Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6967
Peer-review started: August 13, 2023
First decision: August 30, 2023
Revised: August 31, 2023
Accepted: September 12, 2023
Article in press: September 12, 2023
Published online: October 6, 2023
Processing time: 42 Days and 11.6 Hours
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.
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.
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.
Core Tip: Gastric hamartomatous inverted polyps (GHIPs) are benign lesions that mostly present as small submucosal tumors or polyps that are easily removed by endoscopic procedures. We report a rare case of GHIP that presented as a large ulcero-infitrative mass that was removed by total gastrectomy and confirmed to be accompanied by gastric cancer. Our case highlights that GHIPs may be a predisposing factor for malignancy due to ulcerative changes. Furthermore, the unusual endoscopic features of GHIP broaden the outlook of physicians and emphasize the need for a thorough investigation of GHIPs including the importance of complete resection.