Wikipedia

Inflammatory fibroid polyp

An inflammatory fibroid polyp (IFP) is an uncommon digestive system tumor.[1] J. Vanek initially identified it as a separate pathological entity in 1949 when he reported six case reports of eosinophilic infiltration in gastric submucosal granulomas.[2] It is a single, non-encapsulated polypoid lesion that is typically submucosal. It is characterized by a large number of small blood vessels, oedematous connective tissue, and an inflammatory eosinophilic infiltrate.[3]

Inflammatory fibroid polyp
Other namesIFP, Eosinophilic granulomatous polyp, Vanek's tumor.
Low magnification micrograph of an inflammatory fibroid polyp. H&E stain.
SpecialtyGastroenterology

Inflammatory fibroid polyp has also been referred to as polypoid myo-endothelioma,[4] fibroma with eosinophilic infiltration,[5] inflammatory pseudotumour,[5] myxoma,[6] haemangiopericytoma,[7] eosinophilic granuloma,[5] Vanek's tumour,[8] and gastric eosinophilic submucosal granuloma.[2]

When the lesions are symptomatic, they typically measure less than 3 cm in size and are linked to symptoms such as iron deficiency anemia, bleeding, weight loss, and dyspeptic symptoms. Significant complications like obstruction, intussusception, and even hypovolemic shock can result from larger lesions.[9]

Signs and symptoms

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The tumor's size, location, and complications will affect how it presents itself.[1] Common symptoms include epigastric pain and bleeding in the stomach and intestinal symptoms.[10] When it is in the esophagus, symptoms such as bleeding,[11] gastroesophageal reflux,[12] and dysphagia may occur.[13]

Although the inflammatory fibroid polyp's natural history is unknown, it has been known to grow quickly, within a few months,[1] and to reach sizes of up to 20 cm.[14]

Complications

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Inflammatory fibroid polyps emerge from the submucosa and pierce the lamina propria, causing the mucosal layer to bulge. On rare occasions, they may develop ulcers through the mucosa, resulting in bleeding and symptoms similar to hypovolemic shock.[15]

Causes

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The inflammatory fibroid polyp is a benign lesion whose cause is unknown;[13] some reports attribute its genesis to myofibroblasts,[16] while others propose vascular or perivascular tissue.[17] It is widely acknowledged that this is a reactive process to chemical, physical, or microbiological stimuli rather than a neoplasm.[18] In the past, it was believed that the etiology was caused by an inflammatory reaction to an underlying granuloma.[15] An irritating stimulus is frequently linked to the development of a submucosal granuloma (such as trauma, tuberculosis, helicobacter pylori, Crohn's disease, or sarcoidosis).[19]

Parasites have also been implicated as a potential cause of inflammatory fibroid polyps.[20]

There have been suggestions that a factor that has not yet been identified[21] may cause hyperplasia of vessels and stromal cells, leading to localized vascular inflammation.[22]

Risk factors

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The inflammatory fibroid polyp may be connected to neoplastic and neoplastic GI lesions occurring simultaneously or synchronously, but the literature does not support a causal relationship.[23][24] Isolated reports have been made of inflammatory fibroid polyps at different locations coexisting with granular cell tumors[25] and certain immune system conditions, such as neurofibromatosis,[26] Crohn's disease,[10][27] ankylosing spondylitis,[22] and human immunodeficiency virus infection,[28] however, these results are inconsistent and most likely coincidental.[10]

Genetics

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Inflammatory fibroid polyps have demonstrated a higher incidence in individuals with a family history of gastrointestinal polyps.[29] Activating mutations in the platelet-derived growth factor receptor alpha (PDGFRA) gene were found in 70% of cases in a genetic study involving inflammatory fibroid polyps.[30]

Diagnosis

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Over 90% of gastrointestinal polyps found during routine endoscopic examination are present in patients who are asymptomatic and do not appear to be cancerous.[31] By using a gross examination alone, these polyps cannot be identified from those that need additional treatment.[15] Consequently, to identify the type of polyp and whether underlying dysplasia is present, histological analysis is always recommended.[32] To accurately determine the type of polyp, additional diagnostic techniques such as tandem biopsies, immunohistochemistry staining, and endoscopic ultrasound (EUS) may also be required.[31]

