1954 Hyperplastic Polyp: A Rare Case of Recurrent Iron Deficiency Anemia

Abstract

INTRODUCTION: Hyperplastic polyps are the most common polyps accounting for 17% of all the gastric polyps. Most polyps are asymptomatic but may present with anemia, bleeding or gastric outlet obstruction. Here, we are reporting a case of large benign hyperplastic polyp presenting with iron deficiency anemia. CASE DESCRIPTION/METHODS: A 69-year-old male with a history of chronic back and neck pain and GERD was evaluated for chronic iron-deficiency anemia, treated multiple times with oral and IV iron supplements. The patient had been taking NSAIDs for chronic pain. On labs, patient hemoglobin of 9 with a low iron profile. The patient was scheduled for screening colonoscopy and EGD to further investigate anemia. On EGD patient had a large polypoid lesion about 25 mm in size in the prepyloric antrum extending into the duodenal bulb, likely cause of iron-deficiency anemia. There was also a small superficial clean-based ulcer on the antral lesion. Colonoscopy showed small internal hemorrhoids. Patient was discharged home on PPI and counseled to stop NSAIDs. Pathology report of the biopsies showed fragments of a benign hyperplastic polyp, negative for H pylori. The patient was afterward referred to interventional endoscopist for EUS and polyp excision. DISCUSSION: A hyperplastic gastric polyp is usually an incidental finding on upper endoscopy. With a prevalence of 6.35%, they are seen equally in elderly males and females in their 60s–70s. Hyperplastic polyps are believed to occur as a result of the reactive and inflammatory hyperproliferation of gastric foveolar cells, and Helicobacter pylori are believed to be the precursor. Diagnosis is usually made based on the results of endoscopy and subsequent biopsy of the suspicious area for the histological exam. On endoscopy, they appear as an area of hyperemia with a smooth dome-shaped surface, mostly in the antral area. As the size increases, they become pedunculated and the surface gets eroded resulting in chronic blood loss and anemia. Rarely, gastric outlet obstruction occurs when the large polyps prolapse though the pylorus. Since large polyps (>2 cm) are associated with carcinoma in 0.6%–2% cases, it is important for the pathologist to look carefully for any dysplastic foci and carcinomatous changes in the tissue specimen. Once the diagnosis of hyperplastic polyp is confirmed, treatment consists of endoscopic resection of any polyp measuring >1 cm in size and eradication of H.pylori, when present.