GASTRIC HAMARTOMATOUS INVERTED POLYP WITH ULCERATION

DOI
  • TAKAHASHI Shunsuke
    Department of Gastroenterology, Fukuoka City Hospital.
  • IWAO Risa
    Department of Gastroenterology, Fukuoka City Hospital.
  • ARATONO Chihoko
    Department of Gastroenterology, Fukuoka City Hospital.
  • HASHIMOTO Norikazu
    Department of Gastroenterology, Fukuoka City Hospital.
  • IMAMURA Soushi
    Department of Gastroenterology, Fukuoka City Hospital.
  • HONMA Hitoshi
    Department of Gastroenterology, Fukuoka City Hospital.
  • KUWANO Hiroyuki
    Department of Gastroenterological Surgery, Fukuoka City Hospital.
  • UMEKITA Shinya
    Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University.
  • SASAKI Taisuke
    Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University.
  • ODA Yoshinao
    Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University.

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Other Title
  • 潰瘍を形成した胃hamartomatous inverted polypの１例

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Abstract

<p>A 66-year-old man was referred to our hospital for further evaluation of a polypoid lesion of the stomach detected on radiographic examination. Esophagogastroduodenoscopy revealed a broad-based elevated lesion (24mm) with a relatively steep but smooth surface and submucosal tumor-like morphology in the upper body of the stomach, with an edematous red apex and a shallow ulcer. Endoscopic ultrasonography revealed a lesion of low echogenicity with multiple aechoic images in the mucosal-submucosal layers, and we performed endoscopic resection using a snare followed by circumferential incision and submucosal dissection using ESD techniques. Histopathological examination of the resected specimen revealed that the polypoid lesion was composed of submucosal proliferation of cystically dilated gastric glands and fibromuscular elements. Based on these findings, we diagnosed the tumor as a hamartomatous inverted polyp (HIP). Only six cases (including the current case) of HIP with ulceration have been reported in Japan, which indicates the rarity of this form of HIP. The atypical ulcer observed in this case of HIP was probably attributable to mechanical stimulation. HIP is rare and is known to be complicated by cancer. Therefore, preoperative diagnosis is invariably challenging, and it is important to carefully devise the optimal treatment strategy.</p>

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