An inflammatory fibroid polyp presents histologically as an exuberant,[10] non-encapsulated, localized proliferation of spindle-shaped mononuclear cells,[4] with an inflammatory infiltrate that is frequently dominated by eosinophils.[33] The fuzzy borders visible on endoscopic ultrasound correspond with the non-encapsulated proliferating spindle cells.[34] Most inflammatory fibroid polyps are vascular, consisting of a network of varying diameter blood vessels.[35] Occasionally, the spindle-shaped cells are arranged in a concentric pattern that resembles "onion skin".[36][4] Surface ulceration in focal areas can occasionally be observed.[6] Though usually polypoidal,[7] the lesion is thought to originate in the lower layer of the lamina propria[23] and may be sessile.[24][7] The layers of the muscle wall atrophy, fraying, and splitting are brought on by inflammatory fibroid polyps.[6]

When inflammatory fibroid polyps from different GI sites are stained with immunohistochemistry, the spindle cell component exhibits nearly 100% positivity for vimentin[5] and CD34,[17] but varying staining for smooth muscle actin, HHF-35, KP1, and Mac 387.[23]

Classification

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The literature describes four histopathological groups into which inflammatory fibroid polyps can be divided: classical fibrovascular, nodular, sclerotic, and edematous.[3]

Treatment

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The only available treatment option is surgical excision of the lesion using either an open or endoscopic approach, depending on the location and size of the tumor.[1] In certain instances, a formal oesophagectomy or lateral oesophagotomy was required for resection.[37] Moreover, reports of using Nd YAG laser and thermocautery to treat tiny polyps exist.[1]

Epidemiology

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Individuals who have inflammatory fibroid polyps usually show up in their fifth or seventh decade of life.[38] In children, it is uncommon.[39] Even though the female-to-male ratio has varied from 2.8:1[24] to 0.7:1,[7] both sexes seem to be equally affected.[38]

