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Massive Gastric Juvenile Polyposis: A Clinicopathologic Study Using SMAD4 Immunohistochemistry
Margaret E Lawless1, Daniel L Toweill1, Kim D Jewell1
1From the Department of Pathology, University of Washington School of Medicine, Seattle.
American Journal of Clinical Pathology
|March 25, 2017
Summary
Massive gastric juvenile polyposis is rare, often causing anemia and hypoalbuminemia. Loss of SMAD4 in polyps increases risks of bleeding, hypoproteinemia, dysplasia, and gastric adenocarcinoma.
Area of Science:
- Gastroenterology
- Pathology
- Oncology
Background:
- Juvenile polyps are uncommon in the stomach.
- Massive gastric juvenile polyposis represents an even rarer clinical entity.
Purpose of the Study:
- To describe the clinicopathologic features of massive gastric juvenile polyposis.
- To investigate the association between SMAD4 expression and clinical outcomes.
Main Methods:
- Clinicopathologic analysis of nine cases of massive gastric juvenile polyposis.
- Immunohistochemical staining for SMAD4.
Main Results:
- All patients presented with anemia; four had hypoalbuminemia.
- Polyps showed dilated crypts with edematous stroma and inflammatory infiltrates.
- Two patients developed adenocarcinoma; six cases (66.6%) showed loss of SMAD4, correlating with severe bleeding, hypoproteinemia, dysplasia, or adenocarcinoma.
Conclusions:
- Loss of SMAD4 immunoreactivity is a significant finding in massive gastric juvenile polyposis.
- SMAD4 immunohistochemistry aids in diagnosing juvenile polyposis syndrome involving the stomach and predicting associated risks.
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