Gastric hamartomatous inverted polyps have high internal echoes: A case report

A 58-year-old woman with an elevated lesion in the stomach was referred to our hospital. Gastroscopy showed a lobulated mass resembling a submucosal tumor. The tumor showed early enhancement on computed tomography. Endoscopic ultrasound showed a lobulated tumor with distinct borders, no attenuated posterior echoes, and high internal echoes. Fine needle aspiration biopsy pathologically showed normal gastric mucosa and spindle cells growing sparsely with SMA positivity and DOG1/S100 negativities, suggesting an inflammatory fibroid polyp. The patient, therefore, underwent laparoscopy endoscopy cooperative surgery to the gastric lesion. Postoperative pathological study showed downward mucosal proliferation into the submucosal layer in a lobulated manner with hyperplasia of the crypt epithelium. Some part of the lesion was located under the normal orthotopic gastric mucosa. These pathologic findings led us to the diagnosis of gastric hamartomatous inverted polyp (GHIP). In conclusion, endoscopy specialists should note that fibrous component-rich tumors have low internal echoes and attenuated posterior echoes, whereas GHIPs have high internal echoes and no attenuated posterior echoes.