Inflammatory Fibroid Polyp Research Articles

Inflammatory Fibroid Polyp within the Ileum

Small bowel tumors are detected in approximately 10% of patients with small bowel endoscopies for obscure or overt mid-intestinal bleeding. Small bowel tumors may be of malignant or benign etiology. Malignant etiologies include adenocarcinoma, neuroendocrine tumors, or lymphoma, whereas benign lesions are typically lipomas, inflammatory polyps, or adenomas. Within the group of nonneoplastic lesions inflammatory polyps are most frequent. Significant bleeding and bowel obstruction due to intussusception might occur, and surgical or endoscopic treatment has been reported for symptomatic patients. A case is demonstrated with an inflammatory fibroid polyp detected by capsule endoscopy and confirmed by balloon enteroscopy. This article is part of an expert video encyclopedia.

Inflammatory Fibroid Polyp of the Gallbladder Bearing a Platelet-Derived Growth Factor Receptor Alpha Mutation

The inflammatory fibroid polyp (IFP) is a benign lesion occurring in the digestive tract, mostly in the stomach and small bowel, composed of fibrovascular tissue infiltrated by inflammatory cells including eosinophils and mastocytes. Its pathogenesis has been controversial (reactive versus neoplastic). The recent finding of mutations in platelet-derived growth factor receptor α (PDGFRA) in most gastric and small intestinal IFPs supported their neoplastic etiology, moreover helping in their differential diagnosis. In the only gallbladder IFP reported so far, the diagnosis was based on morphologic and immunohistochemical grounds, which in current standards would probably be considered not fully conclusive. Conversely, the gallbladder IFP we report shows typical pathologic features supported by a PDGFRA mutation, similar to its usual gastric and small intestinal counterparts, constituting the first report of an unequivocal IFP at gallbladder level. Thus, IFPs must be considered in the differential diagnosis of gallbladder mesenchymal masses, and genetic analysis of PDGFRA is a helpful tool for this purpose.

Management of Gastric Polyps: An Endoscopy-Based Approach

The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions that have not been addressed in formal guidelines: do all polyps need to be excised, or can they just be sampled for biopsy? If so, which ones and how many should be sampled? What follow-up evaluation is needed, if any? This review relies on the existing literature and our collective experience to provide practical answers to these questions. Fundic gland polyps, now the most frequent gastric polyps in Western countries because of widespread use of proton pump inhibitors, and hyperplastic polyps, the second most common polyps notable for their association with gastritis and their low but important potential for harboring dysplastic or neoplastic foci, are discussed in greater detail. Adenomas have had their name changed to raised intraepithelial neoplasia and are decreasing in parallel with Helicobacter pylori infection; however, they do retain their importance as harbingers of gastric cancer, particularly in East Asia. Gastrointestinal stromal tumors have low incidence and no known associations, but their malignant potential is high; early diagnosis and proper management are crucial. Although rare and benign, inflammatory fibroid polyps need to recognized, particularly by pathologists, to avoid misdiagnosis. Gastric neuroendocrine tumors (carcinoids) are important because of their association with either atrophic gastritis or the multiple endocrine neoplasia syndromes; those that do not arise in these backgrounds have high malignant potential and require aggressive management. The review concludes with some practical suggestions on how to approach gastric polyps detected at endoscopy.

