Gastric polyp in pernicious anemia: an argument to remove even when biopsy shows hyperplasia.

ity of nonfundic gland gastric polyps found incidentally at endoscopy [1]. Ma− lignant transformation has been reported in hyperplastic polyps but invasive carci− noma is rare [2]. A 63−year−old female was referred for routine screening colonoscopy and eso− phagogastroduodenoscopy because of pernicious anemia diagnosed 10 years previously. Upper gastrointestinal endos− copy revealed a 3 cm benign−appearing polyp at the gastroesophageal junction with a broad stalk (l" Fig. 1). Repeated biopsies showed benign hyperplastic polyp with active chronic inflammation, negative for Helicobacter pylori and intes− tinal metaplasia. Fasting gastrin levels were elevated at 557 ng/L (normal fasting levels < 90 ng/L). Subsequently, a snare polypectomy was performed after the ap− plication of an endoloop, and the entire polyp was retrieved for pathological ex− amination. Histology showed focal areas of intestinal metaplasia, dysplasia, and a small focus of intramucosal carcinoma arising within the hyperplastic polyp (l" Fig. 2 a, b). Postpolypectomy there was no recurrence of the hyperplastic polyp (l" Fig. 3). Gastric hyperplastic polyps and carcinoid tumors have also been associated with pernicious anemia. Hyperplastic polyps may have a rare malignant potential [3]. Polyp histology cannot be reliably deter− mined by endoscopic appearance, and therefore either biopsy or polypectomy is warranted in any suspicious lesion. Some recent studies have suggested the presence of dysplastic elements in up to 19% of hyperplastic polyps, including some cases of focal carcinoma [3, 4], lead− ing some authors to recommend endo− scopic removal of gastric polyps > 0.5 cm in size [4]. Carcinoma in hyperplastic polyps is thought to arise from dysplastic epithelium, and can be associated with the p53 gene mutations [5]. The exact time of occurrence of these polyps in pernicious anemia is unpredictable, and there are no long−term studies describ− ing the natural history of hyperplastic polyps. Gastric polyp in pernicious anemia: an argument to remove even when biopsy shows hyperplasia