Gastric outlet obstruction secondary to a pedunculated hyperplastic polyp with early malignant changes

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Hyperplastic polyps are the most frequent polypoidal lesions in the stomach.
• While often asymptomatic, they can manifest with symptoms like anemia or gastric outlet obstruction.
• Malignant transformation represents a significant, albeit uncommon, complication.

Observation:

• A case study involving an elderly woman presenting with epigastric pain and vomiting.
• Esophagogastroduodenoscopy revealed a large, pedunculated polyp causing gastric outlet obstruction.
• Imaging confirmed a soft-tissue mass extending from the stomach into the duodenum.

Findings:

• Endoscopic polypectomy followed by histopathology revealed early gastric carcinoma.
• Subsequent follow-up over two years showed mild-to-moderate dysplasia at the excision site.
• A laparoscopic wedge resection confirmed a hyperplastic polyp with low-grade dysplasia.

Implications:

• This case underscores the potential for hyperplastic polyps to undergo malignant transformation.
• Regular endoscopic surveillance is crucial for detecting dysplasia and early-stage cancer.
• Prompt diagnosis and management, including surgical resection when indicated, are vital for patient outcomes.