Diagnosis Of Inflammatory Fibroid Polyp Research Articles

Inflammatory fibroid polyp (Vanek's tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report

Introduction and importanceThe majority of the of small bowel intussusception causes are benign, and different types of benign tumors have been reported as the lead points of an intussusception. Among these, some studies have reported inflammatory fibroid polyp as a cause of small bowel intussusception. However, according to our knowledge this is the first case to be reported in Africa of an adult double compound intussusception due to an inflammatory fibroid polyp.Case reportA 32-year-old female presented with epigastric abdominal pain, nausea, vomiting and diarrhea for 2 weeks. Investigations revealed a small bowel obstruction due to intussusception, and exploratory laparotomy was planned.Clinical discussionInflammatory fibroid polyp causing this unique feature of double compound ileo-ileal intussusception should be observed in adult patients who presents with intestinal obstruction. A CT scan is the diagnostic modality of choice, and we think that the disease is the first of its kind to be reported in Africa.ConclusionsDouble ileo-ileal intussusception is a rare cause of intestinal obstruction in adult patients.Interventions and outcomeLaparotomy reviled an ileo-ileal intussusception. After manual reduction of this intussusception, another intussusception was observed and containing a polyp. A clear margin resection and end-to-end primary anastomosis were performed. The histopathological report established the diagnosis of Inflammatory Fibroid Polyp. After the procedure, the patient's condition improved well with no complications.MethodsThis case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [1]).

A large inflammatory fibroid polyp of the rectum removed by transanal excision

Inflammatory fibroid polyps (IFP) are rare benign lesions arising from the submucosa of the gastrointestinal tract, most commonly found in the stomach and small intestine. IFPs are very rarely found in the rectum, with only a few reported cases, and their presentation is quite varied. The patient is a 53 year old male who underwent routine screening colonoscopy, during which a lobular mass of the proximal rectum was discovered. The patient subsequently underwent an endoscopic ultrasound (EUS) with fine needle aspiration (FNA) biopsy. Pathology displayed scant spindle cells with benign glandular epithelium suspicious for a spindle cell neoplasm. The mass was excised transanally. The morphological and immunohistochemical findings supported the diagnosis of inflammatory fibroid polyp. Although this is not a malignant tumor, the treatment and surveillance guidelines have not been determined and there is no standard of care.

Clinical and endoscopic features of 49 cases of gastric inflammatory fibroid polyp

Objective To summarize the endoscopic appearance, endoscopic ultrasound findings and histopathological characteristics of gastric inflammatory fibroid polyp (IFP) in order to improve diagnosis of IFP. Methods From September 2011 to November 2016, 49 patients with pathologically comfirmed gastric IFP, who underwent endoscopy in Taizhou Hospital of Zhejiang Province, were enrolled. The medical history, endoscopic examination, treatment and follow-up were retrospectively analyzed. Results Among 49 patients with gastric IFP (16 males and 33 females; average age 54 years) the maximum diameter of 33 cases (67.3%) was between 1.0 cm and 2.0 cm. Forty-eight cases had single lesion and one case had multiple lesions. The lesions of 17 cases (34.7%) were located at the anterior wall of gastric antrum, the lesions of seven cases (14.3%) were at the posterior wall of gastric antrum, the lesions of seven cases (14.3%) were at the lesser curvature of gastric antrum and the lesions of seven cases (14.3%) were at the great curvature of gastric antrum. Among the lesions of 41 patients who received endoscopic ultrasonography, 28 lesions were located in the submucosa of stomach, 13 lesions were located in mucosa and muscularis mucosa. The rate of misdiagnosis of endoscopic ultrasonography was 29.3%(12/41). The endoscopic ultrasound findings of the lesions included 26 hypoechoic structures, 11 hyperechoic structures and four slightly hypoechoic structures. The lesions of all the patients were successfully removed by endoscopic polypectomy without any complication. Thirty-seven lesions were treated by endoscopic submucosal dissection (ESD) and 12 lesions by endoscopic mucosal resection (EMR). All the patients were not clearly diagnosed before operation and were finally diagnosed by pathological examination. Postoperative pathological examination showed that in the suhmucosa and mucosa lamina propria, spindle-shaped cells proliferated and arranged in an interwoven pattern or cells around vessels or mucosal glands formed vortex-like or onion skin-like pattern. Forty-seven patients were followed up and the median follow-up time was 31 months. All patients survived withont recurrence or metastasis until the submission of this paper. Conclusions The rate of misdiagnosis of gastric IFP is high before operation, and the diagnosis is depended on histopathological examination. Endoscopic resection is the first choice because the diameter of most lesions are less than 5 cm. Key words: Gastrointestinal diseases; Diagnosis; Inflammatory fibroid polyp of the stomach; Endoscopic findings; Treatment

