Evaluation of clinico-pathological features and Helicobacter pylori infection in gastric inflammatory fibroid polyps

The role of endoscopic submucosal dissection in the management of gastric inflammatory fibroid polyps: a single-center experience

BACKGROUND AND AIM

Gastric inflammatory fibroid polyps constitute only 0.1% of all gastric polyps. They are usually asymptomatic and are most often found in the antrum. These lesions are in the majority of cases amenable to resection by snare polypectomy. However, there are rare case reports of gastric IFP requiring resection by endoscopic submucosal dissection. This study aimed to evaluate the effectiveness and safety of endoscopic submucosal dissection in the management of gastric inflammatory fibroid polyps not amenable to resection with snare polypectomy because of large size and/or deep subepithelial engagement.

METHODS

A retrospective study of all consecutive patients who undergone endoscopic submucosal dissection for gastric inflammatory fibroid polyps between January 2011 and December 2020 was performed.

MAJOR RESULTS

There were 9 cases of gastric inflammatory fibroid polyps resected by endoscopic submucosal dissection. Most patients were female (7/9) with a mean age of 62.2 years. All gastric inflammatory polyps were described as solitary antral subepithelial lesions with mean diameter of 16.7 mm. Helicobacter pylori was detected in only one patient. At endoscopic ultrasound, these lesions were uniformly described as well-circumscribed, homogeneous lesions located at muscularis mucosa and submucosa without invasion of muscularis propria. All lesions were successfully resected en-bloc by endoscopic submucosal dissection and complete resection with free margins was obtained in 8/9 specimens. Adverse events were reported in 2/9 cases including one case of intra-procedural bleeding successfully controlled with hemostatic clips and one case of aspiration pneumonia that evolved favorably. Mean follow-up duration was 33.7 months (range 0-120) and no delayed complications or cases of recurrence were detected during follow-up.

CONCLUSIONS

Endoscopic submucosal dissection appears to be a safe and effective approach for resection of gastric inflammatory fibroid polyps that present as large subepithelial lesions if performed by experienced endoscopists after adequate characterization by endoscopic ultrasound with high rates of technical success and low recurrence rates. .

Giant Ileocecal Inflammatory Fibroid Polyp: Unique Clinical Presentation

Inflammatory fibroid polyps (IFPs) are infrequent gastrointestinal tract benign neoplasms. They mostly occur in the stomach especially the antrum. Signs and symptoms depend on their anatomic location and lesion size. Lesion biopsies are very challenging for accurate diagnosis in these lesions. Histopathological examination of resected tissue along with immunohistochemical studies is the perfect way to confirm the final diagnosis. In this paper, the authors present an unusual case of IFP in a 23-year-old female patient presented to the emergency room (ER) with a picture of intestinal obstruction and severe abdominal pain. Her investigations revealed a huge mass located at the ileocecal valve, with overall features mimic gastrointestinal stromal tumor (GIST) clinical presentation. Surgical resection is considered the most commonly used treatment method. The overall prognosis is good with a low risk of recurrence.

An unusual case report of inflammatory fibrous polyps in the upper gastrointestinal tract

Inflammatory fibrous polyps (IFPs) were considered to be benign and umcommon, which can seriously affect the quality of life. We reported a case with the IFP presented with atypical symptoms and the so-called "ball valve syndrome". The final diagnosis is ultimately made after surgery. At 18 months of follow-up, the case remained symptom-free. It is worth mentioning, the definitive diagnosis of IFPs is always difficult to reach, which should be clinical, radiologic, endoscopic, histological, and immunohistochemical, although abdominal imageology, gastrointestinal endoscopy and endoscopic ultrasonography(EUS) may provide some important clues of the disease. Although therapy options usually include endoscopic mucosal resection and surgical excision, the preferred method was mainly depending on the size, location, biological property of the lesion and clinical presentations.

Gastric inflammatory fibroid polyp tumor with acute intestinal obstruction-Vanek's tumor can mimick a giant gastrointestinal stromal tumor or a gastric lymphoma

An inflammatory fibroid polyp (IFP) is a solitary rare benign neoplasm of the gastrointestinal tract, frequently located in the gastric antrum. IFPs account for about 0.1% of all gastric polyps. We report a case of a giant gastric inflammatory polyp of 2.5 cm × 7 cm that determines a gastric outlet obstruction called "ball valve syndrome" mimicking a gastrointestinal stromal tumor (GIST) and a gastric lymphoma, with an intestinal obstruction of high origin. Therefore, due to acute presentation we have decided to submit the patient to a subtotal gastrectomy. The patient was discharged two weeks later, asymptomatic. At 14 months of follow-up, patient is disease free at abdominal CT and OGDS. Depending on their size and location, IFPs can be associated with unspecific symptoms. Giant IFPs of the gastric antrum or the duodenum can determine an intermittent gastric outlet obstruction called "ball valve syndrome". Endoscopic biopsies are unhelpful and right diagnosis can be reached only with resection. In fact, only about 10% of the gastric lesions are diagnosed correctly prior to resection. Surgical treatment with complete resection with safe margins is curative. Giant IFPs are rare benign lesions whose atypical presentation can mimic GISTs, lymphomas or carcinomas. Clinical and radiological findings may not clarify the right diagnosis until histopathological evaluation aided with immunohistochemical analysis. The resection of IFPs with negative margins is curative with a good clinical outcome. In acute presentation, like in our case, surgery is the mainstay of treatment.

Regulatory B Cell Function Is Suppressed by Smoking and Obesity in H. pylori-Infected Subjects and Is Correlated with Elevated Risk of Gastric Cancer

Helicobacter pylori infection occurs in more than half of the world’s population and is the main cause for gastric cancer. A series of lifestyle and nutritional factors, such as tobacco smoking and obesity, have been found to elevate the risk for cancer development. In this study, we sought to determine the immunological aspects during H. pylori infection and gastric cancer development. We found that B cells from H. pylori-infected patients presented altered composition and function compared to uninfected patients. IL-10-expressing CD24⁺CD38⁺ B cells were upregulated in H. pylori-infected patients, contained potent regulatory activity in inhibiting T cell pro-inflammatory cytokine secretion, and responded directly to H. pylori antigen stimulation. Interestingly, in H. pylori-infected smoking subjects and obese subjects, the number of IL-10⁺ B cells and CD24⁺CD38⁺ B cells were reduced compared to H. pylori-infected asymptomatic subjects. Regulatory functions mediated by CD24⁺CD38⁺ B cells were also impaired. In addition, gastric cancer positive patients had reduced IL-10-producing B cell frequencies after H. pylori-stimulation. Altogether, these data suggest that in H. pylori-infection, CD24⁺CD38⁺ B cell is upregulated and plays a role in suppressing pro-inflammatory responses, possibly through IL-10 production, a feature that was not observed in smoking and obese patients.