Inflammatory Fibroid Polyps of the Gastrointestinal Tract

Inflammatory fibroid polyps (IFPs) are rare, benign tumors that can arise throughout the gastrointestinal tract. Although the molecular pathogenesis of these lesions has been well characterized, their morphologic features often vary. We report the clinicopathologic findings of the largest series of IFPs to date. A total of 83 IFPs seen at our institution were collected between 1999 and 2012. The specimens included 64 biopsies and 19 resections. A review of the clinical features identified a modest female predominance (47 women and 36 men) with patients ranging in age from 26 to 87 years (mean, 60 y). Involved sites included the esophagus (n=2), stomach (n=31; mainly antrum), small intestines (n=17), appendix (n=1), large intestines (n=31; majority within the rectosigmoid), and anal canal (n=1). Although most patients had a nonspecific presentation, those with small intestinal lesions frequently presented with intussusception. Grossly, the tumors ranged in size from 0.2 to 4.2 cm (mean, 1.7 cm). Histologically, IFPs were centered within the submucosa in all resection specimens, but mucosal extension was found in 74 of 83 (89%) cases. The tumors varied in both cellularity and degree of vascularity. However, the characteristic feature of perivascular onion skinning was present in only 54% (45/83) of the cases. In addition, a short fascicular growth pattern was also noted in 36% (30 of 83) of cases, whereas both features were present in 14 cases (17%). Eosinophils were present in 94% (78 of 83) of cases but varied widely in number from abundant (20/hpf) to sparse (1/hpf). Interestingly, in those cases with sparse eosinophils, prominent hyalinization was also present (11 of 78, 13%). In addition, although the majority of IFPs expressed CD34, 6 of 44 (14%) were negative. No associated dysplasia or malignancy was seen. IFPs represent a diverse set of submucosal-based lesions that commonly extend into the mucosa, making them amenable to endoscopic biopsy. Although their classic histologic features of perivascular onion skinning and predominance of eosinophils are well described, they may alternatively present with a short fascicular growth pattern, a sparse number of eosinophils, and prominent hyalinization.

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.

Endoscopic resection of a large inflammatory fibroid polyp of the caecum

Colorectal DiseaseVolume 15, Issue 2 p. e99-e100 Case report Endoscopic resection of a large inflammatory fibroid polyp of the caecum N. McCawley, N. McCawley Departments of Colorectal SurgerySearch for more papers by this authorK. Sheahan, K. Sheahan Histopathology, St Vincents University Hospital, Elm Park, Dublin, IrelandSearch for more papers by this authorA. M. Hanly, A. M. Hanly Departments of Colorectal SurgerySearch for more papers by this author N. McCawley, N. McCawley Departments of Colorectal SurgerySearch for more papers by this authorK. Sheahan, K. Sheahan Histopathology, St Vincents University Hospital, Elm Park, Dublin, IrelandSearch for more papers by this authorA. M. Hanly, A. M. Hanly Departments of Colorectal SurgerySearch for more papers by this author First published: 03 July 2012 https://doi.org/10.1111/j.1463-1318.2012.03163.x Ms Ann Hanly, Department of Colorectal Surgery, St Vincents University Hospital, Elm Park, Dublin 4, Ireland. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume15, Issue2February 2013Pages e99-e100 RelatedInformation

Incidental finding of inflammatory fibroid polyp of the appendix in a patient presenting with acute appendicitis

Incidental finding of inflammatory fibroid polyp of the appendix in a patient presenting with acute appendicitis

Giant inflammatory fibroid polyp causing invagination: case report

Invajinasyon proksimaldeki barsak parcasinin distal parca icine girmesi ile karakterize bir klinik tablodur. Tum invajinasyonlarin yalnizca %5\'i eriskinde gorulur. Inflamatuar fibroid polip gastrointestinal sistemin nadir gorulen, en sik mide antrumundan koken almakla birlikte gastrointestinal sistemin her yerinde gorulebilen lezyonudur. Yazimizda 42 yasinda terminal ileumda dev polipoid kitleye bagli ileokolik invajinasyon gelisen ve malignite suphesiyle terminal ileum rezeksiyonuyla beraber sag hemikolektomi yapilan ve kitlenin patolojisi inflamatuar fibriod polip olarak degerlendirilen olgu sunulmaktadir.

Inflammatory fibroid polyp of caecum. A case report

Inflammatory fibroid polyps are rare benign lesions that occur throughout the gastrointestinal tract.We present a case of inflammatory fibroid poly occurring in caecum. A 26 year old female presented with intestinal obstruction. Caecum showed a polypoidal growth.External surface of polyp was smooth with focal areas of ulceration. Histologically,inflammatory fibroid polyp was the diagnosis.Conclusion:Inflammatory fibroid polyp should be considered as one of the differential diagnosis of pedunculated polyps in proximal colon and caecum.