Small Bowel Intussusception Secondary to Inflammatory Fibroid Polyp of the Ileum

Introduction: Inflammatory fibroid polyps (IFP) are rare, benign, tumor-like lesions that can develop anywhere in the gastrointestinal tract. Most frequently, they are localized in the gastric antrum. Ileum is the most common site where these polyps cause small bowel obstruction. Most IFPs are polypoid masses smaller than 5 cm, although sizes up to 20 cm have been reported. Case report: We report a case of a 56-year-old man presented with progressive abdominal pain for 7 days. He denied any nausea and vomiting but did have foul smelling bloody diarrhea. His abdomen was soft, slightly distended, tympanic to percussion, and tender in left lower quadrant. Bowel sounds were hyperactive. CT scan revealed a tubular, elongated, both intraluminal and extraluminal ileal mass causing mild partial obstruction and short segment intussusception. The patient underwent resection; gross examination showed a large solid tan-white elongated mass protruding into the small bowel lumen on one side and pushing the serosal surface on the other side. The large luminal portion of the protruding tumor measured 15.0 x 5.5 x 4.0 cm, and the extraluminal portion measured 5.5 x 4.0 cm. The total length was 20.5 cm. Multiple sections showed a well demarcated, non-encapsulated, polypoid, fibrohistiocytic mass, composed of hypocellular stroma with proliferation of widely spaced bland spindled and stellate-shaped cells emdedded in a collagenous fibromyxoid stroma. The intervening stroma demonstrated prominent vascularity, diffuse eosinophils, and few scattered plasma cells with foci of benign lymphoid aggregates. No mitoses or necrosis was present. There was no other histologic evidence of malignancy. The histopathologic features, as well as the immunoperoxidase stains, were consistent with a benign, non-neoplastic tumor-like mass, consistent with a Giant Inflammatory Fibroid Polyp-Tumor Like (Vanek Tumor). Discussion: The present lesion is the largest inflammatory fibroid polyp reported to date. The ileal location is rare. Even if inflammatory fibroid polyps are benign lesions, surgical treatment is the only option when they present with intestinal intussusception. Preoperative diagnosis of inflammatory fibroid polyps is often difficult, and confirmation can only be obtained by histological and immunohistochemical examination.Figure

Inflammatory fibroid polyp of the gastrointestinal tract: a clinicopathologic features of 37 cases

To study the clinicopathologic features, pathogenesis, and differential diagnosis of inflammatory fibroid polyp (IFP) of the gastrointestinal tract. The clinical and pathologic findings of 37 IFPs in the gastrointestinal tract were retrospectively analyzed. Immunohistochemical study and KIT, PDGFRA molecular analysis were carried out and the literatures reviewed. There were 9 males and 28 females. The median age was 57 (range 37 to 78) years. Twenty-two were in the antrum, nine in the ileum, three in the cardia, and one each in the gastric angle, corpora ventriculi and duodenum. The lesion ranged in size from 0.5 to 5.5 cm (mean 3 cm). Grossly, the majority appeared as a solitary non-encapsulated, submucosal, polypoid lesion. There was associated mucosal ulceration in three cases. Microscopically, the gastric lesions showed spindle-shaped cells arranged in an onion skin-like pattern around vessels and mucosal glands in a concentric formation. But the lesions in the ileum represented Vanek's tumor subtype devoid of concentric formations, with spindled to epithelioid cells dispersed in edematous stroma. Most of the lesions were in the mucosa and submucoma, but one small intestinal IFP infiltrated the muscularis propria. The inflammatory component of the lesions consisted predominantly of lymphocytes and eosinophils. Immunohistochemically, all cases displayed diffuse reactivity for vimentin and CD34; and 18 expressed PDGFRA. Analysis of KIT and PDGFRA mutations was performed in 18 cases. No KIT mutations were identified. However, four cases harbored activating mutations in PDGFRA exon 18 (D842V), five showed mutations in exon 12 (p.566-571delSPDGHEinsR). Follow-up in 30 cases showed no recurrence or metastasis. IFPs not only exhibit two morphologies, but also show mutations in the PDGFRA gene. IFP is a benign mesenchymal tumor rather than a reactive lesion.

