Images in pathology: myxoglobulosis of the appendix

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.