Gastric adenomas in familial adenomatous polyposis are common, but subtle, and have a benign course

Saowanee Ngamruengphong, Lisa Allyn Boardman, Russell I. Heigh, Murli Krishna, Maegan E. Roberts, Douglas L. Riegert-Johnson

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Abstract

Background: Patients with familial adenomatous polyposis (FAP) are known to have an increased risk for gastric adenomas. The clinical features of gastric adenomas in FAP have not been well characterized, and there is a lack of standardized approaches to the management of these lesions.Aims: To study the endoscopic appearance, risk factors, clinical course, and response to therapy of gastric adenomas in patients with FAP.Methods: We retrospectively reviewed the records of 97 patients with FAP who underwent esophagogastroduodenoscopy (EGD) at Mayo Clinic (Florida, Rochester and Arizona) between 2004 and 2013.Results: Nine patients (9%) had biopsy-proven gastric adenomas. Adenomas were located in the antrum (five patients), in the body and fundus in the setting of background fundic gland polyps (FGP) (three patients), and in the body not associated with FGP (one patient). Adenoma size was 3-40 mm and the number of adenomas per patient ranged from one to 20. Adenomas in the antrum were flat and subtle, whereas those in the gastric body or fundus were polypoid and difficult to differentiate from the cystic FGPs seen in patients with FAP. The performing endoscopists reported difficulty with identifying adenomas, and six patients had at least one EGD within the previous three years where gastric adenomas were not reported. Adenomas were classified as tubular in eight patients and tubulovillous in one patient. High grade dysplasia was noted in one patient. After a median follow-up of 63 months (interquartile range: 20-149 months), no patient in our entire cohort (with or without gastric adenomas) developed gastric cancer. The patients in whom gastric adenoma developed, compared to those without gastric adenoma, were more likely to be younger [36 ± 12 vs. 48 ± 15 years, p = 0.02], have concomitant chronic gastritis [22% vs. 0%, p = 0.008], and have desmoid tumors [5 (56%) vs. 19 (22%), p = 0.04].Conclusions: Gastric adenomas are not uncommon in patients with FAP and are often difficult to identify endoscopically. Endoscopists should have a high degree of suspicion for gastric adenomas in these patients and a low threshold to biopsy. Given the benign clinical course, recommended initial management is conservative with endoscopic therapy and periodic surveillance.

Original languageEnglish (US)
Article number4
JournalHereditary Cancer in Clinical Practice
Volume12
Issue number1
DOIs
StatePublished - Feb 24 2014

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Adenomatous Polyposis Coli
Adenoma
Stomach
Digestive System Endoscopy
Polyps
Aggressive Fibromatosis
Biopsy
Gastritis

Keywords

  • Familial adenomatous polyposis
  • Gastric adenoma
  • Stomach neoplasm

ASJC Scopus subject areas

  • Oncology
  • Genetics(clinical)

Cite this

Gastric adenomas in familial adenomatous polyposis are common, but subtle, and have a benign course. / Ngamruengphong, Saowanee; Boardman, Lisa Allyn; Heigh, Russell I.; Krishna, Murli; Roberts, Maegan E.; Riegert-Johnson, Douglas L.

In: Hereditary Cancer in Clinical Practice, Vol. 12, No. 1, 4, 24.02.2014.

