Giant Gastric Polypoid Adenoma with High-Grade Dysplasia: A Case Report

We report the case of a 72-year-old woman, followed for type 2 diabetes, referred for progressive epigastric pain and iron-deficiency anemia. Upper gastrointestinal endoscopy revealed a giant sessile gastric polypoid lesion located in the antrum–fundus, with an irregular friable surface. Multiple biopsies were inconclusive, showing no evidence of malignancy. Abdominal CT did not demonstrate locoregional invasion or secondary lesions. Due to the size, symptomatic anemia, and inability to achieve complete endoscopic resection, surgical management was decided. The patient underwent atypical gastric resection via laparotomy. The resected specimen measured 8 cm in largest diameter. Histopathological examination showed a tubulovillous adenoma with high-grade dysplasia, without invasive carcinoma, and negative resection margins. The non-tumoral mucosa revealed chronic active follicular gastritis with glandular atrophy, intestinal metaplasia, and marked Helicobacter pylori infection. Postoperative course was uneventful, and the patient was discharged on day 5. This case highlights the importance of considering surgical resection in large symptomatic gastric polyps with high dysplastic potential, particularly when biopsies are non-diagnostic.