Inflammatory fibroid polyp (IFP) of ileum causing intussusception with small bowel obstruction: a case report and literature review

A 27-year-old male presented with worsening abdominal pain, nausea and vomiting over 2 days and previous intermittent abdominal pain for 3 weeks. CT scan revealed terminal ileum obstruction. Ileo-colic intussusception with a 27 mm ileal polyp lead point was noted during the right hemicolectomy procedure. Histology showed a submucosal based mural lesion extending into serosa and mucosa with focal mucosal erosion. Haphazardly-arranged spindle cells and inflammatory cells (with prominence of eosinophils) were seen. The stroma was generally loose and focally oedematous, with regularly arranged small blood vessels. Nuclear pleomorphism, hypercellularity and necrosis were absent. Sparse mitotic figures were noted, with no abnormal forms. The spindle cells weakly expressed CD34 and SMA. CD117, S100 and AE1/AE3 were negative. A diagnosis of IFP was made. IFP is an uncommon benign lesion in the gastrointestinal tract and is usually observed in the stomach. It arises from the submucosa and forms polypoid lesions. Many are asymptomatic and are detected incidentally. The aetiology of IFP is uncertain. Prominence of eosinophils or concentric perivascular arrangement of spindle cells is typical but is not always present. Immunohisto-chemistry helps distinguish IFP from mesenchymal tumours such as leiomyoma, neurogenic tumours and gastrointestinal stromal tumour.

Gastric Inflammatory Fibroid Polyp Presenting with Occult Bleeding and Anemia

Purpose: Inflammatory fibroid polyps (IFPs) are rare, benign, submucosal, sessile or pedunculated polyps which can occur anywhere along the gastrointestinal (GI) tract. Roughly 80% are found in the gastric antrum. Incidence is low, accounting for less than 3% of all GI polyps. IFPs can be asymptomatic or present with bleeding, abdominal pain and/or dyspeptic symptoms. Immunohistochemical staining is diagnostic. Treatment typically requires surgical resection to alleviate symptoms, and/or to stop bleeding. We report the case of a 61-year-old male who presented with occult bleeding and anemia, and was found on endoscopy to have a 5-6-cm submucosal gastric mass prolapsing into the duodenum. Immunohistochemical staining was consistent with the diagnosis of IFP. The patient was subsequently taken to the operating room for surgical resection. Following excision, the anemia resolved and he maintained a stable blood count at discharge. While uncommon, IFPs are benign lesions that should be considered in the differential diagnosis of patients with occult bleeding and anemia. Resection with clean margins leads to resolution of symptoms and typically does not show reoccurrence.Figure: IFP prolapsing through the pylorus.Figure: Polyp in the duodenum.Figure: H&E stain shows spindle shaped cells and a background of inflammatory cells with increased eosinophils.

