AIRP Best Cases in Radiologic-Pathologic Correlation: Gastritis Cystica Polyposa

Abstract

A 55-year-old man presented to the emergency department with a chief complaint of right-sided chest pain and was found to be severely anemic, requiring multiple blood transfusions. The patient's history was notable for a Billroth II procedure performed 22 years earlier for peptic ulcer disease. The patient was admitted to rule out myocardial infarction and for work-up for severe anemia. The stool specimen was guiac positive, and subsequent upper and lower endoscopy revealed a large, tannish-red polypoid mass arising from the gastrojejunal anastomosis created with the prior Billroth II procedure. No symptoms of bowel obstruction were present. Multiple endoscopic biopsies were performed, all of which were negative for malignancy.

Gastritis cystica polyposa in an unoperated stomach

“…CT can show a heterogeneously iso‐ to hypoattenuating intraluminal lesion with multiple small cysts (several millimeters in diameter). The cysts in GCP may differentiate it from gastric adenocarcinoma, but the appearance may be similar to GIST [6]. On EUS, GCP can appear as a polymorphic, homogeneous cystic mass with a minimal solid component within the gastric mucosa [3,7].…”

“…Case reports have also revealed the possibility of a malignant transformation from GCP, even in an unoperated stomach, but the incidence of malignancy in GCP patients remains unknown [6,10]. Choi et al [4] reported a significantly higher rate of Epstein – Barr virus in cancer tissue with gastritis cystica profunda (31.1%) than in that without gastritis cystica profunda (5.8%), and its possible role as a premalignant factor requires further clarification.…”

“…Surgical intervention for removal of GCP is considered for the following reasons: (1) potential malignancy, (2) obstruction of a gastroenterostomy site, (3) symptomatic anemia and (4) inability to make a definite diagnosis with radiologic study or endoscopic biopsy [6]. Endoscopic polypectomy for GCP [3,9] and endoscopic submucosal dissection for GCP‐related early cancer [10] are also possible in selected patients.…”