endoscopy, about 5 cm mass (arrow) with villous surface is noted. The base of the tumor is narrowed, suggesting probable stalk. The mass moves according to postural change. D, E. Follow-up CT scan after 2 years, axial (D) and coronal view (E) demonstrates heniation of gastric body portion into the antrum with large polyp increased in size. Noted that the tip of the polyp reaches the 2nd portion of the duodenum (arrow). F. Gross specimen reveals a 10 × 6 cm sized papillary polypoid mass with a stalk (arrow). G. Histopathologic findings of the mass (hematoxylin-eosin stain; original magnification, × 40) show focal area with atypical nuclear change and prominent mitosis (black circle) in the background of a typical hyperplastic polyp with glandular and stromal changes. Adenocarcinoma with high grade dysplasia is confirmed by Ki-67 and P53 immunohistochemistry.

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