Coffey Amy, Patel Kalyani, Quintanilla Norma, Kellermayer Richard, Wu Hao
1 Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.
2 Department of Pathology and Laboratory Medicine, Texas Children's Hospital, Houston, Texas.
Pediatr Dev Pathol. 2017 Nov-Dec;20(6):482-489. doi: 10.1177/1093526617706816. Epub 2017 Apr 21.
We retrospectively studied the clinical and histologic features of pediatric fundic gland polyps (FGPs) in 16 patients. FGPs had an endoscopic prevalence of 0.25% in 8527 pediatric gastric biopsies. Five patients had familial adenomatous polyposis (FAP). The median age of onset was 17.7 years in FAP and 17.3 years in sporadic patients. All syndromic patients were asymptomatic and FGPs were identified during surveillance for existing or concurrent colon polyps. They did not take antacids. In comparison, all 11 sporadic FGPs were identified during evaluation of symptomatic patients who had taken antacids (median duration 21 months). Syndromic FGPs can be multiple at single endoscopy and were more likely to recur, while sporadic FGPs were often single. None of the sporadic patients had recurrence of FGPs or a subsequent diagnosis of FAP during a median follow-up of 20.5 months. The dilated fundic glands were lined by parietal and chief cells only in a majority (22/41, 53.7%) of syndromic FGPs, while additional tall mucinous lining cells were found in all sporadic FGPs. Syndromic FGPs did not have parietal cell hypertrophy in the background oxyntic mucosa. Nuclear immunopositivity for beta-catenin was essentially absent in all the FGPs. In conclusion, FGPs were rare in pediatric patients. In syndromic patients, FGPs are asymptomatic and did not precede colon polyps. Prolonged antacid intake seems to be associated with development of sporadic FGPs. Cellular components of dilated fundic glands and background parietal cell hypertrophy can be useful features to eliminate concern for syndromic polyposis.
我们回顾性研究了16例儿童胃底腺息肉（FGP）的临床和组织学特征。在8527例儿童胃活检中，FGP的内镜检出率为0.25%。5例患者患有家族性腺瘤性息肉病（FAP）。FAP患者的发病中位年龄为17.7岁，散发性患者为17.3岁。所有综合征患者均无症状，FGP是在对现有或并发结肠息肉的监测过程中发现的。他们未服用抗酸剂。相比之下，所有11例散发性FGP都是在对服用抗酸剂（中位持续时间21个月）的有症状患者进行评估时发现的。综合征性FGP在单次内镜检查时可能为多发，且更易复发，而散发性FGP通常为单发。在中位随访20.5个月期间，散发性患者均未出现FGP复发或随后被诊断为FAP。在大多数（22/41，53.7%）综合征性FGP中，扩张的胃底腺仅由壁细胞和主细胞衬里，而在所有散发性FGP中均发现有额外的高柱状黏液衬里细胞。综合征性FGP在背景胃体黏膜中没有壁细胞肥大。所有FGP中β-连环蛋白的核免疫阳性基本不存在。总之，FGP在儿童患者中罕见。在综合征患者中，FGP无症状，且不先于结肠息肉出现。长期服用抗酸剂似乎与散发性FGP的发生有关。扩张胃底腺的细胞成分和背景壁细胞肥大可能是消除对综合征性息肉病担忧的有用特征。
