Ochiai Yorinari, Kikuchi Daisuke, Ito Shinji, Takazawa Yutaka, Hoteya Shu
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Department of Pathology, Toranomon Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2021 Feb 3;15(1):123-130. doi: 10.1159/000512399. eCollection 2021 Jan-Apr.
A 57-year-old man with a 10-year history of proton pump inhibitor (PPI) use presented with multiple fundic gland polyps (FGPs) including one >20 mm, whitish, semi-pedunculated polyp. Black spots and cobblestone-like mucosa were also observed in the stomach upon endoscopy; therefore, the lesion was considered to result from long-term PPI administration. Endoscopically, we diagnosed this polyp as a neoplastic lesion with gastric phenotype rather than a non-neoplastic lesion. Biopsy revealed an atypical glandular lesion that was indeterminate for neoplasia; therefore, we performed en bloc resection via endoscopic submucosal dissection (ESD) of the 22 × 22 × 10 mm-sized polyp. Histologically, the polyp was composed of hyperplastic foveolar epithelia in the upper half of the mucosa and hyperplastic fundic glands in the lower half of the mucosa, with luminal dilatation and parietal cell protrusion. The pathological diagnosis for this ESD specimen was FGP associated with PPI administration. We herein describe this rare case of a large FGP in -uninfected gastric mucosa associated with long-term PPI administration, which was mimicking gastric-type neoplasm and resected by endoscopy.
一名有10年质子泵抑制剂（PPI）使用史的57岁男性，出现多个胃底腺息肉（FGP），其中包括一个直径大于20mm、白色、半带蒂的息肉。内镜检查时在胃内还观察到黑点和鹅卵石样黏膜；因此，该病变被认为是长期服用PPI所致。在内镜下，我们将这个息肉诊断为具有胃表型的肿瘤性病变而非非肿瘤性病变。活检显示为非典型腺性病变，肿瘤性质不确定；因此，我们通过内镜黏膜下剥离术（ESD）对这个大小为22×22×10mm的息肉进行了整块切除。组织学检查显示，息肉由黏膜上半部分的增生性小凹上皮和黏膜下半部分的增生性胃底腺组成，伴有管腔扩张和壁细胞突出。该ESD标本的病理诊断为与PPI使用相关的FGP。我们在此描述了这例罕见的、发生于未感染胃黏膜的、与长期PPI使用相关的大FGP病例，该病例酷似胃型肿瘤并通过内镜切除。
