High-grade dysplasia in sporadic fundic gland polyps: clinically relevant or not?

Sporadic fundic gland polyps (FGPs) are the most frequent gastric polyps. These FGPs develop almost exclusively in a normal corpus mucosa without Helicobacter pylori infection. This means that they represent an absolutely benign disease (no ulcers, almost no gastric carcinoma and mucosa associated lymphoid tissue (MALT) lymphoma). Most probably there exists a statistically accumulated coincidence rate of sporadic FGPs with colorectal epithelial neoplasias, so it is recommended to consider preventive colonoscopy. In familial adenomatous polyposis (FAP), FGPs are present in up to 80-93% of patients. In such patients, low-grade dysplasia and/or foveolar microadenomas may be present in 44-54% of cases. To date, only three case reports on early gastric carcinoma have been published. In this issue, to the best of our knowledge the first case of a high-grade dysplasia (intraepithelial neoplasia) in a sporadic FGP is reported. Recently, it has been shown that beta-catenin mutations might have led to FGP. Therefore, in the future, patients showing nuclear beta-catenin expression must undergo examination to discover whether this expression may lead to neoplasia. According to the data available at present, such a constellation must be regarded as an extremely rare event.