1
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Nagy D, Ellinger J, Ritter M, Pelusi N, Kristiansen G. Inflammatory fibroid polyp of the renal pelvis: first report at an extra-gastrointestinal site with molecular confirmation. Virchows Arch 2023; 483:535-539. [PMID: 37184764 PMCID: PMC10611610 DOI: 10.1007/s00428-023-03557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
Inflammatory fibroid polyps (IFP) are rare and benign mesenchymal tumours of the gastrointestinal tract. They are submucosal spindle cell lesions with an eosinophilic-rich inflammatory infiltrate and mutations in the platelet-derived growth factor receptor alpha (PDGFRA) gene. In this report, we present the case of a 74-year-old female with a solid tumour of the kidney, which presented as a bland proliferation of spindle cells with thin-walled blood vessels and an inflammatory infiltrate with eosinophilic granulocytes. Immunohistochemistry revealed a positivity for vimentin and a weak staining for CD99 and CD34 in the spindle cells. Because of the morphological similarity to IFPs of the gastrointestinal tract, a molecular pathology analysis was performed. This identified an oncogenic mutation in exon 18 of the PDGFRA gene, which is characteristic for inflammatory fibroid polyps of the gastrointestinal tract. To the best of our knowledge, this is the first case of an IFP in the urogenital tract.
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Affiliation(s)
- Dora Nagy
- Institute of Pathology, University Hospital Bonn (UKB), Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Jörg Ellinger
- Clinic for Urology, University Hospital Bonn (UKB), Bonn, Germany
| | - Manuel Ritter
- Clinic for Urology, University Hospital Bonn (UKB), Bonn, Germany
| | - Natalie Pelusi
- Institute of Pathology, University Hospital Bonn (UKB), Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Hospital Bonn (UKB), Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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2
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Anand A, Nagpal A, Arsia A, Ahuja A. Rare cause of intussusception in a young male with a new possible etiology - A case report. Int J Surg Case Rep 2023; 106:108204. [PMID: 37119754 PMCID: PMC10173147 DOI: 10.1016/j.ijscr.2023.108204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Inflammatory Fibroid Polyp (IFP) is a rare benign tumor of the gastrointestinal tract with no proven etiology. IFPs may sometimes produce complications like intussusception when present in the small bowel. This is a case report of a patient with an established diagnosis of inflammatory fibroid polyp with abdominal tuberculosis. Such co-existence has not been reported yet in literature. CASE PRESENTATION In this case report we see a 22-year-old gentleman presenting with a 10-day history of generalized abdominal pain which then progressed to obstipation. X-ray abdomen findings were consistent with small bowel obstruction. Computerized tomography imaging revealed the presence of a Jejuno-ileal intussusception. The patient was taken up for emergency laparotomy and he underwent resection of the intussuscepted segment with a polyp found as the lead point accompanied by dense bowel adhesions. Histopathological examination revealed it to be a Benign Fibro epithelial Polyp. Histopathology of the resected bowel segment and mesenteric lymph node also revealed findings confirmatory of abdominal tuberculosis. This may be a possible new etiology of the fibro epithelial polyp and this co-existence has never been reported before in literature. CONCLUSION Tuberculosis may be a possible inciting factor for the development of benign fibro epithelial polyp in the small bowel which may in turn lead to complications such as small bowel intussusception warranting need for surgical intervention.
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Affiliation(s)
- Arti Anand
- Lady Hardinge Medical College, New Delhi 110001, India.
| | | | - Ashish Arsia
- Department of Surgery, Lady Hardinge Medical College, New Delhi 110001, India
| | - Arvind Ahuja
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi 11001, India
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3
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Affiliation(s)
- Robert Bechara
- Department of Medicine, Division of Gastroenterology, Queens University, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - David Hurlbut
- Department of Pathology and Molecular Medicine, Queens University, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Andrea Grin
- Department of Pathology and Molecular Medicine, Queens University, Kingston Health Sciences Center, Kingston, Ontario, Canada
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4
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Murota A, Yoshi S, Okuda R, Oowada S, Yamakawa T, Kazama T, Hirayama D, Ishigami K, Yamano HO, Narimatu E, Sugita S, Hasegawa T, Nakase H. Successful hemostasis of bleeding gastric inflammatory fibroid polyp by endoscopic treatment in a patient with severe COVID-19. Clin J Gastroenterol 2021; 14:1008-1013. [PMID: 33840076 PMCID: PMC8038534 DOI: 10.1007/s12328-021-01402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
The coronavirus disease-2019 (COVID-19) has rapidly become a pandemic, resulting in a global suspension of non-emergency medical procedures such as screening endoscopic examinations. There have been several reports of COVID-19 patients presenting with gastrointestinal symptoms such as diarrhea and vomiting. In this report, we present a case of successful hemostasis of bleeding gastric inflammatory fibroid polyp by endoscopic treatment in a patient with severe COVID-19. The case was under mechanical ventilation with extracorporeal membrane oxygenation (ECMO), and the airway was on a closed circuit. This indicates that COVID-19 is associated with not only lung injury but also intestinal damage, and that proper protective protocols are essential in guaranteeing the best outcomes for patients and clinical professionals during this pandemic.
