Surg Today (2011) 41:1428–1431 DOI 10.1007/s00595-010-4440-8 Case Report Sporadic Diffuse Gastric Polyposis: Report of a Case ERASMO SPAZIANI 1 , MARCELLO PICCHIO 2 , ANNALISA DI FILIPPO 1 , PIERO NARILLI 3 , CLAUDIO DI CRISTOFANO 4 , VINCENZO PETROZZA 4 , FRANCESCO DE ANGELIS 1 , and GIUSEPPE RAGONA 4 1 Department of Surgery, University of Rome “La Sapienza”, Polo Pontino, Hospital “A. Fiorini”, Latina, Italy 2 Department of Surgery, Civil Hospital “P. Colombo”, Rome, Italy 3 Department of Surgery, General Hospital “Nuova Itor”, Rome, Italy 4 Department of Experimental Medicine and Pathology, University of Rome “La Sapienza”, Polo Pontino, “I.C.O.T.”, Latina, Italy Abstract A 50-year-old woman was admitted because of severe sideropenic anemia. The gastrin levels were within normal ranges. Esophagogastroduodenoscopy showed diffuse gastric polyposis with signs of diffuse oozing. Colonoscopy showed the presence of a 3-cm wide pedunculated polyp of the ascending colon, which was removed by diathermy. The patient was treated by total gastrectomy with Roux-Y esophagojejunostomy. His- tological examination showed the presence of diffuse gastric polyposis with the contemporary occurrence of hyperplastic polyps and mixed hyperplastic and adeno- matous polyps, with a tubular pattern and the focal aspect of serrate adenoma. This is the first case report of sporadic diffuse hyperplastic and adenomatous polyposis of the stomach. Key words Stomach · Gastric polyposis · Surgery Introduction Gastric hyperplastic polyposis has been defined as a syndrome comprising at least 50 hyperplastic polyps. 1 Thus far, there have been only a few reports of gastric hyperplastic polyposis. 1–7 Gastric adenomas are defined as circumscribed, polypoid lesions, composed of either tubular and/or villous structures, lined by dysplastic epi- thelium. Most of these adenomas are solitary; however, multiple adenomas have been reported in the context of familial adenomatous polyposis. We herein present a unique case of sporadic gastric polyposis with aspects of hyperplastic and adenomatous polyps. Case Report A 50-year-old woman was admitted to our department because of severe sideropenic anemia. Physical exami- nation showed pallor with no cutaneous abnormal pigmentation and/or onychodystrophy. Laboratory data revealed hemoglobin of 4.1 g/dl. On further investiga- tion, the patient’s serum iron was observed to be low at 9 μg/dl, and her total iron-binding capacity was elevated at 450 μg/dl. Her transferrin saturation was low at 2.3%, while her serum ferritin was 3.8 μg/dl and reticulocyte count 2.9%. Gastrin levels were within the normal range. The patient was taking warfarin, since she had received aortic valve replacement 3 years before the present admission. Esophagogastroduodenoscopy showed diffuse gastric polyposis with signs of diffuse oozing (Fig. 1). According to histological examinations of the endoscopic biopsies, the polyps were either hyperplastic or adenomatous. The upper gastrointesti- nal series did not show any polyps in the small bowel. Colonoscopy showed the presence of a 3-cm wide pedunculated polyp of the ascending colon that was removed with diathermy. At histological examination, the polyp was tubulovillous with moderate dysplasia. A total body computed tomography scan showed no signs of lymph node enlargement and/or metastasis. The patient underwent a total gastrectomy with peri- gastric lymph node resection (D1 lymphadenectomy). Roux-Y esophagojejunostomy reconstruction was per- formed. The macroscopic appearance of the gastrec- tomy specimen is shown in Fig. 2. The postoperative course was uneventful. The histological examination of the specimen con- firmed the presence of diffuse gastric polyposis with the contemporary occurrence of hyperplastic polyps, mixed hyperplastic and adenomatous polyps, and adenoma- tous polyps with a tubular pattern (Fig. 3). Some polyps had aspects of serrate adenoma (Fig. 4). Atrophic gas- Reprint requests to: M. Picchio, Via Giulio Cesare 58, 04100 Latina, Italy Received: August 24, 2010 / Accepted: October 13, 2010