Gastric Polyposis Case Report Medical Trust Hospital, Kochi Clinical August 2001 Female, 45 Yr Longstanding Dyspepsia Recently diagnosed anemia No GI Bleed, Diarrhea, Constitutional symptoms Clinical H2 blocker therapy in 1992 Self medication : H2 blocker till : Evaluation UGIE / USG : Report NA CECT Abdomen : Stromal Tumor in D2 PPI course for 1 Mth Self medication with PPI since then Examination & Laboratory Severe pallor Scar of LSCS Rest NAD Hemoglobin : 5.9 gm % Peripheral blood smear : Hypochromic microcytic anemia Routine biochemistry : Normal UGI Endoscopy Markedly hypertrophic gastric mucosal folds Fundus, body studded with polypoid lesions (sessile). Size:0.5-2cm, with umbillication Relative sparing of antrum Smaller umbillicated nodules in antrum and D1. D2 and D3 Normal No E/o Ulcer disease, active or old CECT Thickened gastric wall in fundus and body up to 2 cm 5 cm mass lesion on anterolateral aspect of D2 Pancreas, retroperitoneum, liver normal CECT CECT Jan 2000 EUS Submucosal thickening of stomach Mass in relation to D2 with intact serosa Pancreas normal Snare biopsy of polyp EUS Histology Atrophic Gastritis Gastric Carcinoid Immunostaining : Synaptophysin positive Investigations 24 Hr Urinary 5-HIAA : 10.5 mg Normal range ( ) Serum Gastrin Assay (After withholding PPI for 1 wk) : 520 pg/ml Normal ( Upto 120 pg) H. Pylori Serology : Negative Surgery Preoperative blood transfusion Total Gastrectomy with excision of paraduodenal mass. Esophagojejunal pouch anaestomosis Roux en y Findings: Pancreas, D2, Hepatoduodenal ligament, small bowel normal. Specimen Pouchogram Histology Gastric Carcinoid extending upto muscularis at places Atrophic Gastritis Metastatic Lymph node Follow up Asymptomatic (No Dyspepsia !!!) Tolerates near normal size meal Hemoglobin maintained Follow up Gastrin assay awaited Not popping pills Gastric Carcinoid Uncommon Three variants *Type I : Associated with Atrophic Gastritis *Type II : Associated with Gastrinoma *Type III: Sporadic Multiple Gastric Carcinoids Type I and II Associated with hypergastrinemic state Reversal reported on correction of hypergastrinemia with small tumor volume Prognosis better than Sporadic variant 5 yr survival % Association with prolonged acid suppression not reported yet in humans