Gastroenterology image challenge: A 72-year-old man with compensated cirrhosis owing to autoimmune hepatitis presented for evaluation of an indeterminate gastric lesion found during an otherwise normal ERCP performed for incidental ductal dilation seen on cross-sectional imaging. He did not endorse any abdominal pain, dyspepsia, or weight loss and was not on a proton pump inhibitor. Family history was notable for a daughter diagnosed with metastatic gastric adenocarcinoma at the age of 44 years.
Upper endoscopy showed innumerable sessile polyps of variable size carpeting the gastric body and fundus (Figure A) with a large, mound-like mass lesion in the fundus (Figure A, arrow and inset). Echoendoscopy revealed a hypoechoic, noncircumferential mass restricted to the mucosal surface with well-defined borders (Figure B, arrow). A technically challenging, piecemeal endoscopic mucosal resection was performed. The patient also underwent a colonoscopy that was unremarkable. Pathology of the gastric lesion was consistent with a fundic gland polyp (Figure C, arrowheads) containing low-grade and high-grade dysplasia (Figure C, arrows).
How would you diagnose and treat this patient?
To find out the diagnosis, read the full case in Gastroenterology.
