Inflammatory fibroid polyp: report of two cases and review of the literature with emphasis on the molecular features and its differential diagnosis

Inflammatory fibroid polyp: report of two cases and review of the literature with emphasis on the molecular features and its differential diagnosis

Ioanna Maria Grypari, Nikolaos Drakos, Evangelos Hliopoulos, Pantelis Kraniotis, Thomas Makatsoris, Ioannis Kehagias, Vasiliki Tzelepi

Abstract


Inflammatory fibroid polyp (IFP) is an uncommon benign mesenchymal polyp arising in the gastrointestinal tract. The clinical presentation can be challenging, as it depends on the size and the location of the lesion. Histopathologic examination of the polyp is the mainstay of the diagnosis as the endoscopic and macroscopic features of the lesion are not specific. Herein we describe the clinical, radiologic, pathologic, and molecular characteristics of two cases of enlarged IFPs. The first one was located in the ileum causing chronic intestinal obstructive symptoms and the other one was located in the antrum of the stomach, presented with anemia and had a synchronous villous adenoma located on the overlying mucosa. The presence of dysplastic epithelium on biopsy, along with the size and intramural location of the tumor lead to the erroneous pre-operative diagnosis of gastric adenocarcinoma. The coexistence of dysplasia or malignancy of the epithelium along with IFP is unusual and only a few cases have been reported so far. Histologically, IFP is a hypocellular submucosal tumor, consisting of spindle shaped cells with a concentric arrangement around vessels. Abundant eosinophils are seen between the tumor cells. Immunohistochemistry is an important diagnostic tool that excludes other entities like gastrointestinal stromal tumor and inflammatory myofibroblastic tumor that have an aggressive potential. At the molecular level, PDGFRa mutation is characteristic for IFPs and can be used to confirm the diagnosis. In conclusion, IFP is a benign mesenchymal neoplasm that may pose diagnostic difficulties both clinically and histologically. 

 


Keywords


Inflammatory fibroid polyp, PDGFRα mutations, mesenchymal tumors of the GI tract, differential diagnosis, spindle neoplastic cells

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