[A giant inflammatory fibroid polyp of the esophagus]. / A nyelocso óriás inflammatorikus fibroid polipja.

Inflammatory fibroid polyp (IFP) is an uncommon benign tumor of the gastrointestinal tract. IFP in the esophagus is very rare, in particular in giant size. A case of a 63 year old woman with a 13 × 7 × 4.5 cm polyp originated of the lower third of the oesophagus is presented. Her esophageal polyp extended proximally from the level of the tracheal bifurcation, prolapsing through the cardia as well as the herniated stomach, and entered distally into the abdominal part of the stomach. Resection of the polyp was performed via a right oesophago-gastrotomy. Histology verified inflammatory fibroid polyp of the esophagus. An overview of clinical features of the inflammatory fibroid polyp is presented in connection of our case report.

Vanek's Tumour as a Rare Cause of Dyspeptic Syndrome in a Patient with Primary Biliary Cholangitis: A Case Report.

BACKGROUND: Inflammatory Fibroid Polyp (IFP), also known as Vanek's tumour, is a rare mesenchymal gastrointestinal tumour, potentially causing a wide range of clinical manifestations (even though it can be completely asymptomatic) primarily related to the location of the formation. The available evidence suggests a fundamentally non-neoplastic behaviour of IFP. CASE PRESENTATION: A 67-year-old female was presented with persistent dyspepsia despite symptomatic therapy. The patient's medical history included primary biliary cholangitis, managed with ursodeoxycholic acid, non-haemorrhagic uterine fibroids, and right knee arthrosis. Clinical examination revealed mild epigastric tenderness, and esophagogastroduodenoscopy identified a sessile mucosal formation. Histological analysis of biopsy samples revealed a gastric hyperplastic polyp, leading to a subsequent esophagogastroduodenoscopy for polypectomy. The excised specimen confirmed the diagnosis of gastric IFP. Post-polypectomy, the patient experienced progressive symptom amelioration, leading to complete resolution within three weeks. DISCUSSION: This case thus describes a rare cause of dyspeptic syndrome associated with the presence of a gastric IFP, promptly managed and resolved after endoscopic removal of the polyp, with no histological signs of neoplasia within the en bloc resected sample. CONCLUSION: IFP is a possible and rare cause of dyspeptic syndrome. There remain significant challenges in diagnosing this rare condition, which lacks pathognomonic or specific signs and symptoms of its presence (especially when it causes symptoms). Endoscopy, when feasible, remains a cornerstone in the resective management of such lesions.

[Small bowel intussusception and Vanek's tumor in an elderly woman]. / Intususcepción intestinal por pólipo fibroide inflamatorio en una anciana.

Inflammatory fibroid polyps are non-frequent benign lesions, described by Vanek in 1949, originated in the sub mucosa of the gastrointestinal tract. They have an uncertain origin and they are formed of fibroblastic and mesenchymal proliferations with an important eosinophilic proportion. Depending on where are they localized, could present different type of symptoms. The inflammatory fibroid polyps are one of the rare benign conditions causing intestinal intussusception in adults. We present the case of a 82 years old woman, who presented an intestinal intussusception due to an inflammatory fibroid polyp localized in the small bowel.

A rare case of jejunal Vanek's tumor causing intussusception in an adult: a case report and comprehensive literature overview.

Inflammatory fibroid polyp, or Vanek's tumor, is an uncommon benign small bowel tumor and a rare cause of intussusception in adults. This case involves a 62-year-old man with persistent abdominal pain, diagnosed with jejunoileal intussusception. A 4 cm inflammatory fibroid polyp was discovered during surgery, leading to distal jejunal resection. Despite the rarity of adult intussusceptions, they should be considered in abdominal pain diagnoses. The optimal management approach, whether en bloc resection or initial reduction with limited resection, remains debated.

Intussusception in an adult revealing a Vanek's tumor: A case report.

