Gastric and Colonic Polyposis in a Patient Without Genetic or Hereditary Predisposition Presenting as Iron Deficiency Anemia

Abstract

A 44 year-old female with no medical history presented with a 3-week history of melena. Labs revealed hemoglobin 8.5 g/dL, iron 16 ug/dL, and ferritin 5.3 ng/mL. Imaging noted large soft tissue densities of the stomach and multiple lesions in the right colon. EGD revealed a large (>15 cm), polypoid lesion extending from the fundus into the body and several large polyps in the cardia and antrum. Colonoscopy revealed large polyps at the cecum (5 cm), transverse (8 cm), and small (< 1 cm) polyps in the rectosigmoid. Gastric histology demonstrated hyperplastic polyps (HPP), and colonic biopsies revealed tubulovillous adenomas without dysplasia or malignancy. EUS of the gastric lesion showed areas of submucosal involvement without invasion of the muscularis propria, capsule endoscopy was negative for small bowel lesions. Genetic testing for polyposis syndromes was negative. Attempts at endoscopic debulking were unsuccessful, and a total gastrectomy and right hemicolectomy were performed. This case of diffuse gastric hyperplastic and colonic adenomatous polyposis represents a rare cause of iron deficiency anemia in a young patient. Few cases detailing both gastric and colonic polyposis in an individual with no hereditary predisposition are reported. HPP are the most common gastric polyps encountered. Reports demonstrate large HPP may have malignant potential similar to adenomas. HPP greater than 1 cm in size may indicate the presence of premalignant or neoplastic changes. In cases of diffuse gastric involvement, gastrectomy may be warranted as biopsies may be insufficient in detecting cancer. An association between gastric hyperplastic polyposis, carcinomas, and colonic neoplasms has been described. Hypergastrinemia has been postulated as a possible link between gastric polyposis and colorectal neoplasms due to the role of gastrin as a growth-promoting tumoral agent. Gastric adenomatous polyps increase the risk of colorectal neoplasia, however, information is limited regarding HPP and their risk. A recent study investigated the association of sporadic gastric HPP with colorectal neoplasia and found the risk of colorectal adenomas increased in patients with sporadic gastric hyperplastic polyposis. In our case, gastrectomy histology was consistent with hyperplastic polyps and colectomy histology showed foci of invasive adenocarcinoma. This case supports the notion for consideration of surveillance colonoscopy in patients with large or multiple gastric HPP.Figure 1Figure 2Figure 3