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Affiliation(s)
- Ayako Murota
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan.
| | - Shinji Yoshi
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Ryu Okuda
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sae Oowada
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Tsukasa Yamakawa
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Tomoe Kazama
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Daisuke Hirayama
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Keisuke Ishigami
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Hiro-O Yamano
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
| | - Eichi Narimatu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 063-8543, Japan
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5
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Kawai A, Matsumoto H, Haruma K, Kanzaki T, Sugawara Y, Akiyama T, Hirai T. Rare case of gastric inflammatory fibroid polyp located at the fornix of the stomach and mimicking gastric cancer: a case report. Surg Case Rep 2020; 6:292. [PMID: 33226546 PMCID: PMC7683674 DOI: 10.1186/s40792-020-00980-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Gastric inflammatory fibroid polyp (IFP) is a rare polypoid lesion of the stomach that is characterized pathologically by the presence of spindle cells, a prominent network of blood vessels, and inflammatory infiltration of eosinophils. IFP is mainly located in the gastric antrum and is usually semi-pedunculated and covered with normal mucosa. There have been several reports of large IFPs with ulceration on the surface, at the apex, but no report of the IFP with ulceration at the fornix of the stomach. We report a case of IFP with ulceration that was suggested to be gastric cancer and was resected for diagnostic treatment. Case presentation A 79-year-old woman presented to our hospital. During mass screening for cancer, stomach fluoroscopy revealed an abnormal shadow. Endoscopy showed an ulcerated tumor at the fornix of stomach; hence, gastric cancer was suggested because of the polypoid lesion with irregular ridges and ulceration. Pathological diagnosis of gastric biopsy specimens revealed an inflammation of the gastric mucosa, and specific findings for gastric cancer were not obtained. Because we could not exclude gastric malignancies such as cancer or gastrointestinal stromal tumor, we performed a partial resection of the stomach with a 2-cm margin using the laparoscopic-assisted method. Pathological examination of the resected specimen revealed that the tumor was present in the submucosal layer and consisted of collagen fiber containing inflammatory cell infiltration of mainly eosinophils. A prominent network of blood vessels was also found in the specimens. Immunohistochemical staining revealed mild positivity for CD34, and α-SMA and was negative for c-kit, DOG-1, s-100, desmin, ALK, and IgG4. The lesion was thus diagnosed as an IFP. The postoperative course was uneventful. The patient is currently asymptomatic and has shown no recurrence. Conclusion IFPs have variable locational, morphological, histological, pathological, and immunohistochemical features. We reported that the gastric IFP was located at the fornix of the stomach and was similar in morphology to gastric cancer. This case is clinically significant to avoid over-surgery.
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Affiliation(s)
- Akimasa Kawai
- Department of Surgery, Mitsugi General Hospital, 124, Ichi, Mitsugi-cho, Onomichi, Hiroshima, 722-0393, Japan.
| | - Hideo Matsumoto
- Department of Surgery, Mitsugi General Hospital, 124, Ichi, Mitsugi-cho, Onomichi, Hiroshima, 722-0393, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama, Okayama, 700-8505, Japan
| | - Tomoko Kanzaki
- Department of Internal Medicine, Mitsugi General Hospital, 124, Ichi, Mitsugi-cho, Onomichi, Hiroshima, 722-0393, Japan
| | - Yuji Sugawara
- Department of Surgery, Mitsugi General Hospital, 124, Ichi, Mitsugi-cho, Onomichi, Hiroshima, 722-0393, Japan
| | - Takashi Akiyama
- Department of Pathology, Kawasaki Medical School, 577, Matsushima, Kurasiki, Okayama, 701-0192, Japan
| | - Toshihiro Hirai
- Department of Surgery, Mitsugi General Hospital, 124, Ichi, Mitsugi-cho, Onomichi, Hiroshima, 722-0393, Japan
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6
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Park KB, Jee YS, Kim DW. Laparoscopic resection of two inflammatory fibroid polyps: An unusual cause of jejunojejunal intussusception. Int J Surg Case Rep 2020; 69:20-23. [PMID: 32248011 PMCID: PMC7132045 DOI: 10.1016/j.ijscr.2020.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 01/25/2023] Open
Abstract
IFPs are rare, clinically benign tumors that can present as an intussusception. 23-year-old man suffered from intussusception caused by two IFPs. Surgical resection may be the optimal treatment method for IFPs accompanied by intussusception.
Introduction Inflammatory fibroid polyps (IFPs) are rare, clinically benign tumors that can present as an intussusception causing intestinal obstruction. Presentation of case We present a rare case of a 23-year-old man who suffered from intussusception caused by two IFPs. The patient complained of aggravated squeezing epigastric pain that prompted him to visit the emergency department. Moderate abdominal distention with mild tenderness was noted without signs of peritonitis. Abdominal computed tomography confirmed the presence of intussusception in the left lower quadrant. During laparoscopic surgery, the intussuscepted segment of the jejunum was identified, after which laparoscopic small bowel resection and anastomosis were performed. The patient was subsequently discharged without postoperative complications. Discussion IFPs are rare, clinically benign tumors of the gastrointestinal tract originating from the submucosa. IFPs can present as an intussusception causing intestinal obstruction. Conclusion Surgical resection is the optimal treatment method for IFPs accompanied by intussusception.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University Hospital, Chungnam, Republic of Korea
| | - Dong-Wook Kim
- Department of Surgery, Dankook University Hospital, Chungnam, Republic of Korea.
