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Large gastric hamartomatous inverted polyp accompanied by advanced gastric cancer: A case report
Gyerim Park1, Jihye Kim2,3, Sung Hak Lee1
1Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
Background:
Gastric hamartomatous inverted polyps (GHIPs) are benign polyps of the gastric submucosal layer. Currently there are 52 reported cases in the English literature. According to a literature review, approximately 27% of GHIPs show a coexisting carcinoma.
Case Summary:
A 66-year-old man was referred to our institution with ulcerative lesions detected on esophagogastroduodenoscopy (EGD) during a regular check-up. Other medical findings were nonspecific. The lesions had borderline histologic features that could not exclude malignancy and were followed up with three EGDs and biopsies at intervals of 3 mo. The latest biopsy was revealed as an adenocarcinoma. A total gastrectomy was performed to remove the tumor. The surgical specimen revealed a 6.9 cm × 4.5 cm sized GHIP with a coexisting 1.6 cm sized well-differentiated adenocarcinoma which extended to the muscularis propria. The malignancy did not originate from the GHIP but showed an overlap.
Conclusion:
A large GHIP, which was unusually presented as an ulcerative lesion, was surgically removed, and was accompanied by advanced gastric cancer. Regular follow-up and thorough examinations of ulcerative lesions with equivocal biopsy have resulted in appropriate diagnosis and treatment. Therefore, aggressive intervention may be beneficial if GHIP is suspected.

