Sa1870 Fundic Gland Polyps With Dysplasia

Abstract

Fundic gland polyps (FGPs) are the most common type of gastric polyp and are seen in up to 5% of patients on endoscopy. Although considered benign, FGPs are more common in patients with familial adenomatous polyposis (FAP). FGPs occur sporadically in up to 1.9% of the general population and in 84% of patients with syndromic FAP. Dysplasia in FGP is reported in 53% of syndromic FGPs and in only 2.3% of sporadic FGPs. The aim of this study is to compare patients with FGPs with dysplasia and those with FGPs without dysplasia. The pathology files from two institutions were searched from 1/1/2009 to 10/1/2013 for FGPs with dysplasia (FGPD). A similar number of control cases of FGP with no dysplasia (FGPND) were also randomly retrieved. All biopsies were reviewed, and diagnoses were agreed upon by three pathologists. Patient demographic data was recorded and included age, gender, race, diagnosis of FAP, and PPI use. Twenty-five patients with FGPD were identified (Male: 15, Female: 10, mean age: 60). Five patients had a confirmed history of FAP (mean age: 36), 9 had a high probability of FAP based on family or personal GI history (mean age: 61), 3 had no indication of FAP (such as family or personal history of colon cancer or polyps) (mean age: 63), and in 8 patients the family or personal history was not recorded (mean age: 62). Seventeen patients (68%) were on a protein pump inhibitor (PPI). The mean age of FGPD patients with FAP is significantly lower than patients without FAP (p< 0.001). The 26 patients with FGPND included 10 males and 16 females (mean age: 60). None of the patients had a history of FAP, 12 had a high probability of FAP based on family or personal GI history (mean age: 61), 6 had no indication of FAP (mean age: 59), and in 8 patients the family or personal history was not recorded (mean age: 55). Eighteen patients (69%) were on a PPI. There were no ethnic/racial differences between the two groups of patients. Of all biopsies from patients with FGPD, 88% of all fragments were smaller than 5 mm2 and 5% were greater than10 mm2. In contrast, of all the biopsies from patients with FGPND, 68% of all fragments were smaller than 5 mm2 and 20% were greater than 10 mm2. These data show no correlation between PPI use and the presence of low grade dysplasia in FGP. FGPND tended to result in larger biopsy fragments than FGPD; however there was no significant difference in the number of polyps described endoscopically between the two groups. Patients who have low-grade dysplasia in FGP are more likely to have FAP or a high probability of FAP than those without dysplasia. Low grade dysplasia in FGP is seen at a younger age in patients with FAP than in those without FAP. Finding low grade dysplasia in FGP, particularly in patients younger than 40 years, should raise a suspicion for FAP.