An Inflammatory Fibroid Polyp (Vanek’s Tumor) of the Ileum that Presented as Intussusception

Ileoileal intussusceptions caused by inflammatory fibroid polyps are uncommon. Inflammatory fibroid polyps (Vanek’s tumor) are rare benign lesions that originate in the submucosa of the gastrointestinal tract. Here, we report the case of a 54-year-old woman who was admitted with an acute onset of abdominal pain and signs of intestinal obstruction. The ileal segment was resected, and single-layer end-to-end anastomosis was performed. A submucosal polypoid mass measuring approximately 4.5 × 4.0 cm was found. The histopathological analysis revealed an ulcerated mucosal lesion with variable cellularity that was formed by spindle cells with slight mitosis and abundant inflammatory infiltrate that was mainly composed of eosinophils. Immunohistochemistry confirmed the diagnosis of ileal inflammatory fibroid polyps. Cross-sectional imaging (multidetector computed tomography) plays a significant role in diagnosing this condition and guiding its management.

Ileo-ileal Intussusception in an Adult Caused by Vanek’s Tumour: A Rare Case Report

Adult intussusception is relatively rare in patients with bowel obstructions. Adult invagination is mostly caused by benign tumours. Intussusceptions caused by inflammatory fibroid polyps (IFPs) are uncommon. IFPs are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. We are reporting a rare case of intestinal obstruction caused by an ileo-ileal intussusception, caused by an IFP, a rare but peculiar and always benign tumour.

Do Not Be Fooled by Fancy Mutations: Inflammatory Fibroid Polyps Can Harbor Mutations Similar to Those Found in GIST

Goal. Surgeons that remove a typical polyp from the stomach or small intestine should be reluctant to accept a diagnosis of GIST just because there is a mutation in platelet-derived growth factor receptor alfa (PDGFRA). Background. A subtype of gastric and intestinal polyps is denoted as inflammatory fibroid polyp (IFP). In some of these cases a mutation in PDGFRA is found, leading to the diagnosis of gastrointestinal stromal tumor (GIST). Study. This study includes two patients that had polyps removed from the ileum, and an extended investigation was performed with immunohistochemical staining and mutation analyses. Results. The tumors did not show typical immunohistochemical staining for markers used to diagnose GIST, but the mutation analysis revealed a mutation in PDGFRA exon 12. On the basis of the mutation analysis, both polyps were primarily diagnosed as GISTs, but the diagnosis was later changed to inflammatory fibroid polyp. Conclusion. It is important that both surgeons and pathologists be aware that IFP can harbor a mutation in PDGFRA where further treatment and follow-up is different with the two different diagnoses. A mutation analysis can be misleading when taken out of the context of clinical observations, histological characteristics and immunohistochemical staining.

Clinical Features and Risk Factors of Gastric Subepithelial Tumor Needed Surgery in Clinical Practice: A Single-center Retrospective Study

Background/Aims: Gastric subepithelial tumor (SET) is often noted incidentally during esophagogastroduodenoscopy (EGD). The prevalence of SET is increasing in accordance with the increase of EGD and endosonographies. SET can range from benign lesions to tumors with malignant behavior or potential such as gastrointestinal stromal tumor (GIST) and carcinoid tumor. The aim of this study was to evaluate clinical features and risk factors of gastric SET that needed surgery in a single center. Materials and Methods: We retrospectively analyzed medical records of 90 patients who underwent operations due to SET during the period from January 2006 to December 2010. Results: Of the 90 patients, those who were diagnosed with GIST, ectopic pancreas, leiomyoma, schwannoma, carcinoid tumor, and inflammatory fibroid polyp after surgery were 43 (47.8%), 14 (15.6%), 13 (14.4%), 8 (8.9%), 3 (3.3%), and 2 (2.2%), respectively. Most patients who received operation due to SET were asymptomatic (52.2%). Patients were divided into non-GIST and GIST groups, non-malignant and malignant groups, respectively. Baseline characteristics between both groups were significantly different in age, and size (P＜0.05). Age was an independent risk factor of malignant gastric SET (OR, 1.045; 95% CI, 1.008∼1.084; P=0.016). In addition, age and size were independent risk factors of gastric SET with potential of GIST (OR, 1.049; 95% CI, 1.011∼ 1.089; P=0.011, OR, 1.026; 95% CI, 1.002∼1.050; P=0.031). Conclusions: We demonstrated that an independent risk factor of malignant gastric SET that needed surgery was age, and independent risk factors of GIST were age and size of the tumor. (Korean J Helicobacter Up Gastrointest Res 2013;13:44-49)

