Gastric Polyps

Gastric Polyps

Michael P. Federle, MD, FACR

(Left) Graphic shows a pedunculated polyp in the gastric antrum, prone to prolapse through the pylorus with peristalsis. Any type of large polyp may prolapse in this fashion, including large hyperplastic, adenomatous, and even polypoid masses arising from the submucosa, such as lipomas. (Right) Upper GI series shows a polypoid mass image in the duodenal bulb that is a prolapsed gastric antral polyp (adenoma).

(Left) Film from an upper GI series in a 57-year-old man shows multiple small, sessile polyps image in the gastric body. The appearance and age of the patient are typical for hyperplastic polyps. (Right) Film from an upper GI series of adenomatous polyps in a patient with familial polyposis shows innumerable small polyps throughout the stomach. These are somewhat larger, more numerous, and more irregular in shape than most hyperplastic polyps.



  • Protruding, space-occupying, epithelial lesion within stomach


General Features

  • Best diagnostic clue

    • Radiolucent filling defect, ring shadow, or contour defect on barium study

  • Morphology

    • Hyperplastic polyps: Smooth, sessile, pedunculated

      • Fundic gland polyps: Always sessile, multiple, small

    • Adenomatous polyps: Usually single with lobulated or cauliflower-like surface

    • Hamartomas: Cluster of broad-based polyps

  • Other general features

    • 85-90% of gastric neoplasms are benign

      • 50% are mucosal and 50% submucosal

    • Gastric polyps are mucosal lesions

    • More common in hereditary polyposis syndromes

    • Polyps classified into 3 types based on pathology

      • Hyperplastic, adenomatous, & hamartomatous

    • Hyperplastic polyps

      • Most common benign epithelial neoplasms of stomach (80-90%)

      • Virtually no malignant potential

      • Typical: Small, multiple, sessile (< 1 cm)

        • Location: Fundus and body

      • Fundic gland polyps: Variant of hyperplastic polyps (< 1 cm)

      • Atypical large: Solitary, pedunculated (2-6 cm); location (body and antrum)

      • Atypical giant: Polyp (6-10 cm) multilobulated mass; location (antrum and body)

      • 8-28% associated with atrophic gastritis, pernicious anemia, and cancer

    • Adenomatous polyps

      • Less common (< 20% of benign polyps); dysplastic lesions

      • ↑ risk of malignant change via adenomacarcinoma sequence

      • Usually solitary, occasionally multiple, > 1 cm

        • Location: Mostly antrum > body

      • Histologically: Tubular (75%), tubulovillous (15%), villous (10%)

      • Gastric adenomatous polyps 30x less common than gastric cancer

      • Carcinoma in situ and invasive carcinoma: Seen in 50% of adenomatous polyps > 2 cm

      • 30-40% associated with atrophic gastritis, pernicious anemia, and cancer

      • Higher risk of coexisting gastric cancer than risk of malignant change in polyp

    • Polyposis syndromes involving stomach

Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Gastric Polyps
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