Gastric adenomas in familial adenomatous polyposis are common, but subtle, and have a benign courseReport as inadecuate




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Hereditary Cancer in Clinical Practice

, 12:4

First Online: 24 February 2014Received: 04 June 2013Accepted: 28 January 2014DOI: 10.1186-1897-4287-12-4

Cite this article as: Ngamruengphong, S., Boardman, L.A., Heigh, R.I. et al. Hered Cancer Clin Pract 2014 12: 4. doi:10.1186-1897-4287-12-4

Abstract

BackgroundPatients with familial adenomatous polyposis FAP are known to have an increased risk for gastric adenomas. The clinical features of gastric adenomas in FAP have not been well characterized, and there is a lack of standardized approaches to the management of these lesions.

AimsTo study the endoscopic appearance, risk factors, clinical course, and response to therapy of gastric adenomas in patients with FAP.

MethodsWe retrospectively reviewed the records of 97 patients with FAP who underwent esophagogastroduodenoscopy EGD at Mayo Clinic Florida, Rochester and Arizona between 2004 and 2013.

ResultsNine patients 9% had biopsy-proven gastric adenomas. Adenomas were located in the antrum five patients, in the body and fundus in the setting of background fundic gland polyps FGP three patients, and in the body not associated with FGP one patient. Adenoma size was 3–40 mm and the number of adenomas per patient ranged from one to 20. Adenomas in the antrum were flat and subtle, whereas those in the gastric body or fundus were polypoid and difficult to differentiate from the cystic FGPs seen in patients with FAP. The performing endoscopists reported difficulty with identifying adenomas, and six patients had at least one EGD within the previous three years where gastric adenomas were not reported. Adenomas were classified as tubular in eight patients and tubulovillous in one patient. High grade dysplasia was noted in one patient. After a median follow-up of 63 months interquartile range: 20–149 months, no patient in our entire cohort with or without gastric adenomas developed gastric cancer. The patients in whom gastric adenoma developed, compared to those without gastric adenoma, were more likely to be younger 36 ± 12 vs. 48 ± 15 years, p = 0.02, have concomitant chronic gastritis 22% vs. 0%, p = 0.008, and have desmoid tumors 5 56% vs. 19 22%, p = 0.04.

ConclusionsGastric adenomas are not uncommon in patients with FAP and are often difficult to identify endoscopically. Endoscopists should have a high degree of suspicion for gastric adenomas in these patients and a low threshold to biopsy. Given the benign clinical course, recommended initial management is conservative with endoscopic therapy and periodic surveillance.

KeywordsGastric adenoma Stomach neoplasm Familial adenomatous polyposis AbbreviationsAPCAdenomatous polyposis coli

EGDEsophagogastroduodenoscopy

FAPFamilial adenomatous polyposis

FGPFundic gland polyps

HGDHigh-grade dysplasia

NSAIDNonsteroidal anti-inflammatory drugs

PPIProton pump inhibitors.

Electronic supplementary materialThe online version of this article doi:10.1186-1897-4287-12-4 contains supplementary material, which is available to authorized users.

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Author: Saowanee Ngamruengphong - Lisa A Boardman - Russell I Heigh - Murli Krishna - Maegan E Roberts - Douglas L Riegert-Johns

Source: https://link.springer.com/







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