2785 Vanek's Tumor: A Rare Presentation of Abdominal Pain and Reflux Disease

Abstract

INTRODUCTION: Inflammatory fibroid polyps (IFPs), or Vanek’s tumors, are benign subepithelial tumors most commonly found in the stomach and small intestine. Histologically, they classically demonstrate spindle cell onion skinning with an abundance of eosinophilic infiltration. IFPs are most commonly found incidentally upon endoscopic evaluation, but may drive certain symptoms such as early satiety or epigastric pain depending on position. We describe a case of IFP successfully removed from the gastric antrum of a patient presenting with reflux and pain with resolution of symptoms after polypectomy. CASE DESCRIPTION/METHODS: A 47-year-old female with a history of gastroesophageal reflux with poor symptom control despite high dose twice daily proton pump inhibitor (PPI) therapy presented to the clinic for evaluation of worsening reflux. She also endorsed epigastric discomfort, chronic cough, and laryngitis. Her last upper endoscopy in 2015 was normal. Upper endoscopy was completed, which revealed the presence of a single pedunculated polyp measuring 1.2 cm in the gastric antrum near the pylorus. Polyp was removed with hot snare cautery and the residual defect was closed with clips. Given the endoscopic appearance, the lesion was initially thought to be hyperplastic. On pathologic review, the architecture and immunohistochemical profile was most consistent with an IFP. On follow-up several weeks later, the patient had improved reflux and abdominal pain symptoms and was then weaned off of her PPI without return of symptoms after several months. DISCUSSION: Although IFPs were initially postulated to be robust host responses to local injury with resultant inflammation, recent evidence has shown that IFP proliferation is driven by an activating mutation in the platelet derived growth factor receptor alpha (PDGFRA), which is suggestive of a neoplastic and possibly insidious etiology. While most are found incidentally and there are no guidelines on surveillance of these lesions, any large polyp in the stomach should be removed to reduce the risk of progression to malignancy. Furthermore, polyp removal may result in symptom improvement. Whether our patient’s symptom resolution was placebo-driven or actually a result of the IFP removal, our patient demonstrated a remarkable improvement exclusively with IFP polypectomy.