Abstracts
Inflammatory fibroid polyp (IFP) is a benign uncommon lesion (1%-4% of gastric benign lesions), originated from the submucosa of the gastrointestinal tract. Its origin is controversial and immunohistochemical studies of lesions have largely refuted the possible vascular, neural or smooth muscle origin. Recent studies suggest a neoplastic etiology due to a mutation, in some cases, in the alpha-type platelet-derived growth factor receptor gene (PDGFRa). Our objective is to report the case of a patient aged 70 years, with gastric IFP, comparing her immunohistochemical profile with those of other studies, and a brief review of the literature.
gastric polyp; inflammatory fibroid polyp; Vanek; immunohistochemistry
Pólipo fibroide inflamatório (PFI) é uma lesão benigna, pouco frequente (1%-4% das lesões benignas gástricas), originada na submucosa do trato gastrointestinal. Sua origem é controversa e vários estudos imuno-histoquímicos da lesão refutaram uma possível origem vascular, neural ou muscular lisa. Recentes estudos sugerem etiologia neoplásica devida à mutação, em alguns casos, no gene receptor tipo alfa para fator de crescimento derivado de plaquetas (PDGFRa). Nosso objetivo é relatar o caso de uma paciente de 70 anos de idade, com PFI gástrico, comparando seu perfil imuno-histoquímico com o de outros estudos, além de breve revisão da literatura.
pólipo gástrico; pólipo fibroide inflamatório; Vanek; imuno-histoquímica
INTRODUCTION
The inflammatory fibroid polyp (IFP) is a benign lesion that arises from the submucosa
of the gastrointestinal (GI) tract(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.
2 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
-33 Yoon JH. An inflammatory fibroid polyp (Vanek's tumor) of the ileum that
presented as intussusception. ACT. 2013; 2: 140-4. Available at:
http://dx.doi.org/10.4236/act.2013.24024.
http://dx.doi.org/10.4236/act.2013.24024...
), most commonly in the
antrum (70%) and ileum (20%) and, only occasionally, in the duodenum and jejunum(44 De Haan PM, Martínez YR, Gutiérrez FR. Intususcepción intestinal debido
a un pólipo fibroide inflamatório (tumor de Vanek). Med Leg Costa Rica.
2014;31(1):0.
5 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.
6 Piñero A, García-Muñoz PA, López MJ, Ruiz-Maciá JA, Sola J, Pons JA.
Ileal Vanek's tumor mimickingcecal carcinoma. Tumori. 2012;98:e13-5.-77 Singhn NG, Kahvic M, Mannan R, Enezi AA. Gastric inflammatory fibroid
polyp: report of a case. IJP. 2011;6(1):42-5.). Its frequency ranges from 1% to 4% of diagnoses among benign stomach
lesions, and usually occurs between the fifth and the seventh decade of life(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
). Malignancy is a rare event(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
), however, up to 8% of IFPs have been described as
concomitant lesions with adenoma or carcinoma(88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.).
The lesion may be polypoid or sessile, usually single and covered with normal or
ulcerated mucosa(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.). Histologically, IFP is composed of
proliferation of spindle cell elements and a prominent network of small capillaries, in
an inflammatory background(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
55 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.,
88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.,
1111 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
) composed of plasma cells, lymphocytes and
eosinophils, more predominantly(44 De Haan PM, Martínez YR, Gutiérrez FR. Intususcepción intestinal debido
a un pólipo fibroide inflamatório (tumor de Vanek). Med Leg Costa Rica.
2014;31(1):0.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1313 Gara N, Falzarano JS, Limm WML, Namiki TS, Tom LKS. Ileal inflammatory
fibroid polyp causing chronic ileocolic intussusception and mimicking cecal
carcinoma. World J Gastrointest Oncol. 2009;1(1):89-92.,
1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory
fibroid polyp. Rom J Intern Med. 2012;50(2):179-85.).
Several studies on structural and immunohistochemical analysis of lesion has been
conducted in order to clarify the origin of the IFPs, which, however, remains
controversial(44 De Haan PM, Martínez YR, Gutiérrez FR. Intususcepción intestinal debido
a un pólipo fibroide inflamatório (tumor de Vanek). Med Leg Costa Rica.
