Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET): a case report

Springer Science and Business Media LLC - 2020
Suguru Hayase1, Mei Sakuma1, Shun Chida1, Masaru Saito1, Hirofumi Ami1, Yoshihisa Koyama1, Shinji Ohki2, Koji Kono2
1Department of Surgery, Ohara General Hospital, Fukushima, Japan
2Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan

Tóm tắt

Gastric hamartomatous inverted polyp (GHIP) is a pathological condition where enlarged gastric glands with cystic dilatation grow in the submucosa. It is difficult to excise the tissue due to its location. In addition, even if the tissue is taken correctly, making an accurate diagnosis is difficult due to foveolar epithelium in the tissue, which can be misdiagnosed as gastric mucosal epithelium. Thus, an accurate diagnosis of GHIP is rarely established from a biopsy alone preoperatively. We here report a case of GHIP with a central dimple, which was diagnosed and treated using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET). A 60-year-old man with a submucosal tumor (SMT) in the stomach was referred to our hospital by a primary care doctor. On examination, a gastrointestinal stromal tumor was suspected. Modified CLEAN-NET was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed an enlarged gland duct in the submucosal layer. This finding, along with immunostaining results, led to the diagnosis of GHIP. The postoperative course was uneventful without any symptoms. GHIP should be considered among the differential diagnoses of SMT of the stomach. Modified CLEAN-NET may be beneficial in the removal of SMTs such as GHIP with a central dimple because it can avoid stomach deformation of the stomach and tumor dissemination.

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Tài liệu tham khảo

Ming SC. Tumor of the esophagus and stomach. In: Tumors of the Stomach. 2nd ed: Armed Forces Institute of Pathology; 1973. p. 124–43.

Dohi M, Gen Y, Yoshioka M. A case of gastric hamartomatous inverted polyp resected endoscopically. Endosc Int Open. 2016;4:E608–9.

Odashima M, Otaka M, Nanjo H, Jin M, Horikawa Y, Matsuhashi T, et al. Hamartomatous inverted polyp successfully treated by endoscopic submucosal dissection. Intern Med. 2008;47:259–62.

Mori H, Kobara H, Tsushimi T, Fujihara S, Nishiyama N, Matsunaga T, et al. Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth. World J Gastroenterol. 2014;20:5918–23.

Imamura T, Komatsu S, Ichikawa D, Kobayashi H, Miyamae M, Hirajima S, et al. Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery. World J Gastrointest Oncol. 2015;7:118–22.

Kim DH, Kim KM, Oh SJ, Oh JA, Choi MG, Noh JH, et al. Early gastric cancer arising from heterotopic gastric mucosa in the gastric submucosa. J Korean Surg Soc. 2011;80(Suppl 1):S6–11.

Classen M, Tytgat GNJ, Lightdale CJ, Koff RS, Wu GY. Gastroenterological endoscopy. 2nd ed. Stuttgart and New York: Thieme; 2010.

Inoue H, Ikeda H, Hosoya T, Yoshida A, Onimaru M, Suzuki M, et al. Endoscopic mucosal resection, endoscopic submucosal dissection, and beyond: full-layer resection for gastric cancer with nonexposure technique (CLEAN-NET). Surg Oncol Clin N Am. 2012;21:129–40.

Aoki M, Yoshida M, Saikawa Y, Otani Y, Kubota T, Kumai K, et al. Diagnosis and treatment of a gastric hamartomatous inverted polyp: report of a case. Surg Today. 2004;34:532–6.

Namikawa T, Ishida N, Yokota K, Munekage E, Iwabu J, Munekage M, et al. Early gastric cancer with multiple submucosal heterotopic gastric gland: a case report. Mol Clin Oncol. 2019;10:583–6.

Sipponen P, Siurala M. Cystic “hamartomatous” epithelial polyps of the stomach. Acta Hepatogastroenterol. 1978;25:380–3.

Iida M, Yao T, Watanabe H, Itoh H, Iwashita A. Fundic gland polyposis in patients without familial adenomatosis coli: its incidence and clinical features. Gastroenterology. 1984;86:1437–42.

Itoh K, Tsuchigame T, Matsukawa T, Takahashi M, Honma K, Ishimaru Y. Unusual gastric polyp showing submucosal proliferation of glands: case report and literature review. J Gastroenterol. 1998;33:720–3.

Yamashita M, Hirokawa M, Nakasono M, Kiyoku H, Sano N, Fujii M, et al. Gastric inverted hyperplastic polyp. Report of four cases and relation to gastritis cystica profunda. APMIS. 2002;110:717–23.

Yamagiwa H, Matsuzaki O, Ishihara A, Yoshimura H. Heterotopic gastric glands in the submucosa of the stomach. Acta Pathol Jpn. 1979;29:347–50.

Ueo T, Ishida T, Nagamatsu H, Narita R, Takahashi K, Kodera T, et al. Two cases of hamartomatous inverted polyp preoperatively diagnosed based on EUS findings, and successfully treated with endoscopic resection. Gastroenterol Endosc. 2012;54:24–32.

Sugiyama K, Asaki S, Ohara S, Sekine H, Toyota T. Juvenile submucosal heterotopia of gastric glands removed by endoscopic polypectomy. Gastroenterol Endosc. 1992;34:2354–60.

Hibino S, Ko K, Katayama M, Ogura Y, Abe T. A case of hamartomatous inverted polyp resembling a submucosal tumor. Nippon Shokaki Geka Gakkai zasshi. 2002;35:598–602.

Nabeshima K, Tomioku M, Nakamura K, Yasuda S. Combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) for GIST with ulceration. Tokai J Exp Clin Med. 2015;40:115–9.

Onimaru M, Inoue H, Ikeda H, Abad MRA, Quarta Colosso BM, Shimamura Y, et al. Combination of laparoscopic and endoscopic approaches for neoplasia with non-exposure technique (CLEAN-NET) for gastric submucosal tumors: updated advantages and limitations. Ann Transl Med. 2019;7:582.

Fujishima H, Etoh T, Hiratsuka T, Akagi T, Tajima M, Shibata T, et al. Serosal and muscular layers incision technique in laparoscopic surgery for gastric gastrointestinal stromal tumors. Asian J Endosc Surg. 2017;10:92–5.

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