Morphology and natural history of familial adenomatous polyposis-associated dysplastic fundic gland polyps

Histopathology. 2014 Sep;65(3):353-62. doi: 10.1111/his.12393. Epub 2014 Apr 8.


Aims: Most patients with familial adenomatous polyposis (FAP) develop gastric fundic gland polyps, with many displaying low-grade dysplasia. This study evaluates the natural history and morphological phenotype of dysplasia in FAP-associated fundic gland polyps.

Methods and results: Patients with FAP and dysplastic fundic gland polyps (n = 24) were identified. Twenty-two of 24 FAP-associated dysplastic fundic gland polyps showed a gastric phenotype and two had mixed phenotype. During a mean 6.1-year follow-up (range 0.8-12.6 years) and 5.7 endoscopies (range 2-22), one patient (4%) was diagnosed with a fundic gland polyp with high-grade dysplasia, while 23 patients (96%) in this cohort had either no dysplasia or persistent low-grade dysplasia. Contemporary patients with sporadic fundic gland polyps with low-grade dyplasia had similar morphology and outcomes to the FAP-associated fundic gland polyp cohort. Dysplasia in fundic gland polyps (FAP-associated and sporadic) was associated less frequently with intestinal phenotype, high-grade dysplasia and the finding of concurrent or subsequent carcinoma compared to contemporary patients with sporadic gastric dysplasia not occurring in fundic gland polyps.

Conclusions: This cohort of patients with FAP-associated dysplastic fundic gland polyps rarely developed high-grade dysplasia and gastric adenocarcinoma was absent.

Keywords: dysplasia; familial adenomatous polyposis; fundic gland polyp; stomach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenomatous Polyposis Coli / etiology
  • Adenomatous Polyposis Coli / pathology*
  • Adenomatous Polyps / etiology
  • Adenomatous Polyps / pathology*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Disease Progression
  • Female
  • Gastric Fundus / pathology
  • Gastric Mucosa / pathology
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Stomach Neoplasms / etiology
  • Stomach Neoplasms / pathology*
  • Young Adult

Supplementary concepts

  • Polyposis, Gastric