See also

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References

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  1. ^ a b c d e Godey, Shashi Kanth; Diggory, Robert T. (30 May 2005). "Inflammatory fibroid polyp of the oesophagus". World Journal of Surgical Oncology. 3 (1): 30. doi:10.1186/1477-7819-3-30. ISSN 1477-7819. PMC 1180860. PMID 15924624.
  2. ^ a b J, Vanek (1949). "Gastric submucosal granuloma with eosinophilic infiltration". The American Journal of Pathology. 25 (3). Am J Pathol: 397–411. ISSN 0002-9440. PMC 1942901. PMID 18127133.
  3. ^ a b Wysocki, A. Peter; Taylor, Graeme; Windsor, John A. (2007). "Inflammatory fibroid polyps of the duodenum: a review of the literature". Digestive Surgery. 24 (3): 162–168. doi:10.1159/000102099. ISSN 0253-4886. PMID 17476106.
  4. ^ a b c Trillo, A. A.; Rowden, G. (November 1991). "The histogenesis of inflammatory fibroid polyps of the gastrointestinal tract". Histopathology. 19 (5): 431–436. doi:10.1111/j.1365-2559.1991.tb00233.x. ISSN 0309-0167. PMID 1757082. S2CID 30279230.
  5. ^ a b c d Kuestermann, Sven A.; Saleeb, Samy F.; Teplick, Steven K. (1999). "General Case of the Day". RadioGraphics. 19 (2). Radiological Society of North America (RSNA): 539–541. doi:10.1148/radiographics.19.2.g99mr19539. ISSN 0271-5333. PMID 10194795.
  6. ^ a b c SP, Benjamin; WA, Hawk; RB, Turnbull (1977). "Fibrous inflammatory polyps of the ileum and cecum: review of five cases with emphasis on differentiation from mesenchymal neoplasm". Cancer. 39 (3): 1300–1305. doi:10.1002/1097-0142(197703)39:3<1300::aid-cncr2820390342>3.0.co;2-4. ISSN 0008-543X. PMID 912661. S2CID 44527499. Retrieved January 10, 2024.
  7. ^ a b c d Johnstone, J. M.; Morson, B. C. (1978). "Inflammatory fibroid polyp of the gastrointesthal tract". Histopathology. 2 (5): 349–361. doi:10.1111/j.1365-2559.1978.tb01727.x. ISSN 0309-0167. PMID 721077. S2CID 71709900.
  8. ^ Daum, Ondrej; Hes, Ondrej; Vanecek, Tomas; Benes, Zdenek; Sima, Radek; Zamecnik, Michal; Mukensnabl, Petr; Hadravska, Sarka; Curik, Romuald; Michal, Michal (2003). "Vanek's tumor (inflammatory fibroid polyp). Report of 18 cases and comparison with three cases of original Vanek's series". Annals of Diagnostic Pathology. 7 (6). Elsevier BV: 337–347. doi:10.1016/j.anndiagpath.2003.09.003. ISSN 1092-9134. PMID 15018116.
  9. ^ Maccagno, Andrea; Sander, Björn; Dintner, Sebastian; Harloff, Manuela; Füzesi, László; Märkl, Bruno (2023). "Inflammatory fibroid polyp: A series of 29 cases and a systematic review of the literature". Human Pathology Reports. 32. Elsevier BV: 300703. doi:10.1016/j.hpr.2023.300703. ISSN 2772-736X.
  10. ^ a b c d Shimer, G. R.; Helwig, E. B. (June 1984). "Inflammatory fibroid polyps of the intestine". American Journal of Clinical Pathology. 81 (6): 708–714. doi:10.1093/ajcp/81.6.708. ISSN 0002-9173. PMID 6731350.
  11. ^ Wolf, B. C.; Khettry, U.; Leonardi, H. K.; Neptune, W. B.; Bhattacharyya, A. K.; Legg, M. A. (February 1988). "Benign lesions mimicking malignant tumors of the esophagus". Human Pathology. 19 (2): 148–154. doi:10.1016/s0046-8177(88)80342-3. ISSN 0046-8177. PMID 3343031.
  12. ^ Leand, P. M.; Murray, G. F.; Zuidema, G. D.; Shelley, W. M. (July 1968). "Obstructing esophageal polyp with eosinophilic infiltration. So-called eosinophilic granuloma". American Journal of Surgery. 116 (1): 93–96. doi:10.1016/0002-9610(68)90424-8. ISSN 0002-9610. PMID 5652366.
  13. ^ a b Costa, P. M.; Marques, A.; Távora, null; Oliveira, E.; Diaz, M. (March 1, 2000). "Inflammatory fibroid polyp of the esophagus". Diseases of the Esophagus. 13 (1): 75–79. doi:10.1046/j.1442-2050.2000.00086.x. ISSN 1120-8694. PMID 11005337.
  14. ^ Savargaonkar, Pratima; Morgenstern, Nora; Bhuiya, Tawfiqal (April 2003). "Inflammatory fibroid polyp of the ileum causing intussusception: report of two cases with emphasis on cytologic diagnosis". Diagnostic Cytopathology. 28 (4): 217–221. doi:10.1002/dc.10258. ISSN 8755-1039. PMID 12672099. S2CID 41610174.
