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Asymptomatic Multiple Gastric and Duodenal Tumors Yang-Yuan Chen, 1 Tsung-Wei Chen, 1 and Yung-Fang Chen 2 Division of Gastroenterology, Departments of 1 Pathology and 2 Radiology, China Medical University Hospital, China Medical University, Taichung, Taiwan Question: A 63-year-old woman was referred from another hospital because of gastric and duodenal tumors. She underwent endoscopic and colonoscopic examinations. The endoscopic images revealed multiple gastric tumors (Figure A) and a tumor with a bud and long stalk from the stomach to the duodenum (Figure B). The colonoscopy was negative. Physical examination was negative, including a lack of mucosal pigmentation, abdominal masses, and anemia. There was no family history of colonic or gastric carci- noma. Abdominal computed tomography showed multiple gastric polypoid masses (Figure C). The small intestinal series also showed negative ndings. What is the diagnosis? See the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Conicts of interest: The authors disclose no conicts. © 2013 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2013.05.055 GASTROENTEROLOGY 2013;145:e7e8 Electronic Clinical Challenges and Images in GI

Asymptomatic Multiple Gastric and Duodenal Tumors

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Page 1: Asymptomatic Multiple Gastric and Duodenal Tumors

Electronic Clinical Challenges and Images in GI

Asymptomatic Multiple Gastric and Duodenal TumorsYang-Yuan Chen,1 Tsung-Wei Chen,1 and Yung-Fang Chen2

Division of Gastroenterology, Departments of 1Pathology and 2Radiology, China Medical University Hospital, China Medical University, Taichung, Taiwan

Question: A 63-year-old woman was referred from another hospital because of gastric and duodenal tumors. She underwentendoscopic and colonoscopic examinations. The endoscopic images revealed multiple gastric tumors (Figure A) and a tumor with abud and long stalk from the stomach to the duodenum (Figure B). The colonoscopy was negative. Physical examination was negative,including a lack of mucosal pigmentation, abdominal masses, and anemia. There was no family history of colonic or gastric carci-noma. Abdominal computed tomography showed multiple gastric polypoid masses (Figure C). The small intestinal series also showednegative findings.

What is the diagnosis?See the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to

Clinical Challenges and Images in GI.

Conflicts of interest: The authors disclose no conflicts.© 2013 by the AGA Institute0016-5085/$36.00http://dx.doi.org/10.1053/j.gastro.2013.05.055

GASTROENTEROLOGY 2013;145:e7–e8

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Electronic Clinical Challenges and Images in GI, continued

Answer to theClinical Challengesand Images in GIQuestion: Image 4:Sporadic GastricHamartomatousPolyps With Gas-troduodenal In-tussusception andAdenocarcinomaTransformationThe endoscopic diagnosis

suggested multiple gastric polyps with gastroduodenal intussusception. To relieve the gastroduodenal intussusception, we used anendoscope with forceps for reduction (Figure D) and removed all the gastric polyps with endoscopic mucosal resection. The histologyshowed scant intramucosal adenocarcinoma arising from the hamartomatous polyp background (Figure E, arrow).

The gastric hamartomatous polyp is a rare clinical entity and is typically comorbid with Peutz–Jeghers syndrome (PJS). Thesporadic hamartomatous gastric polyp is considerably rarer than PJS. The sporadic hamartomatous polyp, like PJS, is also composedof foveolar-type epithelia and branching cores of smooth muscle.1 The sporadic hamartomatous gastric polyp typically presents as asingle polyp, but in our case, multiple polyps appeared with a cluster located at the great curvature of the mid-body stomach, and along stalk with gastroduodenal intussusception that grew a bud. The sporadic hamartomatous polyps become symptomatic after theage of 50. Our case showed gastric polyps with gastroduodenal intussusception and no signs of obstruction. According to ourresearch, ours is the first case of gastroduodenal intussusception secondary to sporadic gastric hamartomatous polyps withadenocarcinoma transformation without obstruction or symptoms of anemia.

The sporadic gastric hamartomatous polyp with adenocarcinoma transformation is extremely rare,2,3 and ours is only the fourthreported case. Patients with sporadic gastric hamartomatous polyps with adenocarcinoma transformation typically require surgerybecause of the advanced stage of gastric adenocarcinoma. In our case, the adenocarcinoma transformation of the gastric polyp waswithin the mucosal layer. The 6-month follow-up and the repeated endoscopy showed no further polyps in the stomach.

References1. Lin JC, Huang TU, Shih YL, et al. Management of symptomatic hamartomatous polyps in stomach: analysis of a single center

experience. J Med Sci 2013;33:29–36.2. Su PY, Yen HH, Chen CJ. Clinical challenges and images in GI. Peutz-Jeghers syndrome with gastroduodenal secondary to

gastric cancer. Gastroenterology 2009;136:774.3. Oh SJ, Oh CA, Kim DH, et al. Adenocarcinoma derived from gastric hamartomatous polyps. J Korean Surg Soc 2011;

81:419–422.

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