Journal of Pediatric Gastroenterology & Nutrition:
Image of the Month
*Division of Gastroenterology and Nutrition, Department of Pediatrics, USA
†Department of Pathology, University of Texas Southwestern Medical Center at Dallas, USA
A 13-year-old boy presented with a 1-day history of vomiting and hemoglobin of 6.1 g/dL. He had a history of duodenal perforation at 1½ months of age of unknown etiology that required gastrectomy and duodenal resection. The subsequent course was uneventful.
Endoscopy demonstrated a normal esophagus and a small gastric cavity (gastric stump) with edematous and polypoid-appearing mucosa (Fig. 1). The small bowel had 2 loops, 1 of which was a blind end, with normal-appearing mucosa. The results of the colonoscopy were normal. No active source of bleeding was found. No therapy was needed during the procedure. Histological examination of the esophagus, small bowel, and colon provided unremarkable results. The stomach showed marked elongation and serration of the foveolae with mucin depletion of the epithelium (Fig. 2). The underlying glands were mostly pyloric in type and many were cystically dilated. The lamina propria was edematous and contained a mild lymphoplasmacytic infiltrate and increased smooth muscle fibers. There was no epithelial dysplasia or intestinal metaplasia. Based on these results, the patient was diagnosed with gastritis cystica polyposa (GCP). He did well without needing further blood transfusion, and was discharged from the hospital with a prescription for iron supplements. His follow-up hemoglobin has remained within normal limits.
GCP is a rare inflammatory disease characterized histologically by elongation of the gastric foveolae along with hyperplasia and cystic dilatation of the gastric glands. These lesions are usually found at gastroenterostomy sites, presumably due to excessive reflux of duodenal contents into the stomach. The disease is characterized by gastrointestinal bleeding with anemia and possible increased risk for the development of gastric adenocarcinoma.
Resecting the site and choosing surgical techniques to minimize bile reflux into the stomach appears to be the preferred method of treatment.
The authors report no conflicts of interest.
Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.
© 2008 Lippincott Williams & Wilkins, Inc.