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Small gastric hyperplastic polyp with acute bleeding as an unusual presentation of malignancy: A case report
Kyoung Sun Park1, Seung-Woo Lee, Junguee Lee
1Division of Gastroenterology, Department of Internal Medicine Department of Pathology, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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.
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