2014;31(1):0.,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.
16 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a
rare benign tumor of the alimentary tract in children presenting as intussusception -
case report and review of literature. Eur J Pediatr Surg Rep.
2014;2(1):16-9.-1717 Wong MMM, García RAA, Folch RG, Torres MM, Grillo CC, Guardia IML.
Pólipo inflamatório de intestino delgado. Presentación de 2 casos. [Internet]. Actas
Hispanoamericanas de Patología. 2006. Available at:
http://conganat.cs.urjc.es.
http://conganat.cs.urjc.es...
). Several immunohistochemical studies have refuted a potential to vascular
or neural origin for the lesion, since IFPs resulted negative for factor VIII-Ra and
S-100, respectively(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.,
1919 Wille P, Borchard F. Fibroid polyps of intestinal tract are
inflammatory-reactive proliferations of CD34-positive perivascular cells.
Histopathology. 1998;32(6):498-502.), or a smooth muscle origin due to a negative
reaction for alpha smooth muscle actin (SMA), desmin and myoglobin(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.). Some studies have promoted the idea that fibroblasts are the
main cells, primitive mesenchymal cells(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.
19 Wille P, Borchard F. Fibroid polyps of intestinal tract are
inflammatory-reactive proliferations of CD34-positive perivascular cells.
Histopathology. 1998;32(6):498-502.
20 Kolodziejczyk P, Yao T, Tsuneyoshi M. Inflammatory fibroid polyp of the
stomach. A special reference to an immunohistochemical profile of 42 cases. Am J Surg
Pathol. 1993;17(11):1159-68.-2121 Suster S, Robinson MJ. Inflammatory fibroid polyp of the small
intestine: ultrastructural and immunohistochemical observations. Ultrastruct Pathol.
1990;14(2):109-19.) or even dendritic
cells(2222 Pantanowitz LMD, Antonioli DA, Pinkus GS, Shahsafaei A, Odze RD.
Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic
cell origin. Am J Surg Pathol. 2004;28(1):107-14.). Other, more recent, have shown a
mutation in the alpha type receptor for the platelet derived growth factor (PDGFRa),
suggesting a possible neoplastic factor in the etiology of this lesion(88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.,
1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory
fibroid polyp. Rom J Intern Med. 2012;50(2):179-85.,
1616 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a
rare benign tumor of the alimentary tract in children presenting as intussusception -
case report and review of literature. Eur J Pediatr Surg Rep.
2014;2(1):16-9.).
We report the case of a female patient aged 70 years with gastric IFP comparing her morphological and immunohistochemical features with the actual studies, and we reviewed the literature on this lesion.
CASE REPORT
Case
A 70-year-old female patient with diabetes mellitus, undergoing well differentiated endometrioid endometrial adenocarcinoma follow-up, presented nausea, vomiting, and bloody stools lasting one week. Upper digestive endoscopy demonstrated expanded diaphragmatic hiatus and hiatal hernia with 3 cm slip, and pedunculated polyp in the antrum region, covered by preserved mucosa, similar to the adjacent, measuring 3 cm in diameter. There were no other abnormalities, and the endoscopic polypectomy of the lesion was analyzed.
Histopathological analysis
Histopathological examination revealed a well-defined polypoid lesion, composed of proliferation of spindle cell elements, a prominent network of small capillaries and inflammatory cells located in the submucosa. The cells have ovoid nuclei, uniform chromatin, and abundant cytoplasm. The stroma is myxoid edematous, concentrically arranged around blood vessels with "onion skin" pattern. The inflammatory cells are predominantly composed of eosinophils (Figure 1). The overlying mucosa was preserved. Special staining for H. pylori caused negative result.
Histopathological images of the lesion
A) antral mucosa and submucosal IFP (HE, 25×); B) edematous myxoid stroma arranged in concentric layers around blood vessels, and inflammatory background predominantly consisted of eosinophils (HE, 400×).
IFP: inflammatory fibroid polyps; HE: hematoxylin and eosin.
