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Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
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An ugly polyp !

2/1/2021

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Picture
This nodule has developed at the gastric anastomosis in an elderly patient who had undergone a Billroth II procedure some 30 years ago for peptic ulcer disease.  Initial biopsies (4 samples) have indicated that it is a hyperplastic polyp. 
HOW WOULD YOU MANAGE THIS CASE?
■ Reassure and discharge the patient
INCORRECT!
■ Keep lesion under surveillance
INCORRECT
■ Take another set of biopsies
INCORRECT!
■ Remove the lesion endoscopically
ABSOLUTELY!
■ Refer patient for surgery
INCORRECT!
explanation
For some reason, histopathologists often find it difficult to report on nodules sampled at a gastric stoma. In this case, I actually removed the polyp and took a full set of biopsies from around the stoma.  The histology wasn't entirely clear cut.  A couple of our histopathologists thought that the lesion was benign whilst three thought that it contained a small spot of intramucosal cancer. 

My endoscopic diagnosis was of a malignant polyp as it seemed a little too irregular with a funny deep cleft for being a simple inflammatory polyp. 
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    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
    Corrosive Ingestion
    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
    HPB
    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

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