Adult jejunoileal intussusception caused by inflammatory fibroid polyp

Adult jejunoileal intussusception caused by inflammatory fibroid polyp

Surgical resection of small bowel inflammatory fibroid polyp associated with intussusception using single port laparoscopy

Surgical resection of small bowel inflammatory fibroid polyp associated with intussusception using single port laparoscopy

Multi-photon microscopic imaging of inflammatory fibroid polyps/Multi-Photonen-Mikroskopie entzündlich fibroider Polypen

AbstractMost applications of multi-photon microscopy (MPM) in biology and medicine focus on high-resolution imaging of physiology, morphology and cell–cell interactions in intact tissues or live animals. In this paper, our aim is to assess whether MPM has the ability to provide comparable information for stained histology slides and to identify inflammatory fibroid polyp (IFP) tissue sections without H&E staining.A tissue section without H&E staining was examined using a multi-photon microscope consisting of a mode-locked Ti: sapphire femtosecond laser (Mira 900-F; Coherent, Inc.) and a commercial laser scanning microscope (LSM 510 META; Carl Zeiss, Inc.) with a Plan-Neofluar 40×/0.75 objective. Large area images and a series of optical sectioning images were obtained using an optional fine-focusing stage (HRZ 200; Carl Zeiss, Inc.).MPM images showed the main characteristics of IFP that corresponded well with H&E microscopic results, such as a typical onion skin arrangement of reticular fibers around thin-walled blood vessels, and short spindle cells intermixed with abundant inflammatory cells. A series of optical sectioning images displayed morphological structure of tissue sections at different depths.MPM has the ability to provide comparable results to H&E staining. Its capability of optical sectioning can present the morphological structure of different optical sectioning planes, making MPM an alternative for those cases where the sample is very thick or cannot be stained.

腹腔鏡下に整復・切除した腸重積を伴う回腸inflammatory fibroid polypの1例

腹腔鏡下に整復・切除した腸重積を伴う回腸inflammatory fibroid polypの1例

ESDにて病理診断した胃炎症性類線維ポリープ（IFP）の1例

ESDにて病理診断した胃炎症性類線維ポリープ（IFP）の1例

小腸重積症で緊急手術を行った小腸Inflammatory fibroid polypの一例

小腸重積症で緊急手術を行った小腸Inflammatory fibroid polypの一例

Ileo-ileal intussusception secondary to inflammatory fibroid polyp with initial presentation of bloody stool

Summary Adult intussusception is relatively rare, and in most cases is associated with underlying pathology that draws attention to the condition. The most common initial presentation is a variety of obstructions. A 55-year-old man complained of bloody stools for 5 days. Ileoileal intussusception was suspected on abdominal computed tomography imaging. During exploratory laparotomy, an intussusception caused by a tumor was identified 50 cm proximal to the ileocecal valve, and segmental resection of the ileum with an end-to-end anastomosis was performed. The excised bowel segment had a polypoid submucosal mass, measuring 5.1 cm in size. Immunohistopathological examination revealed an inflammatory fibroid polyp. This case report shows that intussusceptions secondary to an inflammatory fibroid polyp, although rare in adults, should be considered in the differential diagnosis of bloody stools.