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7
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Jan ZU, Muslim M, Ullah K, Shoaib A, Ahmed N, Khan ZM, Aurangzeb M. Vanek's tumor as an unusual cause of ileo-ileal intessuception - A unique case report. Ann Med Surg (Lond) 2018; 32:14-17. [PMID: 30002823 PMCID: PMC6039895 DOI: 10.1016/j.amsu.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Vanek's tumor is a rare solitary lesion that is non-neoplastic, and arises from the submucosa of the gut. The most commonly affected sites are the stomach and the ileum [1]. IFP causing intestinal obstruction is uncommon and that ileo-ileal intussusception has been reported in the literature rarely. We present a case of an ileo-ileal intessuception in a patient who presented with acute on chronic pain abdomen and anorexia. CT abdomen & pelvis revealed a 46 × 36 mm intraluminal mass in the left iliac fossa causing ileo-ileal intussusception. CASE PRESENTATION A 60 years old gentleman was brought to the A&E with a history of intestinal obstruction. He was examined and admitted to the surgical unit. CBC revealed unique feature of reactive thrombocytosis apart from a low hemoglobin and a raised TLC. His CT scan demonstrated findings of ileo-ileal intussusception. After an informed written consent, patient underwent an exploratory laparotomy and had resection and anastomosis of the bowel. Histopathology of the specimen revealed findings compatible with IFP. Patient made an uneventful recovery post-operatively and was sent home in the next few days. On follow-up, the patient was doing well and had no complaints of abdominal pain or anorexia. CONCLUSION Vanek's tumor although a rare entity, should be considered in each case of acute abdomen and physicians and surgeons need to have a high degree of suspicion in such cases. Moreover, IFP can cause reactive thrombocytosis that gets resolved after a post-operative period of 6-8 weeks.
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Affiliation(s)
- Zaka Ullah Jan
- Department of General Surgery, Khyber Teaching Hospital Peshawar, Pakistan
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8
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Harima H, Kimura T, Hamabe K, Hisano F, Matsuzaki Y, Sanuki K, Itoh T, Tada K, Sakaida I. Invasive inflammatory fibroid polyp of the stomach: a case report and literature review. BMC Gastroenterol 2018; 18:74. [PMID: 29855265 PMCID: PMC5984322 DOI: 10.1186/s12876-018-0808-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 05/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Inflammatory fibroid polyps (IFPs) are rare mesenchymal lesions that affect the gastrointestinal tract. IFPs are generally considered benign, noninvasive lesions; however, we report a case of an invasive gastric IFP. To the best of our knowledge, this is only the second case report of an invasive gastric IFP. Case presentation A 62-year-old woman presented with complaints of epigastric pain and vomiting. Computed tomography showed a 27-mm, hyper-enhancing tumor in the prepyloric antrum. Upper endoscopy also showed a submucosal tumor causing subtotal obstruction of the gastric outlet. Because a gastrointestinal stromal tumor was suspected, distal gastrectomy was performed. Histopathological examination revealed spindle cell proliferation in the submucosal layer. The spindle cells had invaded the muscularis propria layer and extended to the subserosal layer. The tumor was finally diagnosed as an IFP based on immunohistochemical findings. No mutations were identified in the platelet-derived growth factor receptor alpha (PDGFRA) gene via molecular genetic analysis. Discussion and conclusions After the discovery that IFPs often harbor PDGFRA mutations, these growths have been considered neoplastic lesions rather than reactive lesions. Based on the present case, IFPs might be considered not only neoplastic but also potentially invasive lesions.
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Affiliation(s)
- Hirofumi Harima
- Department of Gastroenterology, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan.
| | - Tokuhiro Kimura
- Department of Pathology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kouichi Hamabe
- Department of Gastroenterology, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan
| | - Fusako Hisano
- Department of Gastroenterology, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan
| | - Yuko Matsuzaki
- Department of Gastroenterology, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan
| | - Kazutoshi Sanuki
- Department of Gastroenterology, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan
| | - Tadahiko Itoh
- Department of Cancer Screening Center, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan
| | - Kohsuke Tada
- Department of Surgery, Ube Industries Central Hospital, 750 Nishikiwa, Ube, Yamaguchi, 755-0042, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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9
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Kameda C, Miwa H, Kawabata R, Marukawa D, Murakami M, Noura S, Shimizu J, Hasegawa J. Laparoscopic Resection of a Jejunal Inflammatory Fibroid Polyp that Caused Occult Gastrointestinal Bleeding, Diagnosed via Capsule Endoscopy and Double-Balloon Enteroscopy: A Case Report. Clin Endosc 2018; 51:384-387. [PMID: 29554795 PMCID: PMC6078929 DOI: 10.5946/ce.2017.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/15/2018] [Indexed: 12/28/2022] Open
Abstract
An inflammatory fibroid polyp (IFP) is a mesenchymal tumor of the gastrointestinal tract. IFPs in the small intestine are the most frequently detected with symptoms, such as abdominal pain and tarry stool due to intussusception. Accordingly, few studies have reported jejunal IFP as a cause of occult gastrointestinal bleeding (OGIB) diagnosed via both of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). A 68-year-old woman presented with a progression of anemia and a positive fecal occult blood test result. Esophagogastroduodenoscopy and total colonoscopy findings were unremarkable. CE revealed a tumor with bleeding in the jejunum. DBE also revealed a jejunal polypoid tumor. Bleeding from the tumor seemed to have caused anemia. The patient underwent partial laparoscopic resection of the jejunum, including resection of the tumor. The tumor was histopathologically diagnosed as IFP. To our knowledge, this is the first reported case of laparoscopic resection of jejunal IFP with OGIB diagnosed via CE and DBE preoperatively.