Immunohistochemistry
For immunohistochemical technique, the spindle cells of lesion were positive for CD34 (monoclonal, dilution 1:100, Novocastra) and vimentin (monoclonal, dilution 1:200, DAKO) (Figure 2) and negative for muscle actin smooth - SMA (monoclonal, dilution 1:50, DAKO), VIII-Ra factor (dilution 1:10, DAKO), CD117 - c-kit (polyclonal, dilution 1:100, DAKO - and S-100 protein (polyclonal, dilution 1:1200, DAKO). However, was positive for VIII-Ra factor and smooth muscle actin in the blood vessels walls, showing the rich vascularization of the lesion. IFP diagnosis was assigned.
DISCUSSION
IFP was first described as "polypoid fibroma" in 1920 by Konjetzny(77 Singhn NG, Kahvic M, Mannan R, Enezi AA. Gastric inflammatory fibroid
polyp: report of a case. IJP. 2011;6(1):42-5.). In 1949, Vanek named it as "gastric submucosal granuloma with
eosinophilic infiltration" and described six cases(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.,
2323 Vanek J. Gastric submucosal granuloma with eosinophilic infiltration. Am
J Pathol. 1949;25(3):397-411.). Later, it became recognized by a variety of
different names: eosinophilic granuloma, polypoid fibroma, gastric fibroma with
eosinophilic infiltration, polypoid eosinophilic granuloma, inflammatory pseudotumor,
and Vanek's polyp(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.,
1616 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a
rare benign tumor of the alimentary tract in children presenting as intussusception -
case report and review of literature. Eur J Pediatr Surg Rep.
2014;2(1):16-9.). In 1953, Helwig et al.
introduced the term "inflammatory fibroid polyp" to define the disease(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
1313 Gara N, Falzarano JS, Limm WML, Namiki TS, Tom LKS. Ileal inflammatory
fibroid polyp causing chronic ileocolic intussusception and mimicking cecal
carcinoma. World J Gastrointest Oncol. 2009;1(1):89-92.,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.).
IFP lesion that arises from the GI tract submucosa(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
33 Yoon JH. An inflammatory fibroid polyp (Vanek's tumor) of the ileum that
presented as intussusception. ACT. 2013; 2: 140-4. Available at:
http://dx.doi.org/10.4236/act.2013.24024.
http://dx.doi.org/10.4236/act.2013.24024...
,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.), and are classified as submucosal tumor of
connective tissue(44 De Haan PM, Martínez YR, Gutiérrez FR. Intususcepción intestinal debido
a un pólipo fibroide inflamatório (tumor de Vanek). Med Leg Costa Rica.
2014;31(1):0.,
55 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
); it is most commonly found in the antrum
(70%) and ileum (20%) (22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
66 Piñero A, García-Muñoz PA, López MJ, Ruiz-Maciá JA, Sola J, Pons JA.
Ileal Vanek's tumor mimickingcecal carcinoma. Tumori. 2012;98:e13-5.,
1111 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
). Other sites in descending order are colon,
jejunum, duodenum, and esophagus(99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.). Rarely it reaches more than 6 cm(44 De Haan PM, Martínez YR, Gutiérrez FR. Intususcepción intestinal debido
a un pólipo fibroide inflamatório (tumor de Vanek). Med Leg Costa Rica.
2014;31(1):0.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.), however there is a case of IFP reported with
12.5 cm diameter(33 Yoon JH. An inflammatory fibroid polyp (Vanek's tumor) of the ileum that
presented as intussusception. ACT. 2013; 2: 140-4. Available at:
http://dx.doi.org/10.4236/act.2013.24024.
http://dx.doi.org/10.4236/act.2013.24024...
,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.).
Most often, IFPs are incidentally discovered in asymptomatic patients(33 Yoon JH. An inflammatory fibroid polyp (Vanek's tumor) of the ileum that
presented as intussusception. ACT. 2013; 2: 140-4. Available at:
http://dx.doi.org/10.4236/act.2013.24024.
http://dx.doi.org/10.4236/act.2013.24024...
