Your Health and Fitness Partner: Androxal & FitHub

We are also excited to expand our scope by including valuable information on Androxal, a potent medication beneficial in various medical conditions. This remarkable drug, derived from the testosterone molecule, has made its mark significantly in the field of endocrinology. Patients and medical professionals can rely on our comprehensive, unbiased, and scientifically grounded content on Androxal for gaining a robust understanding of its uses, side effects, and the latest studies related to it. We understand the necessity of accurate information when it comes to medication. Our newly launched section dedicated to Androxal aims at not only educating the readers about its nuances but also at contributing beneficially to their wellbeing. Stay tuned for insightful articles unraveling the potential of Androxal in medical science.

Sitemap | Policies | Feedback    
 About the Journal
Editorial Board
Journal Subscription
Instructions for Authors
E-mail Alerts
Forthcoming Events
Advertise with Us
Contact Us
 
Article Options
FULL TEXT
PDF
Printer Friendly Version
Search Pubmed for
Search Google Scholar for
Article Statistics
Bookmark and Share
Case Report
 
A rare case of multiple inflammatory fibroid polypsin a young woman with family history of inflammatory fibroid polyps
Keywords :
KP Balsara1, M Hussain1, C Dubash1, SK Arneja2, S Pathan2
Department of Gastrointestinal and Laparoscopic Surgery,1
Department of Surgical Pathology and Cytology,2
Breach Candy Hospital Trust, Mumbai, India


Corresponding Author
: Dr. SK Arneja
Email: drsarabjeetarneja@gmail.com


DOI: http://dx.doi.org/10.7869/tg.215

48uep6bbphidvals|639
48uep6bbph|2000F98CTab_Articles|Fulltext
Vanek[1] was the first to describe the inflammatory fibroid polyp (IFP). These polyps are rare, usuallysolitary,benign lesions, arisingfrom the intestinal submucosa and display a marked eosinophilic reaction.[2] They have a slight male preponderance and are commonly seen in patients after the sixth decade of life.[3] The stomach is the commonest site of origin, followed by the small bowel, colon and duodenum.[4] Surgical resection is generally curative though recurrences have been reported if inadequate excision is done.[5]Multiple inflammatory fibroid polyps requiring repeated laparotomies have been reported withinaffected families,up to over three successive generations.[6]Only one other case of multiple polyps has been recorded, where the patient had one polyp each in the duodenum and jejunum.[7]Most other case reports document only solitary IFPs, including solitary giant IFPs.[8]Recurrence of multiple polyps has not been encountered up to now. We report a rare case of a young female patient who underwent three laparotomies for recurrent intestinal obstruction due to multiple IFPs.

Case report

A 30-year-old female patient first presented in 2002 with features of small bowel obstruction which on computerized tomography was found to be secondary to an ileo-ileal intussusception. The lead point of the intussuscepiens on exploration was a 5cm polyp in mid-ileum and two more sessile polyps were identified close to it. A local resection-anastomosis was done and the histopathology revealed the lesions to be centered in the submucosa with vascular and fibroblastic proliferation with a polymorphic inflammatory response dominated by eosinophils. A histopathologicaldiagnosis of inflammatory fibroid polyp with myofibroblastic proliferation was offered. She was subsequently re-admitted in 2006 with small bowel obstruction, not responding to conservative management. Exploratory laparotomy revealed multiple distal ileal polyps causing intussusception. Again a small bowel resection was done. The histopathology was identical to the first surgical specimen. Her third surgery was for a similar clinical picture in 2012, where a large polypoidal lesion was identified in the proximal ileum with multiplesubmucosal nodules adjacent to it (Figure 1A). Also noted were subserosalnodules alongthe length of proximal small bowel. A local resection of the involved segment was one. Histopathology showed similar picture in all the polyps. They were composed of loose connective tissue, containing bland spindle cells with variably inflamed stroma. Perivascular orientation of tumor cells was noted (Figures 1C and 1D).Immunohistochemistry (Figures 1E and 1F) was positivefor CD34and negative for C-Kit, DOG-1, desmin, SMA, S-100 and HMB-45. This confirmed the diagnosis of IFP. The patient recovered without sequelae and is under follow-up at  present.



Family history revealed that the patient’s father was also operated thrice for obstruction due to polyps, the last surgery being in 2002. Only the last histopathology report was available and it suggested an IFP. However no immunohistochemistry was done for confirmation.