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Affiliation(s)
- Chizu Kameda
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Hideaki Miwa
- Department of Pathology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Daiki Marukawa
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
| | | | - Shingo Noura
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
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10
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Klingbeil KD, Balaban A, Fertig RM, Gamret AC, Gong Y, Torres C, Satahoo SS. Inflammatory fibroid polyp of the gastric antrum presenting as hypovolemic shock: Case report and literature review. Intractable Rare Dis Res 2017; 6:304-309. [PMID: 29259861 PMCID: PMC5735286 DOI: 10.5582/irdr.2017.01060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inflammatory fibroid polyps (IFP) are an extremely rare entity that arise within the submucosa of the gastrointestinal tract, and represent less than 0.1% of all gastric polyps. They are most commonly localized to the gastric antrum, small intestines and recto-sigmoid colon. IFPs are most commonly found incidentally upon endoscopic evaluation in the absence of symptoms. Presenting symptoms depend on the location of the tumor, although polyps located in the stomach most commonly present with epigastric pain and early satiety. Classic histologic features include perivascular onion skinning of spindle cells with an abundance of eosinophilic infiltration. The prompt diagnosis and management of IFP is essential due to its underlying risk for intussusception, outlet obstruction and acute hemorrhage. In addition, recent evidence has shown that IFP is driven by an activating mutation in the platelet derived growth factor receptor alpha (PDGFRA) gene, suggesting a neoplastic etiology. Herein, we discuss a case of a 65-year-old woman with an inflammatory fibroid polyp of the gastric antrum who initially presented with early hypovolemic shock and melena. Diagnosis was made by endoscopic visualization, biopsy and immunohistochemical analysis.
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Affiliation(s)
- Kyle D. Klingbeil
- University of Miami, Miller School of Medicine, Miami, FL, USA
- Address correspondence to: Dr. Kyle D. Klingbeil, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, Florida 33136, USA. E-mail:
| | | | | | | | - Yuna Gong
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Miami, FL, USA
| | - Carolyn Torres
- University of Pennsylvania, College of Liberal and Professional Studies, Philadelphia, PA, USA
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11
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Carvalho A, Leitão P, Pinheiro J, Sá Fernandes M, Rodrigues M, Preto AS, Silva N. Small bowel intussusception in 2 adults caused by inflammatory polyps. Radiol Case Rep 2017; 12:710-714. [PMID: 29484055 PMCID: PMC5823309 DOI: 10.1016/j.radcr.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 01/28/2023] Open
Abstract
Inflammatory fibroid polyps are rare, benign pseudotumors of the gastrointestinal tract of unknown etiology, which may rarely present as bowel intussusception and obstruction. The authors describe the clinical, radiologic, and pathologic features of 2 patients with ileal inflammatory fibroid polyps presenting as small bowel intussusception.
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Affiliation(s)
- André Carvalho
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Patrícia Leitão
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Jorge Pinheiro
- Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Margarida Sá Fernandes
- Pathology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Márcio Rodrigues
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Ana Sofia Preto
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Nuno Silva
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
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12
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Castro R, Pimentel-Nunes P, Dinis-Ribeiro M. Evaluation and management of gastric epithelial polyps. Best Pract Res Clin Gastroenterol 2017; 31:381-387. [PMID: 28842047 DOI: 10.1016/j.bpg.2017.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/05/2017] [Indexed: 01/31/2023]
Abstract
Gastric polyps include a wide spectrum of lesions with different histology and neoplastic potential. They are found in up to 6% of upper gastrointestinal endoscopy and are usually asymptomatic and incidentally diagnosed, being in the vast majority epithelial gastric polyps. Hyperplastic, fundic gland and adenomas are the most common types of gastric polyps and, although each type may have typical endoscopic appearances, they all must be sampled at the initial endoscopy for histological assessment. Also, the normal appearing gastric mucosa should be sampled to stage atrophic changes, rule out endoscopically non-visible dysplasia and to diagnose Helicobacter pylori. Polyposis syndromes that affect the stomach are rare but should be taken into account. Hamartomatous polyps can be found in Juvenile polyposis, Cowden syndrome and Peutz-Jeghers syndrome. On the other hand, multiple fundic gland polyps are present in the majority of patients with familial adenomatous polyposis. In this study we provide a comprehensive review on the evaluation and management of gastric epithelial polyps, in this way helping physicians to properly handle this type of lesions.