,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
). However, depending on the size and location
of the lesion, patients may present dyspepsia symptoms, such as abdominal
epigastralgia-type pain, nausea and, sometimes, vomiting, in addition to
gastrointestinal bleeding, iron-deficiency anemia and change in bowel habits(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
44 De Haan PM, Martínez YR, Gutiérrez FR. Intususcepción intestinal debido
a un pólipo fibroide inflamatório (tumor de Vanek). Med Leg Costa Rica.
2014;31(1):0.,
88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1616 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a
rare benign tumor of the alimentary tract in children presenting as intussusception -
case report and review of literature. Eur J Pediatr Surg Rep.
2014;2(1):16-9.,
2424 Leon-Espinoza C, Gomez-Mateo M, Lopez-Mozos F, Marti-Obiol R,
Raga-Vasquez J, Ortega-Serrano J. Does adult intestinal invagination need surgery?
Report of a case and review of literature. IJCM. 2011;2(4):456-8.).
The typical macroscopic aspect is a polypoid, sessile or pedunculated lesion, usually
single, well defined, without capsule, firm, with grayish surface and covered with
normal or ulcerated mucosa(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.). Histologically, it is characterized by a
submucosal lesion(1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
2222 Pantanowitz LMD, Antonioli DA, Pinkus GS, Shahsafaei A, Odze RD.
Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic
cell origin. Am J Surg Pathol. 2004;28(1):107-14.), which rarely extends to the muscle
layer(99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.), composed of small blood vessels and
mesenchymal spindle cell proliferation(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
1111 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory
fibroid polyp. Rom J Intern Med. 2012;50(2):179-85.) with ovoid nuclei, fine granular chromatin,
small nucleoli and eosinophilic cytoplasm(99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.). It
also presents inflammatory infiltrates containing lymphocytes, plasma cells and
eosinophils, predominantly(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
55 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.,
1313 Gara N, Falzarano JS, Limm WML, Namiki TS, Tom LKS. Ileal inflammatory
fibroid polyp causing chronic ileocolic intussusception and mimicking cecal
carcinoma. World J Gastrointest Oncol. 2009;1(1):89-92.,
1111 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory
fibroid polyp. Rom J Intern Med. 2012;50(2):179-85.), and a edematous myxoid stroma arranged,
generally concentrically around blood vessels, with "onion skin" pattern(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.). The overlying mucosa may be normal or
ulcerated, inflammation or regeneration secondary to erosion(88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.). Mitotic activity and reactive changes are occasionally seen in
the superficial epithelium(99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.).
The differential diagnosis is challenging, even at the microscopic level, and immunohistochemical analysis is performed to differentiate from other tumors, such as gastrointestinal stromal tumor (GIST), inflammatory myofibroblastic tumor (IMT) and schwannoma(1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory fibroid polyp. Rom J Intern Med. 2012;50(2):179-85., 1616 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a rare benign tumor of the alimentary tract in children presenting as intussusception - case report and review of literature. Eur J Pediatr Surg Rep. 2014;2(1):16-9.). IMT is very similar to IFP, with myofibroblast proliferation and mixed inflammatory component(99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J, Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio. Informe de un caso y revisión de la literatura. Cir Cir. 2011;79(3):263-7.). The immunohistochemical analysis of this lesion is positive for smooth muscle actin, and negative for CD34(1313 Gara N, Falzarano JS, Limm WML, Namiki TS, Tom LKS. Ileal inflammatory fibroid polyp causing chronic ileocolic intussusception and mimicking cecal carcinoma. World J Gastrointest Oncol. 2009;1(1):89-92., 1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory fibroid polyp. Rom J Intern Med. 2012;50(2):179-85., 1616 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a rare benign tumor of the alimentary tract in children presenting as intussusception - case report and review of literature. Eur J Pediatr Surg Rep. 2014;2(1):16-9.). GIST is a intramural tumor, positive to CD117(88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol. 2012;27(4):323-5., 99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J, Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio. Informe de un caso y revisión de la literatura. Cir Cir. 2011;79(3):263-7., 1313 Gara N, Falzarano JS, Limm WML, Namiki TS, Tom LKS. Ileal inflammatory fibroid polyp causing chronic ileocolic intussusception and mimicking cecal carcinoma. World J Gastrointest Oncol. 2009;1(1):89-92., 1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory fibroid polyp. Rom J Intern Med. 2012;50(2):179-85.) and CD34(1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory fibroid polyp. Rom J Intern Med. 2012;50(2):179-85.). Schwannoma arise in the lamina propria, has no eosinophils or other inflammatory cells scattered in the stroma and is positive for S-100 protein(1414 Tudose I, Andrei F, Calu V, Staniceanu F, Miron A. Giant inflammatory fibroid polyp. Rom J Intern Med. 2012;50(2):179-85., 2525 Jiménez KH, Franco HM. Schwannoma gástrico: presentación de un caso y revisión de la literatura. Rev Gastroenterol Mex. 2009;74(3):252-5.).
