Inflammatory fibroid polyp explained

Inflammatory fibroid polyp
Synonyms:IFP, Eosinophilic granulomatous polyp, Vanek's tumor.

An inflammatory fibroid polyp (IFP) is an uncommon digestive system tumor. 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.[1] 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.

Inflammatory fibroid polyp has also been referred to as polypoid myo-endothelioma, fibroma with eosinophilic infiltration, inflammatory pseudotumour, myxoma, haemangiopericytoma, eosinophilic granuloma, Vanek's tumour,[2] and gastric eosinophilic submucosal granuloma.[1]

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.[3]

Signs and symptoms

The tumor's size, location, and complications will affect how it presents itself.[4] Common symptoms include epigastric pain and bleeding in the stomach and intestinal symptoms.[5] When it is in the esophagus, symptoms such as bleeding,[6] gastroesophageal reflux,[7] and dysphagia may occur.[8]

Although the inflammatory fibroid polyp's natural history is unknown, it has been known to grow quickly, within a few months,[4] and to reach sizes of up to 20 cm.[9]

Complications

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.[10]

Causes

The inflammatory fibroid polyp is a benign lesion whose cause is unknown; some reports attribute its genesis to myofibroblasts,[11] while others propose vascular or perivascular tissue.[12] It is widely acknowledged that this is a reactive process to chemical, physical, or microbiological stimuli rather than a neoplasm.[13] In the past, it was believed that the etiology was caused by an inflammatory reaction to an underlying granuloma. An irritating stimulus is frequently linked to the development of a submucosal granuloma (such as trauma, tuberculosis, helicobacter pylori, Crohn's disease, or sarcoidosis).[14]

Parasites have also been implicated as a potential cause of inflammatory fibroid polyps.[15]

There have been suggestions that a factor that has not yet been identified[16] may cause hyperplasia of vessels and stromal cells, leading to localized vascular inflammation.

Risk factors

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.[17] [18] Isolated reports have been made of inflammatory fibroid polyps at different locations coexisting with granular cell tumors[19] and certain immune system conditions, such as neurofibromatosis,[20] Crohn's disease,[21] ankylosing spondylitis,[22] and human immunodeficiency virus infection,[23] however, these results are inconsistent and most likely coincidental.

Genetics

Inflammatory fibroid polyps have demonstrated a higher incidence in individuals with a family history of gastrointestinal polyps.[24] 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.[25]

Diagnosis

Over 90% of gastrointestinal polyps found during routine endoscopic examination are present in patients who are asymptomatic and do not appear to be cancerous.[26] By using a gross examination alone, these polyps cannot be identified from those that need additional treatment. Consequently, to identify the type of polyp and whether underlying dysplasia is present, histological analysis is always recommended.[27] To accurately determine the type of polyp, additional diagnostic techniques such as tandem biopsies, immunohistochemistry staining, and endoscopic ultrasound (EUS) may also be required.[26]

An inflammatory fibroid polyp presents histologically as an exuberant, non-encapsulated, localized proliferation of spindle-shaped mononuclear cells,[28] with an inflammatory infiltrate that is frequently dominated by eosinophils.[29] The fuzzy borders visible on endoscopic ultrasound correspond with the non-encapsulated proliferating spindle cells.[30] Most inflammatory fibroid polyps are vascular, consisting of a network of varying diameter blood vessels.[31] Occasionally, the spindle-shaped cells are arranged in a concentric pattern that resembles "onion skin".[32] Surface ulceration in focal areas can occasionally be observed.[33] Though usually polypoidal,[34] the lesion is thought to originate in the lower layer of the lamina propria and may be sessile.[34] The layers of the muscle wall atrophy, fraying, and splitting are brought on by inflammatory fibroid polyps.[33]

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

Classification

The literature describes four histopathological groups into which inflammatory fibroid polyps can be divided: classical fibrovascular, nodular, sclerotic, and edematous.[36]

Treatment

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. 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.

Epidemiology

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 to 0.7:1, both sexes seem to be equally affected.[38]

See also

Further reading

External links

Notes and References

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