  15. ^ a b c Klingbeil, Kyle D.; Balaban, Alexandra; Fertig, Raymond M.; Gamret, A. Caresse; Gong, Yuna; Torres, Carolyn; Satahoo, Shevonne S. (November 2017). "Inflammatory fibroid polyp of the gastric antrum presenting as hypovolemic shock: Case report and literature review". Intractable & Rare Diseases Research. 6 (4): 304–309. doi:10.5582/irdr.2017.01060. ISSN 2186-3644. PMC 5735286. PMID 29259861.
  16. ^ Navas-Palacios, J. J.; Colina-Ruizdelgado, F.; Sanchez-Larrea, M. D.; Cortes-Cansino, J. (1 May 1983). "Inflammatory fibroid polyps of the gastrointestinal tract. An immunohistochemical and electron microscopic study". Cancer. 51 (9): 1682–1690. doi:10.1002/1097-0142(19830501)51:9<1682::aid-cncr2820510921>3.0.co;2-p. ISSN 0008-543X. PMID 6403217. S2CID 39937280.
  17. ^ a b Wille, P.; Borchard, F. (June 1998). "Fibroid polyps of intestinal tract are inflammatory-reactive proliferations of CD34-positive perivascular cells". Histopathology. 32 (6): 498–502. doi:10.1046/j.1365-2559.1998.00433.x. ISSN 0309-0167. PMID 9675587. S2CID 35109526.
  18. ^ LiVolsi, Virginia A.; Perzin, Karl H. (1 May 1975). "Inflammatory pseudotumors (inflammatory fibrous polyps) of the esophagus". The American Journal of Digestive Diseases. 20 (5): 475–481. doi:10.1007/BF01070794. ISSN 1573-2568. PMID 1130373. S2CID 12152963.
  19. ^ Calderon, Mauricio Giusti; Caivano, Valéria Campos; Bagnaresi, Sauro; de Oliveira Lira, José Ozório; Raimundo, Rodrigo Daminello; de Abreu, Luiz Carlos; Correa, João Antonio (24 February 2017). "A unique case of inflammatory fibroid polyp in the duodenum of a female adolescent". Medicine. 96 (8): e6131. doi:10.1097/MD.0000000000006131. ISSN 0025-7974. PMC 5569430. PMID 28225494.
  20. ^ Stolte, M.; Sticht, T.; Eidt, S.; Ebert, D.; Finkenzeller, G. (October 1994). "Frequency, location, and age and sex distribution of various types of gastric polyp". Endoscopy. 26 (8): 659–665. doi:10.1055/s-2007-1009061. ISSN 0013-726X. PMID 7859674. S2CID 25248914.
  21. ^ Martini, Maurizio; Santoro, Luisa; Familiari, Pietro; Costamagna, Guido; Ricci, Riccardo (May 2013). "Inflammatory fibroid polyp of the gallbladder bearing a platelet-derived growth factor receptor alpha mutation". Archives of Pathology & Laboratory Medicine. 137 (5): 721–724. doi:10.5858/arpa.2012-0218-CR. ISSN 1543-2165. PMID 23627457.
  22. ^ a b Muñiz-Grijalvo, O; Reina-Campos, F; Borderas, F (January 1997). "Could a fibroid polyp be a manifestation of enteropathy induced by nonsteroidal anti-inflammatory drugs?". The American Journal of Gastroenterology. 92 (1): 170–171. PMID 8995966.
  23. ^ a b c Kolodziejczyk, P.; Yao, T.; Tsuneyoshi, M. (November 1993). "Inflammatory fibroid polyp of the stomach. A special reference to an immunohistochemical profile of 42 cases". The American Journal of Surgical Pathology. 17 (11): 1159–1168. doi:10.1097/00000478-199311000-00009. ISSN 0147-5185. PMID 8214261. S2CID 28942337.
  24. ^ a b c Kim, Y. I.; Kim, W. H. (June 1988). "Inflammatory fibroid polyps of gastrointestinal tract. Evolution of histologic patterns". American Journal of Clinical Pathology. 89 (6): 721–727. doi:10.1093/ajcp/89.6.721. ISSN 0002-9173. PMID 3369362.
  25. ^ Bickel, A; Szvalb, S; Eitan, A; Cohen, I (November 1994). "The coexistence of inflammatory fibroid polyp and granular cell tumor in the same gastric lesion". The American Journal of Gastroenterology. 89 (11): 2090–2091. PMID 7942750.
  26. ^ Goto, Keisuke; Hirosaki, Takuya; Masubuchi, Mariko (February 2017). "Neurofibromatosis Type 1-Associated Inflammatory Polyp of the Gastrointestinal Tract". International Journal of Surgical Pathology. 25 (1): 65–68. doi:10.1177/1066896916648772. ISSN 1940-2465. PMID 27170677. S2CID 37595484.