IFP may have variable reactivity for smooth muscle actin, CD34, CD117 (c-kit), and S-100
protein(55 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.,
77 Singhn NG, Kahvic M, Mannan R, Enezi AA. Gastric inflammatory fibroid
polyp: report of a case. IJP. 2011;6(1):42-5.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.,
1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
2222 Pantanowitz LMD, Antonioli DA, Pinkus GS, Shahsafaei A, Odze RD.
Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic
cell origin. Am J Surg Pathol. 2004;28(1):107-14.). In this case, the immunohistochemical
analysis excluded GIST (negative for CD117), inflammatory myofibroblastic tumor
(negative for smooth muscle actin) and schwannoma (negative for S-100). Its etiology is
still controversial(55 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.
11 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.-1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.
16 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a
rare benign tumor of the alimentary tract in children presenting as intussusception -
case report and review of literature. Eur J Pediatr Surg Rep.
2014;2(1):16-9.-1717 Wong MMM, García RAA, Folch RG, Torres MM, Grillo CC, Guardia IML.
Pólipo inflamatório de intestino delgado. Presentación de 2 casos. [Internet]. Actas
Hispanoamericanas de Patología. 2006. Available at:
http://conganat.cs.urjc.es.
http://conganat.cs.urjc.es...
,
2222 Pantanowitz LMD, Antonioli DA, Pinkus GS, Shahsafaei A, Odze RD.
Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic
cell origin. Am J Surg Pathol. 2004;28(1):107-14.), but several hypotheses have been proposed,
the most accepted, until recently, the inflammatory theory(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
), according to which, IFP originates due to excessive tissue
reaction to damage applied on the gastrointestinal mucosa, as chemical, mechanical or
biological factors(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
55 Neishaboori H, Maleki I, Emadian O. Jejunal intussusception caused by a
huge Vanek's tumor: a case report. Gastroenterol Hepatol Bed Bench.
2013;6(4):210-3.,
66 Piñero A, García-Muñoz PA, López MJ, Ruiz-Maciá JA, Sola J, Pons JA.
Ileal Vanek's tumor mimickingcecal carcinoma. Tumori. 2012;98:e13-5.,
1010 Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A.
Intususcepción intestinal por pólipo fibroide inflamatório en una anciana. Medicina,
Buenos Aires. 2013;73(5):461-3.
11 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.-1212 Rehman S. Inflammatory fibroid polyp (Vanek'stumour), an unusual large
polyp of the jejunum: a case report. Cases Journal. [Internet]. 2009;2:7152.
Available at:
http://casesjournal.com/casesjournal/article/view/7152.
http://casesjournal.com/casesjournal/art...
,
1515 Nonose R, Valenciano JS, Silva CMG, Souza CAF, Martinez CAR. Ileal
intussusception caused by Vanek's tumor: a case report. Case Rep Gastroenterol.
2011;5:110-6.). It is believed that these factors act on
mucosal fibroblasts and myofibroblasts, stimulating its growth(22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
). An allergic etiology has also been proposed due to the presence
of eosinophilic infiltration(99 Morales-Fuentes GA, Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J,
Terrazas-Espitia F, Pérez-Manauta J. Pólipo de Vanek o pólipo fibroide inflamatorio.