Discussion

Intussusception is an uncommon cause of intestinal obstruction in adults and unlike in children, usually requires surgical treatment.[9]IFP is a rare, though well documented submucosal polypoidal lesion of the gastrointestinal tract, which was first described byVanek in 1949 as an eosinophilicsubmucosal granuloma. Helwig and Ranier in 1953 first labeled these lesions in the stomach as IFPs and the termeventuallygained acceptance for similar lesions throughoutthe gastrointestinal tract.1The commonest site is the gastricantrum (66-75%), followed by small bowel (18-20%), colorectum (4-7%), gallbladder(1%), esophagus (1%), duodenum (1%), and the appendix(<1%).The ileum is the commonest site where these polyps cause intussusception.[10]

The precise etiopathogenesis of IFPs remains unknown. Trauma, allergic reaction, genetic predisposition,bacterial, physical, chemical and even metabolic stimulihave been suggested as initiators of the process.[11] Differential histopathologicaldiagnoses includesmesenchymaltumors of the gastrointestinal tract suchas inflammatory fibrosarcoma, spindle-cell carcinoids, inflammatory myofibroblastictumorsand gastrointestinal stromal tumors (GISTs).[12]A definitive immunohistochemistry profile for the diagnosis of IFPs was devised in 2004. These tumors stain positive for CD34, vimentin and cyclin D1 but are negative for smooth muscle markers (fascin), neural markers (S100) and GIST markers (CD117, DOG1).[13] A recent publication has shown aplatelet derived growth factor receptor alpha (PGDRFA) gene mutation. The authors have suggested that these lesions may actually be benign tumors rather than inflammatory polyps.[14]Multiple, recurrent inflammatory fibroid polyps of the small intestine have been reported only in the Devon family, in whom the lesions appeared in three successive generations (Devon polyposis syndrome).5Literature search revealed only solitary IFPs in other case reports. Our patient underwent surgical resection thrice over a 10 year period and multiple inflammatory polyps were documented during each operation. Her immunohistochemistry corroborated the diagnosis of IFP.She also had a family history of similar disease reported as IFP, making this the second report in literaturesuggestive of a genetic predisposition.

References
  1. Vanek J. Gastric submucosal granuloma with eosinophilic infiltration. Am J Pathol. 1949;25:397–411.
  2. Morales-Fuentes GA, de Arino-Suarez M, Zarate-Osorno A, Rodriguez-Jerkov J, Terrazas-Espitia F, Perez-Manauta J. Vanek’s polyp or inflammatory fibroid polyp. Case report and review of the literature. Cir Cir. 2011;79:242–5, 63–7.
  3. Kim YI, Kim WH. Inflammatory fibroid polyps of gastrointestinal tract. Evolution of histologic patterns.Am J ClinPathol. 1988;89:721–7.
  4. de la Plaza R, Picardo AL, Cuberes R, Jara A, Martinez-Penalver I, Villanueva MC, et al. Inflammatory fibroid polyps of the large intestine. Dig Dis Sci. 1999;44:1810–6.
  5. Wysocki AP, Taylor G, Windsor JA. Inflammatory fibroid polyps of the duodenum: a review of the literature. Dig Surg. 2007;24:162–8.
  6. Allibone RO, Nanson JK, Anthony PP. Multiple and recurrent inflammatory fibroid polyps in a Devon family (‘Devon polyposis syndrome’): an update. Gut. 1992;33:1004–5.
  7. Balmer F, Stucki P, Pedrinis E, Halter F. [Tumors and eosinophilic granuloma of the small intestine in malabsorption]. Schweiz Med Wochenschr. 1974;104:78–83.
  8. Mohamud SO, Motorwala SA, Daniel AR, Tworek JA,Shehab TM. Giant ileal inflammatory fibroid polyp causing small bowel obstruction: a case report and review of the literature. Cases J. 2008;1:341.
  9. Yalamarthi S, Smith RC. Adult intussusception: case reports and review of literature. Postgrad Med J. 2005;81:174–7.
  10. Nonose R, ValencianoJS, da Silva CM, de Souza CA, Martinez CA. Ileal Intussusception Caused by Vanek’s Tumor: A Case Report. Case Rep Gastroenterol. 2011;5:110–6.
  11. Akbulut S. Intussusception due to inflammatory fibroid polyp: a case report and comprehensive literature review. World J Gastroenterol. 2012;18:5745–52.
  12. Singhal M,Singh P, Misra V, Dhingra V, Bhatia R. Inflammatory fibroid polyp ofsmall intestine: report of two caseswith review of literature. JCDR.2010;4:3241–4.
  13. Santos Gda C, Alves VA, Wakamatsu A,Zucoloto S. Inflammatory fibroid polyp: an immunohistochemical study. ArqGastroenterol. 2004;41:104–7.
  14. Schildhaus HU, Cavlar T, Binot E, Buttner R, Wardelmann E,Merkelbach-Bruse S. Inflammatory fibroid polyps harbour mutations in the platelet-derived growth factor receptor alpha (PDGFRA) gene. J Pathol. 2008;216:176–82.