Inflammatory fibroid polyp of rectum mimicking rectal cancer

Inflammatory fibroid polyps (IFPs) are rare benign tumors of the rectum. Mutation and activating platelet-derived growth factor receptor alpha (PDGFRA) contribute to tumor development. We present a case of IFPs in the middle rectum that mimic rectal cancer. A 65-year-old woman presented with the symptom of fresh blood in the stool and body weight loss of 6 kg in the preceding 3 weeks. A rectal polypoid tumor was noted upon digital examination. Sigmoidoscopy showed a middle rectal tumor measuring 3 × 2.7 cm with obstruction. Computed tomography (CT) scans of the abdomen showed a rectal tumor that had invaded the sacral bone and was associated with four enlarged lymph nodes greater than 1 cm. The radiological report suggested a diagnosis of rectal cancer with lymph node metastases. To remove the obstruction, the patient was initially treated with excision of the tumor and loop sigmoidal colostomy to the abdomen wall. Total mesorectal resection of rectal and sacral tumor followed 10 days later. Histopathological examination of the rectal and sacral tumor showed proliferation of vessels, fibroblast-like spindle cells, and mixed inflammatory cells, including the plasma cells and eosinophils. The spindle cells were diffusely positive to PDGFRA and were focal positive to CD34 and smooth muscle actin. Based on histopathological and immunohistochemical findings, the diagnosis of IFP is indicated. This was the first reported case of IFPs of the rectum presenting with lymph node enlargement and attachment to the sacrum mimicking rectal cancer.

Inflammatory Fibroid Polyp of the Gastroesophageal Junction in a Patient Presenting with Melena

Purpose: Inflammatory fibroid polyps (IFPs) are uncommon masses that have been reported throughout the gastrointestinal (GI) tract. They are difficult to distinguish endoscopically and echo-endoscopically from other gastrointestinal mesenchymal tumors. To the best of our knowledge, no cases of IFPs at the location of the GE junction presenting with upper GI bleed were previously reported in the medical literature. Methods: We present a case of an inflammatory fibroid polyp of the gastroesophageal (GE) junction, initially thought to be a gastrointestinal stromal tumor (GIST), in a patient presenting with melena. Results: A 66-year-old female presented with a two-week history of weakness and fatigue associated with melena. Esophagogastroduodenoscopy (EGD) revealed a 3 cm mass with central ulceration at the GE junction, which was likely the source of her upper GI bleed. Biopsies were negative for malignancy, but the mass appeared suspicious. The patient was referred for endoscopic ultrasound (EUS), which revealed a hypoechoic mass that appeared to arise from the muscularis propria. Both the endoscopic and echo-endoscopic appearance of the mass were suspicious for a GIST. EUS-guided fine-needle aspiration was nondiagnostic. The patient was referred for surgery and oncology was consulted for possible adjuvant chemotherapy. The patient underwent gastric wedge resection with removal of the cardia and tissues were sent for pathology, which surprisingly came back with a diagnosis of inflammatory fibroid polyp. Gross upper GI bleeding is a rare presenting symptom of IFPs, which are mostly encountered as incidental polyps during EGD. The endoscopic appearance of an IFP and GIST are very similar. EUS is usually helpful, as GISTs nearly always arise from the muscularis propria, while IFPs are typically submucosal lesions. This case was unique in that the IFP involved the muscularis propria, making it very difficult to differentiate from a GIST on EUS. Immunohistochemistry is the only reliable method of properly distinguishing between a GIST and an IFP. GISTs are typically positive for DOG-1 and CD-117, while IFPs are negative for those markers. Conclusion: Due to the difficulty in distinguishing between inflammatory fibroid polyps and other mesenchymal tumors (including GISTs) by endoscopic appearance and even on EUS, the use of immunohistochemistry is essential to help differentiate between them, as their treatment and prognosis can differ markedly.

CASE OF INFLAMMATORY FIBROID POLYP OF THE ESOPHAGOGASTRIC JUNCTION

Upper gastrointestinal endoscopy of a 25-year-old man with heartburn revealed an elevated lesion in the esophagogastric junction (EGJ). Piecemeal endoscopic mucosal resection (EMR) followed by histopathological examination led to a diagnosis of inflammatory fibroid polyp (IFP). After EMR, the heartburn persisted despite giving a proton pump inhibitor (PPI), and the residual lesion gradually enlarged and a transverse mucosal break developed on the esophageal side of it. However, the combined administration of the PPI and an H2 receptor antagonist reduced the heartburn, and led to endoscopic regression of the lesion and disappearance of the transverse mucosal break. IFP of the esophagogastric junction is extremely rare, and this case is interesting in that potent inhibition of gastric acid secretion resulted in the regression of the lesion.