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Affiliation(s)
- R Castro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
| | - P Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; CIDES-FMUP - Faculty of Medicine of the University of Porto, Porto, Portugal
| | - M Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; CIDES-FMUP - Faculty of Medicine of the University of Porto, Porto, Portugal
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Ahtil R, Bensghir M, Meziane M, Houba A, Jaafari A, Lalaoui SJ, Haimeur C. [Rare etiology of subocclusive syndrome: inflammatory fibroid polyp of the ileum, about a clinical case]. Pan Afr Med J 2017; 26:146. [PMID: 28533869 PMCID: PMC5429441 DOI: 10.11604/pamj.2017.26.146.10775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/24/2017] [Indexed: 11/20/2022] Open
Abstract
Le polype fibroïde inflammatoire (PFI) est une lésion bénigne rare, qui découle de la sous-muqueuse du tractus gastro-intestinal, apparait généralement comme une lésion bénigne solitaire, localisée rarement au niveau de l'iléon. Son origine est controversée. La présentation clinique varie selon sa localisation, l'invagination et l'obstruction constituent les symptômes révélateurs les plus fréquents quand le polype siège au niveau de l'intestin grêle. Nous rapportons le cas d'un patient âgé de 22 ans, qui présentait une douleur abdominale, des nausées et des vomissements avec des antécédents de constipation intermittente et une perte de poids dans l'année précédente. La radiologie a objectivé une invagination iléo-iléale obstruant complètement la lumière de l'iléon. La résection segmentaire du segment iléal obstrué et l'anastomose termino-terminale ont été effectuées. Le diagnostic final de PFI a été établi par l'examen histologique et immuno-histochimique.
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Affiliation(s)
- Redouane Ahtil
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Mustapha Bensghir
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Mohammed Meziane
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Abdelhafid Houba
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Abelhamid Jaafari
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Salim Jaafar Lalaoui
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Charki Haimeur
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
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Shim EJ, Ahn SE, Lee DH, Park SJ, Kim YW. Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach. World J Gastroenterol 2017; 23:2090-2094. [PMID: 28373777 PMCID: PMC5360652 DOI: 10.3748/wjg.v23.i11.2090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/01/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
Inflammatory fibroid polyp (IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography (CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.
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Abstract
Gastric cancer is the fifth (men) and sixth (women) most common cause of cancer-related death in Germany. Despite a declining incidence of distal gastric cancer, the prognosis remains dismal: the 5‑year survival rate ranges between 35% for women and 31% for men. The majority are adenocarcinomas, which occur sporadically, familial or hereditary. Adenomas and intraepithelial neoplasms are considered as precursor lesions. Recently, whole genome sequencing and comprehensive molecular profiling described four molecular subtypes of gastric cancer: Epstein-Barr virus (EBV) positive, microsatellite unstable, chromosomal unstable and genomically stable gastric cancer. Currently, only the TNM classification has stood the test of time for the assessment of patient prognosis. Neuroendocrine tumor types 1-3 and soft tissue tumors occur significantly less often in the stomach. Gastrointestinal stromal tumors and inflammatory fibroid polyps are among the more common soft tissue tumors of the stomach and show distinct phenotypes. This review gives an overview of the current World Health Organization (WHO) classification of gastric tumors.
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Affiliation(s)
- C Röcken
- Institut für Pathologie, Christian-Albrechts-Universität Kiel, Arnold-Heller-Straße 3/14, 24105, Kiel, Deutschland.
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Han GJ, Kim JH, Lee SS, Park SH, Lee JS, Ha HK. Inflammatory fibroid polyps of the gastrointestinal tract: a 14-year CT study at a single institution. ACTA ACUST UNITED AC 2016; 40:2159-66. [PMID: 25896613 DOI: 10.1007/s00261-015-0431-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the computed tomography (CT) features of pathology-proven inflammatory fibroid polyps (IFPs) in the gastrointestinal tract. METHODS This retrospective series study included 27 patients with pathology-proven IFPs in the stomach (n = 16), small (n = 9), and large (n = 2) intestine, who underwent contrast-enhanced CT. Two radiologists reviewed the CT images of the patients to determine in consensus the long diameter, shape, margin, contour, and growth pattern of the lesions, the presence of an ulcer and overlying mucosal hyperenhancement, the lesion enhancement patterns including the homogeneity and the degree of contrast enhancement, and the presence of intussusception and obstruction. The CT results and clinical data of the gastric and intestinal lesions were compared. RESULTS The IFPs typically manifested as well-defined (89%), round or ovoid (81%), slightly lobulated-contoured (70%) masses with a purely endoluminal growth pattern (96%) and an overlying mucosal hyperenhancement (67%). Lesion homogeneity and the degree of contrast enhancement varied. The intestinal IFPs were significantly larger (3.5 vs. 2 cm), more symptomatic (82% vs. 19%), and more frequently associated with intussusception (73% vs. 0%) and obstruction (46% vs. 6%) than the gastric lesions (p ≤ 0.027). CONCLUSIONS The characteristic CT features of IFPs were well-defined, round or ovoid, lobulated-contoured, and endoluminal masses with overlying mucosal hyperenhancement and various enhancement patterns. IFP should be included in the differential diagnosis of patients with a soft-tissue mass in the gastrointestinal tract, especially if a large endoluminal mass in the small intestine is accompanied by intussusception.
