Gastric adenoma with atypical appearance: findings on double-contrast barium study with histopathologic correlation

Background: To describe the radiologic findings of nonpolypoid gastric aden omas and to correlate them with pathologic findings. Methods: During a 9-year period, we reviewed 49 pure gastric adenomas in 13 patients with positive radiologic findings. Of these adenomas, seven with atypical polypoid appearance were retrospectively included in the study. We reviewed these findings with double-contrast barium study and correlated t hem with the pathologic findings. Results: Of seven nonpolypoid adenomas, four were depressed and three were flat at pathologic examination. All were diagnosed as early gastric carcino ma (five as type IIc, one as type IIb, one as type IIa + IIc) in upper gast rointestinal series. Three were located in the gastric angle, two in the lo wer body, and two in the antrum. Size ranged from 10 mm to approximately 25 mm (mean = 15 mm). Six lesions had nodular surface and five had convergenc y of the mucosal folds. A shallow depressed area was seen in six lesions. Conclusions: A considerable proportion of gastric adenomas presents as a de pressed or hat lesion on double-contrast barium study because of histologic characteristics of decreased subjacent mucosa. Because the nonpolypoid ade noma has a greater potentional for malignancy, more precaution is needed du ring the follow-up of this uncommon lesion.