A large inflammatory fibroid polyp of the colon treated by endoclip-assisted endoscopic polypectomy: A case report

Inflammatory fibroid polyp is a rare benign polypoid lesion of the gastrointestinal tract. Histologically, inflammatory fibroid polyp is characterised by an admixture of numerous small vessels, fibroblasts and oedematous connective tissue, accompanied by marked inflammatory infiltration by eosinophils. A 40-year-old man visited our hospital for the purpose of colorectal screening due to a positive faecal occult blood test. A pedunculated and reddish polyp was found endoscopically in the ascending colon. The polyp was large but was resected endoscopically without any problems. Histologically, the abnormal tissue of the polyp was located in the submucosal and mucosal layer. Proliferation of spindle cells and infiltration of inflammatory cells, such as plasma cells and eosinophils, were observed. Immunohistochemically, the spindle cells were positive for CD34, which was localised in the cytoplasm. These cells were also positive for S100 protein but were negative for c-kit and muscle markers. These findings are compatible with the histological diagnosis of inflammatory fibroid polyp. The surgical margin of the polyp was free of the tumour. Inflammatory fibroid polyp is more commonly found in the stomach or small intestine, and rarely in the colon, and therefore our case is a rare example of large and pedunculated colonic inflammatory fibroid polyp, which was treated successfully by endoscopic polypectomy.

Inflammatory fibroid polyps of gastro-intestinal tract

Objective: To review the diagnosis and differential diagnosis of inflammatory fibroid polyp (IFP) of gastrointestinal tract. Methods: The clinical symptoms, histopathologic features and immunohistochemical (ABC method) staining in 9 cases were observed. Results: IFP presented either as a solitary pedunculated or sessile lesion arising from the submucosa and protroding into the lumen; composed of a background of fibroblasts and blood vessels infiltrated by a variable number of inflammatory cells, often numerous eosinophilias leukocytes. Immunohistochemical staining: the spindle cells of all cases reacted with Vimentin. The partial cells of several cases react with Actin, NSE, a -AT. 7 cases were follow-up. No patients had a recurrence of the lesion. Conclusion: IFP are rare lesions, and may represent an exaggerated response to inflammatory or other injury process. The prognosis is good when treated by segmental resections of endoscopic removals.

An inflammatory fibroid polyp of the esophagus concomitant with a superficial flat carcinoma

We report a rare case of an inflammatory fibroid polyp (IFP) of the esophagus associated with an extensive early mucosal carcinoma. At esophagoscopy, a polypoid lesion 2 cm in length, and a non-stained area detected by the Lugol iodine spray staining method were found in the mid-thoracic portion, and esophagectomy was performed. Endoscopic polypectomy is thought to be useful for the diagnosis of IFP, but it should be kept in mind that IFP may be concomitant with carcinoma. Indeed, in our patient, early esophageal carcinoma was discovered because of the symptoms of dysphagia induced by the IFP.

Gastric inflammatory fibroid polyps: endoscopic ultrasonographic analysis in comparison with the histology

Background: Histologic diagnosis of inflammatory fibroid polyp is usually difficult on routine endoscopic examinations. The aim of this study was to describe endoscopic ultrasonographic features of gastric inflammatory fibroid polyps. Methods: Endoscopic ultrasonography was performed in 10 patients with gastric inflammatory fibroid polyps before resection. All lesions were resected by either endoscopic removal or gastrectomy and then confirmed histologically as inflammatory fibroid polyps. To evaluate the diagnostic value of endosonography, endoscopic ultrasonographic images of the lesions were analyzed and compared with resected specimens retrospectively. Results: All lesions were located in the second and/or third sonographic layer of the gastric wall without involvement of the fourth layer. The most frequent endoscopic ultrasonographic features were an indistinct margin (90%), and a hypoechoic (80%), homogeneous (90%) echo pattern. Histologically, inflammatory fibroid polyps developed in the deep mucosa and/or submucosa by proliferation of fibrous tissue, but did not have a capsule. Conclusions: The characteristic endoscopic ultrasonographic attributes of gastric inflammatory fibroid polyps are indistinct margin, hypoechogenicity, homogeneous appearance, and location within the second and/or third layer. These findings correlate very closely to the histologic findings.(Gastrointest Endosc 1997;46:53-7)