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
■ Keep lesion under surveillance
■ Take another set of biopsies
■ Remove the lesion endoscopically
■ Refer patient for surgery
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.