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Differential diagnosis of gastric polypoid lesions include fundic gland polyposis, hyperplastic polyp, adenoma or adenocarcinoma, raised erosions, non‐Hodgkin's lymphoma, mucosal associated lymphoid tumour (MALToma) and metastatic cancers. The fundic gland polyp usually has the same colour as the gastric mucosa and is usually located in the fundus and high body. Hyperplastic polyp could present as sessile to pedunculated shape. Gastric lymphoma could present as different shapes of varying sizes in any portion of the stomach. Our first impression of the gastric polypoid lesions in this case was metastatic cancer and the pathology results from the biopsy surprised us.
The pathology results revealed atypical cells between the gastric foveolae and gastric glands. These cells had angulated nuclei and small to moderate amounts of eosinophilic cytoplasm. Some had multiple nucleoli. Immunohistochemical staining showed these cells were negative for cytokeratin and positive for factor VIII. This histological picture and immunohistochemical staining suggested dysplastic megakaryocytes (see arrow, fig 2). Scanty myeloblasts, eosinophilic myelocytes, and some band and segment forms of white blood cells were noted. According to the above findings, the patient was suffering from the rare condition of extramedullary haematopoiesis in the stomach (fig 2). In patients with haematological disorders, this characteristic endoscopic picture should raise a suspicion of extramedullary haematopoiesis in the stomach. To our knowledge, after extensively review, there have been only three reported cases of gastric extramedullary haematopoiesis in the English medical literature.1,2