INTRODUCTION AND IMPORTANCE: Inflammatory fibroid tumors (IFT) or Vanek's tumors are scarce benign neoplasms. They can affect any part of the digestive tract. They are underdiagnosed conditions that are generally revealed by a life-threatening complication such as intussusception. The final diagnosis is set on the resection specimen after curative surgery. CASE PRESENTATION: A 35-year-old patient presented with an acute small bowel occlusion related with an ileo-ileal intussusception revealed by an emergency CT-scan. The etiology of the occlusion wasn't clear but we suspected a complicated malignant tumor of the small bowel. Therefore, an emergency surgery was performed and we resected the tumor with margins. The diagnosis of Vanek's tumor was set at the pathology examination. DISCUSSION: Inflammatory fibroid tumors are mesenchymal tumors with no malignant potential. However, they can be revealed by a dangerous complication leading to an emergency surgery. Complete resection is required and pathology examination set the diagnosis. CONCLUSION: Surgeons should include IFT among the several differential diagnosis of ileal intussusception of the adults as it mimics other small bowel tumors. Only pathology examination can set the diagnosis.

Ileocolic Intussusception in an Adult Due to Inflammatory Fibroid Polyp: A Case Report.

The ileocolic region is the most common site of intussusception. It occurs mostly in children but can also occur in adults. Ileal tumors and polyps can cause ileocolic intussusception. Inflammatory fibroid polyp (IFP) is one of the rarest benign tumors of the gastrointestinal tract. The most common sites of IFP are the stomach, ileum, colon, duodenum, and esophagus. Small IFPs can be managed endoscopically but larger IFPs and those with complications such as intussusception require surgical resection. We report a case of ileal IFP presenting with small bowel obstruction due to ileocolic intussusception. The patient was successfully treated by surgical excision. The diagnosis of IFP was made based on a histopathological examination of the resected specimen.

Inflammatory Fibroid Polyp: An Unusual Cause of Abdominal Pain in the Upper Gastrointestinal Tract a Case Report.

Inflammatory fibroid polyps (IFPs) tend to occur in the gastrointestinal tract, and they are rare and benign neoplasms. In general, IFPs often come from epithelial tissue. The gastric antrum is the most common location. Endoscopic ultrasound (EUS) often shows a predominantly hypoechoic mass with well-defined borders originating from the submucosal area. Here, we report the case of a 46-year-old woman with abdominal pain who underwent computed tomography (CT), endoscopic ultrasound and endoscopic submucosal dissection (ESD) of resected specimens; the diagnosis was ultimately an inflammatory fibroid polyp. She is currently in clinical remission.

Management of complicated inflammatory fibroid polyp by partial laparoscopic esophagogastrectomy - A case report.

BACKGROUND: Inflammatory fibroid polyps (IFP), known as Vanek tumors, are benign neoplasms, usually located in the stomach and small bowel. The prognosis is good in long term. CLINICAL CASE: We report a 24-year-old woman, with 3 days history of abdominal pain located in the epigastrium, accompanied by melenic evacuations and weight loss since the last month, making the diagnosis of inflammatory fibroid gastric polyp by means of the upper endoscopy and biopsy. CONCLUSIONS: IFP are extremely rare neoplasms in the Mexican population. The symptoms range from asymptomatic, epigastralgia, anemia, and weight loss to intestinal obstruction. Its diagnosis is histopathological.

ANTECEDENTES: Los pólipos inflamatorios fibroideos, conocidos como tumores de Vanek, son neoplasias benignas localizadas en el antro gástrico y en el intestino delgado. El pronóstico es bueno a largo plazo. CASO CLÍNICO: Mujer de 24 años, ingre sada por 3 días de evolución con epigastralgia, acompañada de evacuaciones melénicas y pérdida de peso de 2 kg en el último mes. Se diagnostica, por endoscopía y biopsia, un pólipo inflamatorio fibroideo gástrico. CONCLUSIONES: Los pólipos inflamatorios fibroideos gástricos son neoplasias extremadamente raras en la población mexicana. Sus síntomas varían desde cuadros asintomáticos, epigastralgias, anemia y pérdida de peso hasta obstrucción intestinal. Su diagnóstico es histopatológico.

