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 : Evaluation UGIE / USG : Report NA CECT Abdomen : Stromal Tumor in D2 PPI course for 1 Mth Self medication with PPI since then

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

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

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

CECT

CECT Jan 2000

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

EUS

Histology Atrophic Gastritis Gastric Carcinoid Immunostaining : Synaptophysin positive

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

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.

Specimen

Pouchogram

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

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

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

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 % Association with prolonged acid suppression not reported yet in humans