A Case of Large Fibrovascular Polyp of the Stomach
A 36-year-old male patient visited the emergency room with the chief complaint of melena which began 10 days ago. The patient did not have any medical history, family history, or social history. On his initial visit, his body temperature was 36.5℃, pulse rate was 82 beats per minute, respiratory rate was 18 breaths per minute, and blood pressure was 110/80 mm Hg.\nIn a physical examination, his conjunctiva was pale, and there was tenderness in his epigastric region with normal bowel sound and no palpable abdominal mass. In a laboratory test, hemoglobin level was 6.7 g/dL and the other findings were within normal limits.\nEmergency upper gastrointestinal endoscopy was performed and a pedunculated polyp about 45 mm in diameter, accompanied with ulcer at the base of the polyp, was observed in the gastric antrum. Prominent vascularity with hemorrhagic ulceration on the surface and easy bleeding to light touch with forceps was noted at the proximal side of the lesion, and irregular friable surface with one exposed vessel was noted at the distal side of the lesion (). This was presumed due to thinning or disappearance of swollen gastric mucosa by hemorrhagic, ulcerative change of large submucosal tumor with hypervascular nature. The hemorrhage was controlled with injection of epinephrine followed by thermocoagulation, and intravenous proton pump inhibitor (PPI) and transfusion were started.\nIn his abdominal computed tomography (CT), about 3.5×5 cm-sized pedunculated mass was located in the lesser curvature of the stomach with partial mucosal wall disruption (). The patient was admitted and observed whether melena persisted. His hemoglobin level, which increased up to the normal value after transfusion, later decreased to 9.7 g/dL and a laparoscopic wedge resection was scheduled for uncontrolled bleeding after failing of endoscopic and supportive managements. Under a laparoscopic exploration, the polyp was located in the lesser curvature of the stomach. The right gastric artery was cut, and wedge resection was performed with a boundary of 4 cm from the margin of the polyp. The surgical specimen was a protruding 4×4×3 cm polyp accompanied with ulcer, and its cross section showed a mucosal lesion in the mixture of gray and yellow colors.\nIn microscopic findings, overlying gastric mucosa was nearly disappeared and the surface was replaced by exposed submucosal tissue with ulceration and inflammation. The submucosal tissue was composed of many irregular blood vessels, loose connective tissues, and adipose cells that are consistent with FVP (). After the surgery, the patient has been followed up on an outpatient basis until now for about 1 year without any evidence of gastrointestinal bleeding and antral stricture on endoscopy.