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Affiliation(s)
- Ga Jin Han
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
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Romano-Munive AF, Barreto-Zuñiga R, Rumoroso-García JA, Ramos-Martínez P. Inflammatory fibroid polyp of the gastrointestinal tract: 10 years of experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Rev Gastroenterol Mex 2016; 81:134-40. [PMID: 27157712 DOI: 10.1016/j.rgmx.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/23/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inflammatory fibroid polyp (lFP) is a rare, benign, and solitary neoplasm predominantly located in the gastric antrum and small bowel. Its clinical symptoms are heterogeneous and essentially depend on the location and size of the tumor. Definitive diagnosis is made through histopathology and this pathology has excellent long-term prognosis. AIM To identify the cases of IFP seen at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán over a 10-year period. METHODS A retrospective, cross-sectional, descriptive, and observational study was conducted that included patients with histopathologic diagnosis of IFP within the time frame of January 2001 and December 2011. RESULTS Six cases were found and 5/6 (83.3%) of them were women. The median age was 41 years (minimum-maximum range of 19-56 years). The most frequent symptoms were weight loss (n=3), fever (n=2), nausea (n=2), and vomiting (n=2). Three patients presented with iron deficiency anemia and 2 cases with intussusception. The IFPs were located at the following sites: esophagus (n=1), stomach (n=2), small bowel (n=2), and colon (n=1). Treatment was surgical in 5/6 (83.3%) of the patients. CONCLUSIONS IFPs are extremely rare in our population. They usually present with weight loss and iron deficiency anemia and are more frequently located in the stomach and small bowel. This is the largest reported IFP case series in a Mexican population.
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Affiliation(s)
- A F Romano-Munive
- Servicio de Endoscopia Digestiva, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Ciudad de México, México.
| | - R Barreto-Zuñiga
- Servicio de Endoscopia Digestiva, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Ciudad de México, México
| | - J A Rumoroso-García
- Servicio de Radiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Ciudad de México, México
| | - P Ramos-Martínez
- Servicio de Patología Digestiva. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Ciudad de México, México
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18
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Righetti L, Parolini F, Cengia P, Boroni G, Cheli M, Sonzogni A, Alberti D. Inflammatory fibroid polyps in children: A new case report and a systematic review of the pediatric literature. World J Clin Pediatr 2015; 4:160-166. [PMID: 26566490 PMCID: PMC4637808 DOI: 10.5409/wjcp.v4.i4.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/13/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To study that inflammatory fibroid polyps (IFPs) in children are extremely uncommon tumors that may occur throughout the gastrointestinal tract.
METHODS: A systematic review of the pediatric literature and a report of a new case of IFP is also presented. The PubMed database was searched for original studies on pediatric IFPs since 1960, according to “Preferred reporting items for systematic reviews and meta-analyses” guidelines for systematic reviews.
RESULTS: Five studies were finally enclosed, encompassing 6 children with IFPs (mean age 64 mo). Tumors were located in the stomach (2 patients), in the small bowel (2 patients), in the rectum (1 patient) and in the colon (1 patient). Open surgery was performed in all patients and complete excision of the mass was achieved in all cases. All patients are alive and free of symptom. Authors described a further case of a 3-year-old boy with a large duodenal IFP, in whom the tumor was removed by “en block resection”. The presence of IFP throughout the gastrointestinal tract and its variable clinical appearances make it difficult to diagnose. An accurate pre-operative assessment is fundamental in order to differentiate IFP from other more aggressive gastrointestinal tumor, enabling unnecessary demolitive surgery.
CONCLUSION: When complete resection of the IFP is achieved, the prognosis is excellent.
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19
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Smith-Chakmakova F, Liu YJ, Karamchandani DM. Inflammatory Fibroid Polyp of the Ileocecal Valve: Case Report, Review, and Recent Advances. Ann Clin Lab Sci 2015; 45:441-445. [PMID: 26275697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a case of a 72-year-old woman who underwent a right hemicolectomy for a near-obstructing mass in the ileocecal valve. The histologic diagnosis was inflammatory fibroid polyp (IFP). IFPs are rare mesenchymal lesions that can arise throughout the gastrointestinal tract. Originally considered reactive or inflammatory, recent studies report activating mutations of platelet derived growth factor receptor-alpha (PDGFRA) in IFPs, suggesting that these may in fact be neoplastic. Nonetheless, these are benign lesions cured by local excision and typically do not recur or metastasize. Our patient also had no evidence of local recurrence one year after the surgery. Hence, the clinical importance lies in distinguishing these lesions from other benign and malignant mesenchymal proliferative lesions both on a biopsy and resection specimen. We review the literature on clinicopathologic features, immunohistochemical profile, pathogenesis, recent advances, differential diagnosis, prognosis, and treatment of these uncommon lesions.
