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Gastric ‘Polyposis’ Case Report

Gastric ‘Polyposis’ Case Report. Medical Trust Hospital, Kochi. Clinical. August 2001 Female, 45 Yr Longstanding Dyspepsia Recently diagnosed anemia No GI Bleed, Diarrhea, Constitutional symptoms. Clinical. H2 blocker therapy in 1992 Self medication : H2 blocker till 1999

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Gastric ‘Polyposis’ Case Report

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  1. Gastric ‘Polyposis’Case Report Medical Trust Hospital, Kochi

  2. Clinical • August 2001 • Female, 45 Yr • Longstanding Dyspepsia • Recently diagnosed anemia • No GI Bleed, Diarrhea, Constitutional symptoms

  3. Clinical • H2 blocker therapy in 1992 • Self medication : H2 blocker till 1999 • 1999 : Evaluation • UGIE / USG : Report NA • CECT Abdomen : Stromal Tumor in D2 • PPI course for 1 Mth • Self medication with PPI since then

  4. Examination & Laboratory • Severe pallor • Scar of LSCS • Rest NAD • Hemoglobin : 5.9 gm % • Peripheral blood smear : Hypochromic microcytic anemia • Routine biochemistry : Normal

  5. UGI Endoscopy • Markedly hypertrophic gastric mucosal folds • Fundus, body studded with polypoid lesions (sessile). Size:0.5-2cm, with umbillication • Relative sparing of antrum • Smaller umbillicated nodules in antrum and D1. D2 and D3 Normal • No E/o Ulcer disease, active or old

  6. CECT • Thickened gastric wall in fundus and body up to 2 cm • 5 cm mass lesion on anterolateral aspect of D2 • Pancreas, retroperitoneum, liver normal

  7. CECT

  8. CECT

  9. CECT

  10. CECT Jan 2000

  11. EUS • Submucosal thickening of stomach • Mass in relation to D2 with intact serosa • Pancreas normal • Snare biopsy of polyp

  12. EUS

  13. EUS

  14. Histology • Atrophic Gastritis • Gastric Carcinoid • Immunostaining : Synaptophysin positive

  15. Investigations • 24 Hr Urinary 5-HIAA : 10.5 mg • Normal range (2.0 - 10) • Serum Gastrin Assay (After withholding PPI for 1 wk) : 520 pg/ml • Normal ( Upto 120 pg) • H. Pylori Serology : Negative

  16. Surgery • Preoperative blood transfusion • Total Gastrectomy with excision of ‘paraduodenal mass’. • Esophagojejunal pouch anaestomosis Roux en y • Findings: Pancreas, D2, Hepatoduodenal ligament, small bowel normal.

  17. Specimen

  18. Pouchogram

  19. Pouchogram

  20. Histology • Gastric Carcinoid extending upto muscularis at places • Atrophic Gastritis • Metastatic Lymph node

  21. Follow up • Asymptomatic (No Dyspepsia !!!) • Tolerates near normal size meal • Hemoglobin maintained • Follow up Gastrin assay awaited • Not popping pills

  22. Gastric Carcinoid • Uncommon • Three variants • Type I : Associated with Atrophic Gastritis • Type II : Associated with Gastrinoma • Type III: Sporadic

  23. Multiple Gastric Carcinoids • Type I and II • Associated with hypergastrinemic state • Reversal reported on correction of hypergastrinemia with small tumor volume • Prognosis better than ‘Sporadic’ variant • 5 yr survival 80 -100 % • Association with prolonged acid suppression not reported yet in humans

  24. Thank you

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