Gastric Inverted Hamartomatous Polyp with Active H. Pylori Gastritis and Anemia: A Rare Presentation

Abstract

Background: Gastric inverted hamartomatous polyps are rare polyps constituting less than one percent of all the gastric polyps and characterized by an inverted growth pattern of benign gastric mucosal components into the submucosa. Gastric inverted hamartomatous polyps are known to have malignant potential. Because of their rarity, gastric inverted hamartomatous polyps can pose a histological and clinical challenge. Case presentation: We present a case of a 54-year-old female with gastric inverted hamartomatous polyp with underlying active H. pylori gastritis manifesting as symptomatic anemia and melena. Esophagogastroduodenoscopy showed a 3 cm pedunculated gastric polyp on the lesser curvature with dilated vessels and bleeding on its surface. Due to its long stalk, the polyp was initially found prolapsing through the pylorus but returned spontaneously into the intragastric position (ball valve phenomenon). The polyp was resected with a hot snare and retrieved. Histology revealed an endophytic growth of benign hyperplastic glands with variable cystic dilation into the submucosa with focal benign smooth muscle proliferation. Associated focal erosion and active H. pylori gastritis, confirmed by immunohistochemistry were also identified. The patient was discharged on quadruple H. pylori therapy with a follow-up plan for repeat esophagogastroduodenoscopy in two months. Conclusion: GIHP may be symptomatic presenting as anemia, gastrointestinal obstruction, or involved by H.pylori infection. The pathogenesis of GIHP is still unclear due to rare, reported cases. H. pylori gastritis could be a contributing factor in the pathogenesis of GIHP and warrants further studies. Keywords: Gastric inverted polyp; H. pylori; Anemia; Ball valve mechanism; Histology