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Affiliation(s)
- Faye Smith-Chakmakova
- Department of Pathology, Lebanon Pathology Associates, Good Samaritan Hospital, 4 and Walnut Streets, Lebanon, PA, USA
| | - Yong-Jun Liu
- Department of Pathology, Penn State Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, PA, USA
| | - Dipti M Karamchandani
- Department of Pathology, Penn State Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, PA, USA
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20
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Zhang C, Cui M, Xing J, Shi Y, Su X. Massive gastrointestinal bleeding caused by a giant gastric inflammatory fibroid polyp: A case report. Int J Surg Case Rep 2014; 5:571-3. [PMID: 25105769 PMCID: PMC4200880 DOI: 10.1016/j.ijscr.2014.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Inflammatory fibroid polyps (IFPs) are rare and small benign lesions throughout the digestive tract. The most common location is gastric antrum, but rarely at the upper part. Clinical manifestations of IFPs usually include intestinal obstruction, intussusception, abdominal pain, nausea and vomiting, but rare massive digestive tract hemorrhage. PRESENTATION OF CASE We describe a rare case presenting with massive gastrointestinal bleeding due to a huge gastric fundus IFP (11 cm). Finally, the patient was treated successfully by the laparoscopic assisted partial gastrectomy (LAPG) and recovered uneventfully. To our knowledge, this is the first reported case presenting with massive alimentary tract hemorrhage due to giant gastric fundus IFP. DISCUSSION Giant IFP rarely originates in the gastric fundus, but occasionally results in serious consequence, such as massive gastrointestinal bleeding. It is important to recognize IFP because it responds favorably to operation with no relapse or metastasis. CONCLUSION In the differential diagnosis of alimentary hemorrhage of uncertain etiology, gastric IFP should be considered. For huge gastric IFP, laparoscopic therapy is an apt choice.
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Affiliation(s)
- Chenghai Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Minimally Invasive Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Ming Cui
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Minimally Invasive Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Jiadi Xing
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Minimally Invasive Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Yunfei Shi
- Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Xiangqian Su
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Minimally Invasive Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China.
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21
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Feldis M, Dilly M, Marty M, Laurent F, Cassinotto C. An inflammatory fibroid polyp responsible for an ileal intussusception discovered on an MRI. Diagn Interv Imaging 2014; 96:89-92. [PMID: 24618561 DOI: 10.1016/j.diii.2014.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Feldis
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France.
| | - M Dilly
- Department of Pathological Anatomy, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - M Marty
- Department of Pathological Anatomy, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - F Laurent
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - C Cassinotto
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
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Teli B, Cp M, S S, Mv S. Ileo-ileal Intussusception in an Adult Caused by Vanek's Tumour: A Rare Case Report. J Clin Diagn Res 2013; 7:2994-5. [PMID: 24551704 DOI: 10.7860/jcdr/2013/6863.3821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/27/2013] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Bhavuray Teli
- Assistant Professor, Department of General Surgery, Dmwims , Wayanad, Kerala-673577, India
| | - Madhu Cp
- Professor and Unit Head, Department of General Surgery, JSS Medical College , Mysore, Karnataka, India
| | - Sudhir S
- Associate Professor, Department of General Surgery, JSS Medical College , Mysore, Karnataka, India
| | - Shreeharsha Mv
- Assistant Professor, Department of General Surgery, JSS Medical College , Mysore, Karnataka, India
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Jin JS, Wu CS, Yeh CH, Huang BP, Tsao TY. Inflammatory fibroid polyp of rectum mimicking rectal cancer. Kaohsiung J Med Sci 2013; 29:460-3. [PMID: 23906237 DOI: 10.1016/j.kjms.2012.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/21/2012] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Jong-Shiaw Jin
- Department of Pathology, Tungs' Taichung MetroHarbor Hospital, Wuqi Township, Taichung County, Taiwan
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Akbulut S. Intussusception due to inflammatory fibroid polyp: A case report and comprehensive literature review. World J Gastroenterol 2012; 18:5745-52. [PMID: 23155316 PMCID: PMC3484344 DOI: 10.3748/wjg.v18.i40.5745] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 07/16/2012] [Accepted: 10/23/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To give an overview of the literature on intussusception due to inflammatory fibroid polyp (IFP).
METHODS: We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP, accessed via PubMed and Google Scholar databases. For the search, the keywords used were: intussusception, IFP, intussusception and IFP, intussusception due to IFP, and IFP presenting as intussusception. The search covered all articles from 1976 to November 2011.
RESULTS: We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain, vomiting, and nausea. Ultrasonography demonstrated small bowel intussusception. An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy. Partial ileal resection and anastomosis were performed. A diagnosis of ileal IFP was made based on the immunohistochemical findings. In addition, a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review. The patients were aged 4 to 81 years (mean, 49 ± 16.2 years); 44 were women (mean, 51.8 ± 14.3 years) and 41 were men (mean, 46 ± 17.5 years). According to the location of the IFP, ileal intussusception was found in 63 patients, while 17 had jejunal, three had colonic, and two had ileojejunal intussusception.
CONCLUSION: Although IFPs are rare and benign, surgery is the only solution in case of intestinal obstruction. Differential diagnosis should be made via immunohistochemical examination.
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Xie FL, Yao LQ, Yu YH. Clinicopathologic features of inflammatory fibroid polyp of the esophagus. Shijie Huaren Xiaohua Zazhi 2012; 20:776-780. [DOI: 10.11569/wcjd.v20.i9.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the clinical and pathological features of inflammatory fibroid polyp (IFP) of the esophagus and to discuss its diagnosis, differential diagnosis, treatment and prognosis.
METHODS: A case of IFP of the esophagus was investigated by light microscopy and immunohistochemistry. A literature review was then performed to summarize the clinical and pathological features of the disease.
RESULTS: A 71-year-old man presented with epigastric/retrosternal pain and dysphagia for 3 months. Endoscopy revealed a hemispheric lesion, 2.5 cm in size, in the esophageal mucosa about 35 cm from incisors. On EUS, the lesion (13.2 mm x 11 mm) was hypoechogenic and inhomogeneous, and was located under the mucosa of the esophagus, with a clear boundary. Surgical resection of the esophageal mass was performed, and the final pathologic diagnosis was IFP of the esophagus.