Informe de un caso y revisión de la literatura. Cir Cir.
2011;79(3):263-7.,
66 Piñero A, García-Muñoz PA, López MJ, Ruiz-Maciá JA, Sola J, Pons JA.
Ileal Vanek's tumor mimickingcecal carcinoma. Tumori. 2012;98:e13-5.,
1111 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.,
1717 Wong MMM, García RAA, Folch RG, Torres MM, Grillo CC, Guardia IML.
Pólipo inflamatório de intestino delgado. Presentación de 2 casos. [Internet]. Actas
Hispanoamericanas de Patología. 2006. Available at:
http://conganat.cs.urjc.es.
http://conganat.cs.urjc.es...
), however, in most cases there is no medical
history of allergies and eosinophilia, which is present in only 4% of patients(1616 Siminas S, Qasem E, Shukla R, Turnock R. Inflammatory fibroid polyp: a
rare benign tumor of the alimentary tract in children presenting as intussusception -
case report and review of literature. Eur J Pediatr Surg Rep.
2014;2(1):16-9.,
1717 Wong MMM, García RAA, Folch RG, Torres MM, Grillo CC, Guardia IML.
Pólipo inflamatório de intestino delgado. Presentación de 2 casos. [Internet]. Actas
Hispanoamericanas de Patología. 2006. Available at:
http://conganat.cs.urjc.es.
http://conganat.cs.urjc.es...
). The emergence of these polyps in gastric
location has been associated to Helicobacter pylori infection,
entailing the hypothesis of an immune response during a chronic infection by this
bacterium(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
22 Pérez AMM, Cubas MOH, Martín ML. Tumor de Vanek o pólipo fibroide
inflamatorio. Reporte de un caso. Rev Méd Electrón. [Internet]. 2013;35(4). Available
at:
http://www.revmatanzas.sld.cu/revista%20medica/ano%202013/vol4%202013/tema10.htm.
http://www.revmatanzas.sld.cu/revista%20...
,
88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.,
1717 Wong MMM, García RAA, Folch RG, Torres MM, Grillo CC, Guardia IML.
Pólipo inflamatório de intestino delgado. Presentación de 2 casos. [Internet]. Actas
Hispanoamericanas de Patología. 2006. Available at:
http://conganat.cs.urjc.es.
http://conganat.cs.urjc.es...
,
2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.). Some studies suggest that gastric IFPs are
more frequent in patients with atrophic gastritis and pernicious anemia(88 Eusse AB, Botero AMC, Pérez MdP, Cuartas CB. Presentation of two cases
of Vanek's tumor (inflammatory fibroid polyp) in Medellín. Rev Col Gastroenterol.
2012;27(4):323-5.). Other autoimmune diseases have also been linked
to IFP, such as sarcoidosis, rheumatoid arthritis and ankylosing spondylitis, which
confirms the possibility of an immune reaction as a contributing factor(11 Ayala EG, Anaya HJM, Mastrascusa LRC, Martínez DKS. Pólipo fibroide
inflamatorio gástrico: a propósito de un caso. Med Uis.
2010;23:145-9.,
1111 Polat C, Yazicioglu MB, Turel S, Kosar MN, Arikan Y. A rare combination
of gastric inflammatory fibroid polyp and hiatal hernia. Surgical Science.
2011;2:366-8.,
1717 Wong MMM, García RAA, Folch RG, Torres MM, Grillo CC, Guardia IML.
Pólipo inflamatório de intestino delgado. Presentación de 2 casos. [Internet]. Actas
Hispanoamericanas de Patología. 2006. Available at:
http://conganat.cs.urjc.es.
http://conganat.cs.urjc.es...
).
In this report, the spindle cells of the lesion were positive for CD34 and vimentin, and
negative for SMA actin, factor VIII-Ra, CD117 (c-kit) and S-100 protein. However, the
positivity for factor VIII-Ra and smooth muscle actin in the vessels walls showed the
rich vascularity of the lesion, which may indicate a secondary involvement of vascular
proliferation(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.). Our results corroborate the
literature when indicating that the lesion presents a possible neural, vascular or
smooth muscle origin(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.,
1919 Wille P, Borchard F. Fibroid polyps of intestinal tract are
inflammatory-reactive proliferations of CD34-positive perivascular cells.
