Morular Metaplasia in Fundic Gland Polyps-A Case Report of a Rare Finding in a Common Lesion

Morular metaplasia is a phenomenon described in neoplasms of various sites, including endometrioid neoplasms of the uterus and colonic tubular adenomas. Although of questionable biological significance, they may be confused with squamous differentiation/neoplasia or neuroendocrine lesions.

A 34 year-old female patient on proton-pump inhibitor therapy underwent esophagogastroduodenoscopy for evaluation of bloating and reflux-type symptoms, which revealed three mucosal polyps within the proximal stomach. Microscopic examination showed conventional fundic gland polyps with foci of squamoid nests of whorled cells. These cells were positive for CDX2, demonstrated abnormal beta-catenin staining, and were negative for neuroendocrine markers. The diagnosis is fundic gland polyps with morular metaplasia.

This case expands the types of lesions in which morular metaplasia may be identified, particularly in the setting of lesions with abnormalities of the Wnt/beta-catenin pathway protein expression, and raises awareness of the finding that may be confused with neoplastic lesions.