Small gastric hyperplastic polyp with acute bleeding as an unusual presentation of malignancy: A case report.

RATIONALE

Gastric hyperplastic polyps are frequently found on upper gastrointestinal endoscopy and usually asymptomatic.

PATIENTS CONCERNS

A 65-year-old man visited the emergency department due to melena. Emergency upper endoscopy revealed a semi-pedunculated polyp measuring 1.2 cm in diameter with blood oozing. We resected the polyp using snare polypectomy. Ulceration was noted on the polypectomy specimen and was thought to be a bleeding focus.

DIAGNOSES

Histopathologic findings revealed hyperplastic polyp with focal well-differentiated adenocarcinoma in the ulcerated area and involvement of the lateral resection margin by carcinoma.

INTERVENTION

We performed additional endoscopic resection using endoscopic submucosal dissection at the previous polypectomy site.

OUTCOME

At 1 year follow up, no recurrence or other distant metastasis was detected.

LESSONS

This is a rare case of upper gastrointestinal bleeding from a small gastric hyperplastic polyp, which was found to be adenocarcinoma. When bleeding small gastric polyps are encountered during endoscopy, the possibility of malignancy and wider resection should be considered.