Gastric Neoplasia

Gastric polyps occur in 23-100% of FAP patients [44-46]. Fundic gland polyps (FGP) are the most common gastric polyps in FAP. They usually appear in the gastric fundus and body, and have traditionally been regarded as non-neoplastic, possibly hamar-tomatous lesions. Similar polyps, although fewer in number, are sometimes observed in the general population and possibly associated with chronic use of proton pump inhibitors [47]. These polyps are considered to have little or no potential for malignant transformation; however, recent studies have reported that dysplasia and malignant transformation occur more frequently than previously believed (48, 49). Histologically, these polyps consist of simple hyperplasia of the fundic glands with microcytes. Endoscopically, these are multiple sessile lesions, 1-5 mm in diameter, that are the same color with the surrounding mucosa. They vary considerably in size and number. The polyps are sometimes numerous, and coalesce, forming an irregular matted surface mucosa. These polyps rarely cause symptoms and have been observed as early as 8 years of age.

Adenomatous polyps occur in the stomach of about 10% of patients with FAP. Most often, they are confined to the antrum but occasionally found in the body and fundus (44,50]. The lifetime risk for gastric cancer in FAP is about 0.6%, believed in large part to arise from adenomatous polyps. Interestingly, Japanese and Korean FAP patients have a 3-4 times higher risk of gastric cancer compared with the general population [51, 52], whereas no increased risk has been found in Western countries [9].

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