Premalignant Potential of Fundic Gland Polyps-associated Familial Polyposis Syndromes

Fundic gland polyps (FGPs) are the most common type of gastric polyps (up to 50%). They are found in up to 0.8-1.9 % of the general population, and in 40-84 % of the patients suffering from familial polyposis syndromes. They might be sporadic or associated to polyposis syndromes. When the former, they should be considered exclusively benign lesions, and possibly related to the chronic use of proton pump inhibitors; the latter, associated to familial adenomatous polyposis (FAP) or attenuated familial adenomatous polyposis (AFAP), may not be a completely hamartomatous process as previously suggested, but carry a risk of dysplasia leading to malignancy. We highlight in this case series of four patients, with underlying familial polyposis syndromes, the adenomatous and carcinomatous degeneration of the gastric FGPs, and we provide an overview of the major clinical features concerning syndromic FGPs, to add an argument to the published data, that FGPs-associated polyposis syndromes represent a dysplastic precursor, and their natural history is also subject to the rule of adenoma-carcinoma progression. Modern endoscopic assessment of FGP like electronic coloration could help to differentiate typical FGP from those with adenomatous component or dysplasia and to manage them endoscopically. Syndromic FGPs deserve more attention for their neoplastic potential, and may warrant close endoscopic surveillance for early detection of dysplasia even when the colorectal disease is eradicated.