CONCLUSION: IFP of the esophagus is an extremely rare mesenchymal tumor with benign behavior and good prognosis. A correct preoperative diagnosis is difficult and relies on postoperative pathological examination. Surgical excision is the preferred treatment for IFP.
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Ihimoyan A, Chelimilla H, Balar B. An inflammatory fibroid polyp in the hepatic flexure of the colon treated with argon plasma coagulation, endoscopic clipping and polypectomy. Case Rep Gastroenterol 2012; 6:63-8. [PMID: 22423241 PMCID: PMC3304079 DOI: 10.1159/000336401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Inflammatory fibroid polyp (IFP) is a rare benign polypoid lesion of the gastrointestinal tract. Most IFPs occur in the stomach and colonic occurrence is very rare. Histologically IFP is characterized by a mixture of numerous small vessels, fibroblasts and edematous connective tissue associated with marked inflammatory infiltration by eosinophils. We present a rare case of a pedunculated IFP in the hepatic flexure of the colon treated successfully with a combination of argon plasma coagulation, endoclipping and polypectomy. A 74-year-old asymptomatic female underwent a screening colonoscopy in our hospital. A 12-mm pedunculated polyp was found at the hepatic flexure of the colon. After saline injection, we attempted to remove the polyp with a hot snare. However the polyp stalk was extremely difficult to resect despite several attempts with the hot snare. We placed an endoclip at the base of the stalk and then applied argon plasma coagulation at 1.0 l/min and 40 W. After these measures we were able to resect the stalk and the polyp was retrieved. Histologically the polyp was located in the submucosa of the gastrointestinal tract. Proliferation of spindle cells and infiltration of inflammatory cells such as plasma cells and eosinophils were observed. The spindle cells were positive for CD34 and S100 but negative for c-kit and muscle markers. These findings are consistent with a histopathological diagnosis of IFP.
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Affiliation(s)
- Ariyo Ihimoyan
- Division of Gastroenterology, Bronx-Lebanon Hospital, Bronx, N.Y., USA
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Kordzadeh A. Vanek's tumour mimicking an acute appendicitis. Int J Surg Case Rep 2011; 2:264-6. [PMID: 22096748 DOI: 10.1016/j.ijscr.2011.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Vanek's tumour or Inflammatory Fibroid Polyp (IFP) are rare, benign localised lesions originating from the sub-mucosa of the gastrointestinal tract (GI) tract.(1) They have been widely reported as occurring within the stomach, Duodenum, Jejunum and Ileum, more rarely (<1%) in the caecum or appendix. PRESENTATION OF CASE We present a case of a 28-year-old lady who presented with a 2-day history of right iliac fossa pain, nausea and low-grade fever. Subsequent, ultrasonography (USS) of the abdomen demonstrated an inflamed tubular structure originating from caecum with fluid in the pelvis mimicking an acute appendicitis. Next to normal appendix an inflammatory polypoid mass was identified and on histological examination confirmed to be an IFP (Vanek's tumour). DISCUSSION Right Iliac Fossa (RIF) pain with suspected appendicitis is one of the most common presentations in any acute surgical unit. In young women of childbearing age, the differential diagnosis can be varied and vast. The surgical management of IFP (Vanek's tumour) in such cases ranges from limited resection and caecectomy to limited right hemicolectomy. CONCLUSION To date, the exact histiogenesis of these tumours remains unclear and requires a high level of intra-operative suspicion. According to our search such presentation is not reported.
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Hattori Y, Kobayashi S, Takahashi H, Yoneda M, Inamori M, Abe Y, Kubota K, Saito S, Nakajima A. Gastric inflammatory fibroid polyp treated by endoscopic submucosal dissection. Case Rep Gastroenterol 2008; 2:283-6. [PMID: 21490901 PMCID: PMC3075156 DOI: 10.1159/000151330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The endoscopic examination of a 64-year-old male patient revealed a gastric submucosal tumor in the anterior wall of the gastric antrum. The lesion increased in diameter to 25 mm and was resected completely with endoscopic submucosal dissection (ESD). Histological examination of the submucosal tumor gave a diagnosis of an inflammatory fibroid polyp (IFP). It is suggested that ESD may be an effective and safe therapy for gastric submucosal tumors.
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Affiliation(s)
- Y Hattori
- Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Abstract
A case of an inflammatory fibroid polyp occurring in the transverse colon and diagnosed by endoscopic biopsy is reported. The patient was an 82-year-old man who visited our hospital for further evaluation of occult blood in stool. The Colonoscopy revealed a small, red, and peduncular polyp, about 6 mm in diameter, in the transverse colon. Histological examination of the biopsy specimen obtained from the polyp revealed proliferation of fibroblasts and infiltration of inflammatory cells such as plasma cells and eosinophils. This polyp was diagnosed as an inflammatory fibroid polyp, which can appear in many different locations throughout gastrointestinal tract, though still rare in the transverse colon.
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Affiliation(s)
- Shoji Hirasaki
- Second Department of Internal Medicine, Sumitomo Besshi Hospital, 3-1 Ohji-cho, Niihama 792-8543, Japan.
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