Endoscopic Resection of Giant Infracted Colonic Inflammatory Fibroid Polyp Mimicking Colonic Neoplasm

Abstract

Purpose: Inflammatory fibroid polyp (IFP) is an uncommon non-neoplastic lesion more frequently involving the stomach and the small intestine and they are rarely described in the esophagus or the colon. The colonic IFP are usually asymptomatic, however, when they become very large, they may present with colicky pain, weight loss, diarrhea, bleeding, anemia, and intussusceptions. We report a case of giant infracted colonic IFP causing chronic intermittent abdominal pain and hematochezia treated successfully with endoscopic resection. Case: Our patient is an 83 year old male with past medical history of diabetes mellitus, coronary artery disease and end stage renal disease treated with hemodialysis, presented with one week history of hematochezia, chronic intermittent abdominal cramps, and anemia. Physical exam was unremarkable. He was scheduled for colonoscopy which revealed a giant polypoid mass, nearly obstructing the lumen of the descending colon. The mass was pedunculated, had a wide stalk, and measured 7.0 cm in size. Biopsies obtained with forceps revealed acutely inflamed stroma with granulation tissue but no epithelium was present for evaluation. Serum CEA was 1.3. CT scan of abdomen was done and revealed hypodense and heterogeneous mass within the proximal descending colon with somewhat low internal density corresponding to fat density which may represent lipoma, however, malignancy could not be excluded. Surgical option was declined by the patient. Colonoscopy was repeated and endoscopic polypectomy was performed. The mass was removed in a piecemeal fashion on two sessions. Pathology reported a 7.0 x 4.0 x 3.0 cm polyp with extensive infarction and necrosis with some areas of benign inflammatory fibrosis with scattered eosinophils. Immunostain was positive for CD34 and negative for S 100 and desmin. Patient's symptoms resolved completely after polypectomy. Conclusion: Although large benign colonic polyps can be difficult to differentiate from malignant polyps prior to resection, (even with abdominal imaging and direct endoscopic visualization), carefully selected cases can be accurately and safely diagnosed and treated endoscopically. This report is distinct to demonstrate that endoscopic resection of a giant infracted and symptomatic colonic IFP still remains a safe and effective option of therapy when it is performed by experienced endoscopists at the tertiary centers. To our knowledge this is the largest reported pedunculated colonic inflammatory fibroid polyp successfully treated by endoscopic polypectomy.