Research output: Contribution to journalArticle

Ngamruengphong, Saowanee ; Boardman, Lisa Allyn ; Heigh, Russell I. ; Krishna, Murli ; Roberts, Maegan E. ; Riegert-Johnson, Douglas L. / Gastric adenomas in familial adenomatous polyposis are common, but subtle, and have a benign course. In: Hereditary Cancer in Clinical Practice. 2014 ; Vol. 12, No. 1.
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abstract = "Background: Patients with familial adenomatous polyposis (FAP) are known to have an increased risk for gastric adenomas. The clinical features of gastric adenomas in FAP have not been well characterized, and there is a lack of standardized approaches to the management of these lesions.Aims: To study the endoscopic appearance, risk factors, clinical course, and response to therapy of gastric adenomas in patients with FAP.Methods: We retrospectively reviewed the records of 97 patients with FAP who underwent esophagogastroduodenoscopy (EGD) at Mayo Clinic (Florida, Rochester and Arizona) between 2004 and 2013.Results: Nine patients (9{\%}) had biopsy-proven gastric adenomas. Adenomas were located in the antrum (five patients), in the body and fundus in the setting of background fundic gland polyps (FGP) (three patients), and in the body not associated with FGP (one patient). Adenoma size was 3-40 mm and the number of adenomas per patient ranged from one to 20. Adenomas in the antrum were flat and subtle, whereas those in the gastric body or fundus were polypoid and difficult to differentiate from the cystic FGPs seen in patients with FAP. The performing endoscopists reported difficulty with identifying adenomas, and six patients had at least one EGD within the previous three years where gastric adenomas were not reported. Adenomas were classified as tubular in eight patients and tubulovillous in one patient. High grade dysplasia was noted in one patient. After a median follow-up of 63 months (interquartile range: 20-149 months), no patient in our entire cohort (with or without gastric adenomas) developed gastric cancer. The patients in whom gastric adenoma developed, compared to those without gastric adenoma, were more likely to be younger [36 ± 12 vs. 48 ± 15 years, p = 0.02], have concomitant chronic gastritis [22{\%} vs. 0{\%}, p = 0.008], and have desmoid tumors [5 (56{\%}) vs. 19 (22{\%}), p = 0.04].Conclusions: Gastric adenomas are not uncommon in patients with FAP and are often difficult to identify endoscopically. Endoscopists should have a high degree of suspicion for gastric adenomas in these patients and a low threshold to biopsy. Given the benign clinical course, recommended initial management is conservative with endoscopic therapy and periodic surveillance.",
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AU - Boardman, Lisa Allyn

AU - Heigh, Russell I.

AU - Krishna, Murli

AU - Roberts, Maegan E.

AU - Riegert-Johnson, Douglas L.

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N2 - Background: Patients with familial adenomatous polyposis (FAP) are known to have an increased risk for gastric adenomas. The clinical features of gastric adenomas in FAP have not been well characterized, and there is a lack of standardized approaches to the management of these lesions.Aims: To study the endoscopic appearance, risk factors, clinical course, and response to therapy of gastric adenomas in patients with FAP.Methods: We retrospectively reviewed the records of 97 patients with FAP who underwent esophagogastroduodenoscopy (EGD) at Mayo Clinic (Florida, Rochester and Arizona) between 2004 and 2013.Results: Nine patients (9%) had biopsy-proven gastric adenomas. Adenomas were located in the antrum (five patients), in the body and fundus in the setting of background fundic gland polyps (FGP) (three patients), and in the body not associated with FGP (one patient). Adenoma size was 3-40 mm and the number of adenomas per patient ranged from one to 20. Adenomas in the antrum were flat and subtle, whereas those in the gastric body or fundus were polypoid and difficult to differentiate from the cystic FGPs seen in patients with FAP. The performing endoscopists reported difficulty with identifying adenomas, and six patients had at least one EGD within the previous three years where gastric adenomas were not reported. Adenomas were classified as tubular in eight patients and tubulovillous in one patient. High grade dysplasia was noted in one patient. After a median follow-up of 63 months (interquartile range: 20-149 months), no patient in our entire cohort (with or without gastric adenomas) developed gastric cancer. The patients in whom gastric adenoma developed, compared to those without gastric adenoma, were more likely to be younger [36 ± 12 vs. 48 ± 15 years, p = 0.02], have concomitant chronic gastritis [22% vs. 0%, p = 0.008], and have desmoid tumors [5 (56%) vs. 19 (22%), p = 0.04].Conclusions: Gastric adenomas are not uncommon in patients with FAP and are often difficult to identify endoscopically. Endoscopists should have a high degree of suspicion for gastric adenomas in these patients and a low threshold to biopsy. Given the benign clinical course, recommended initial management is conservative with endoscopic therapy and periodic surveillance.

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KW - Familial adenomatous polyposis

KW - Gastric adenoma

KW - Stomach neoplasm

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