Histopathology. 1998;32(6):498-502.), encouraging the idea that the main cells are
fibroblasts or primitive mesenchymal cells, primarily because it is strongly positive
for vimentin and CD34(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.
19 Wille P, Borchard F. Fibroid polyps of intestinal tract are
inflammatory-reactive proliferations of CD34-positive perivascular cells.
Histopathology. 1998;32(6):498-502.
20 Kolodziejczyk P, Yao T, Tsuneyoshi M. Inflammatory fibroid polyp of the
stomach. A special reference to an immunohistochemical profile of 42 cases. Am J Surg
Pathol. 1993;17(11):1159-68.-2121 Suster S, Robinson MJ. Inflammatory fibroid polyp of the small
intestine: ultrastructural and immunohistochemical observations. Ultrastruct Pathol.
1990;14(2):109-19.). In a study of 14 IFP cases, three cases were
negative for CD-34, and all of positive cases for this marker had concentric stromal
proliferation(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.). The authors concluded that
IFP with concentric proliferation may have a different histogenesis from IFP without
this type of stromal pattern, and that it may originate from a subpopulation of
dendritic interstitial cells(1818 Santos GC, Alves VAF, Wakamatsu A, Zucoloto S. Inflammatory fibroid
polyp. An immunohistochemical study. Arq Gastroenterol.
2004;41:2:104-7.,
2222 Pantanowitz LMD, Antonioli DA, Pinkus GS, Shahsafaei A, Odze RD.
Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic
cell origin. Am J Surg Pathol. 2004;28(1):107-14.). Our case presented stroma concentrically
organized around the vessels and positive for marker CD34.
Recent studies have shown mutations in exons 12(2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.,
2727 Calabuig-Fariñas S, López-Guerrero JA, Ribera MJN, et al. Inflammatory
fibroid polyp of the small bowel with a mutation in exon 12 of PDGFRa. Virchows Arch.
2009;3:327-31.) or 18(2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.,
2828 Lasota J. Gain-of-function PDGFRA mutations, earlier reported in
gastrointestinal stromal tumors, are common in small intestinal inflammatory fibroid
polyps. A study of 60 cases. Modern Pathology. 2009;22:1049-56.) and, less frequently, in exon 14(2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.) of PDGFRa gene (chromosome 4q12), suggesting a
possible neoplastic factor in the etiology of this lesion(2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.
27 Calabuig-Fariñas S, López-Guerrero JA, Ribera MJN, et al. Inflammatory
fibroid polyp of the small bowel with a mutation in exon 12 of PDGFRa. Virchows Arch.
2009;3:327-31.-2828 Lasota J. Gain-of-function PDGFRA mutations, earlier reported in
gastrointestinal stromal tumors, are common in small intestinal inflammatory fibroid
polyps. A study of 60 cases. Modern Pathology. 2009;22:1049-56.). A total of
145 IFP cases, 55.2% had mutations in exons 12 or 18 of PDGFRa gene, and only two cases
presented mutation in exon 14(2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.). Studies on
mutation of this lesion have shown that a type of unidentified mesenchymal stem cells of
the GI tract submucosa is mutated, developing a tumor(2626 Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in
inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with
tumour localization. Histopathology. 2012;61:59-68.,
2727 Calabuig-Fariñas S, López-Guerrero JA, Ribera MJN, et al. Inflammatory
fibroid polyp of the small bowel with a mutation in exon 12 of PDGFRa. Virchows Arch.
2009;3:327-31.).
Thus, IFPs present a possible major component of spindle cells, recognized as fibroblast and primitive mesenchymal cells, and studies on Mutation Research should be conducted to elucidate the mechanisms that lead to the origin of this lesion.
References
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Publication Dates
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Publication in this collection
Mar-Apr 2015
History
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Received
25 Oct 2014 -
Accepted
12 Feb 2015