  27. ^ Williams, G. R.; Jaffe, S.; Scott, C. A. (June 1992). "Inflammatory fibroid polyp of the terminal ileum presenting in a patient with active Crohn's disease". Histopathology. 20 (6): 545–547. doi:10.1111/j.1365-2559.1992.tb01045.x. ISSN 0309-0167. PMID 1607157. S2CID 44489661.
  28. ^ Simmons, M. Z.; Cho, K. C.; Houghton, J. M.; Levine, C. D.; Javors, B. R. (1995). "Inflammatory fibroid polyp of the esophagus in an HIV-infected individual: case study". Dysphagia. 10 (1): 59–61. doi:10.1007/BF00261283. ISSN 0179-051X. PMID 7859536. S2CID 23853464.
  29. ^ Allibone, R O; Nanson, J K; Anthony, P P (July 1992). "Multiple and recurrent inflammatory fibroid polyps in a Devon family ('Devon polyposis syndrome'): an update". Gut. 33 (7): 1004–1005. doi:10.1136/gut.33.7.1004. ISSN 0017-5749. PMC 1379423. PMID 1644320.
  30. ^ Schildhaus, H.-U.; Cavlar, T.; Binot, E.; Büttner, R.; Wardelmann, E.; Merkelbach-Bruse, S. (October 2008). "Inflammatory fibroid polyps harbour mutations in the platelet-derived growth factor receptor alpha (PDGFRA) gene". The Journal of Pathology. 216 (2): 176–182. doi:10.1002/path.2393. ISSN 1096-9896. PMID 18686281. S2CID 37048792.
  31. ^ a b Islam, Rafiul Sameer; Patel, Neal C.; Lam-Himlin, Dora; Nguyen, Cuong C. (October 2013). "Gastric Polyps: A Review of Clinical, Endoscopic, and Histopathologic Features and Management Decisions". Gastroenterology & Hepatology. 9 (10): 640–651. ISSN 1554-7914. PMC 3992058. PMID 24764778.
  32. ^ Park, Do Youn; Lauwers, Gregory Y. (April 2008). "Gastric polyps: classification and management". Archives of Pathology & Laboratory Medicine. 132 (4): 633–640. doi:10.5858/2008-132-633-GPCAM. ISSN 1543-2165. PMID 18384215.
  33. ^ Pantanowitz, Liron; Antonioli, Donald A.; Pinkus, Geraldine S.; Shahsafaei, Ali; Odze, Robert D. (January 2004). "Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic cell origin". The American Journal of Surgical Pathology. 28 (1): 107–114. doi:10.1097/00000478-200401000-00013. ISSN 0147-5185. PMID 14707872. S2CID 26641777.
  34. ^ Matsushita, Matsushita; Hajiro, Kiyoshi; Okazaki, Kazuichi; Takakuwa, Hiroshi (1997). "Gastric inflammatory fibroid polyps: endoscopic ultrasonographic analysis in comparison with the histology". Gastrointestinal Endoscopy. 46 (1). Elsevier BV: 53–57. doi:10.1016/s0016-5107(97)70210-4. ISSN 0016-5107. PMID 9260706.
  35. ^ Mori, M; Tamura, S; Enjoji, M; Sugimachi, K (August 1988). "Concomitant presence of inflammatory fibroid polyp and carcinoma or adenoma in the stomach". Archives of Pathology & Laboratory Medicine. 112 (8): 829–832. PMID 3395220.
  36. ^ Suen, Kenneth C.; Burton, Jeffrey D. (1979). "The spectrum of eosinophilic infiltration of the gastrointestinal tract and its relationship to other disorders of angiitis and granulomatosis". Human Pathology. 10 (1). Elsevier BV: 31–43. doi:10.1016/s0046-8177(79)80070-2. ISSN 0046-8177. PMID 428993.
  37. ^ Solito, B.; Anselmino, M.; Tognetti, A.; Vignati, S.; Rossi, M. (2002). "Rare case of inflammatory fibrous polyp of the esophagus". Diseases of the Esophagus. 15 (4). Oxford University Press (OUP): 326–329. doi:10.1046/j.1442-2050.2002.00258.x. ISSN 1120-8694. PMID 12472481.
  38. ^ a b Wysocki, A. Peter; Taylor, Graeme; Windsor, John A. (2007). "Inflammatory Fibroid Polyps of the Duodenum: A Review of the Literature". Digestive Surgery. 24 (3). S. Karger AG: 162–168. doi:10.1159/000102099. ISSN 0253-4886. PMID 17476106.
  39. ^ Chongsrisawat, Voranush; Yimyeam, Phisek; Wisedopas, Naruemon; Viravaidya, Dusit; Poovorawan, Yong (2004). "Unusual manifestations of gastric inflammatory fibroid polyp in a child". World Journal of Gastroenterology. 10 (3). Baishideng Publishing Group Inc.: 460–462. doi:10.3748/wjg.v10.i3.460. ISSN 1007-9327. PMC 4724902. PMID 14760782.

Further reading

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