Gastric Inflammatory Fibroid Polyp: A Rare Cause of Occult Upper Gastrointestinal Bleeding.

Inflammatory fibroid polyps (IFPs) are rare mesenchymal lesions that can arise throughout the gastrointestinal tract. These tumors represent less than 0.1% of all gastric polypoid lesions and are frequently found incidentally on endoscopic evaluation. While presenting symptoms depend on the location of the tumor, gastric polyps commonly present with epigastric pain and early satiety. We hereby delineate the case of a middle-aged female who presented with chronic iron deficiency anemia and a positive fecal occult blood test. She underwent an upper endoscopy, which revealed an actively oozing umbilicated lesion in the gastric antrum. Endoscopic ultrasound divulged the submucosal origin of the lesion. It was subsequently excised using endoscopic mucosal resection. Pathologic examination of the resected specimen confirmed the diagnosis of gastric IFP. Furthermore, we conducted a systematic literature search of the MEDLINE database centered on gastric IFPs from January 2000 till March 2020. The data on patient demographics, clinical features, endoscopic findings, lesion site and size, and treatment approaches were collected and analyzed. This article illustrates the overarching need for clinicians to be vigilant of gastric IFPs presenting with initial clinical symptoms suggestive of occult upper gastrointestinal bleeding. Prompt diagnosis and management of gastric IFPs carry paramount importance to combat chronic unexplained iron deficiency anemia following occult bleeding in such patients. A concoction of endoscopy, biopsy, and immunohistochemical examination can be employed toward their prompt detection. Although gastric IFPs have conventionally been treated with surgery, endoscopic resection is now emerging as a safe and efficient therapeutic modality.

Bowel intussusception in adults: a report of three interesting cases and current trends for diagnosis and surgical management.

BACKGROUND: Bowel intussusception in adults remains a rare and constant diagnostic challenge for surgeons. It has an incidence of around 2-3 new cases per million per year, and its primary cause is benign or malignant neoplasms of the small bowel and colon. This report aims to outline the importance of high clinical suspicion regarding intussusception in adults presenting with abdominal pain in the emergency department.  Case report: This is a retrospective review of three cases of adult ileocecal intussusception that were treated in a single surgical department in three years (2015-2018). All patients underwent right hemicolectomy in keeping with the principles of surgical oncology. Each patient had a different clinical presentation, while, in terms of the underlining pathology, the first had an adenocarcinoma of the ascending colon, the second an adenocarcinoma of the ileocecal valve, and the third one an inflammatory fibroid polyp of the ileocecal valve, also known as Vanek's tumor. CONCLUSION: Large bowel intussusception in adults is quite an interesting entity, not only for its rarity but for its non-specific and atypical clinical presentation as well. High suspicion from the clinician's part and availability of a computed tomography scan is the key to diagnosis. It is not unusual for imaging modalities to be unable to identify the cause of the intussusception. Thus, surgery is always the preferred method of treatment, as, more often than not, a neoplasm of the small or the large bowel is the underlining pathology.  HIPPOKRATIA 2019, 23(1): 37-41.

Vanek's tumor as an unusual cause of ileo-ileal intessuception - A unique case report.

BACKGROUND AND AIM: Vanek's tumor is a rare solitary lesion that is non-neoplastic, and arises from the submucosa of the gut. The most commonly affected sites are the stomach and the ileum [1]. IFP causing intestinal obstruction is uncommon and that ileo-ileal intussusception has been reported in the literature rarely. We present a case of an ileo-ileal intessuception in a patient who presented with acute on chronic pain abdomen and anorexia. CT abdomen & pelvis revealed a 46 × 36 mm intraluminal mass in the left iliac fossa causing ileo-ileal intussusception. CASE PRESENTATION: A 60 years old gentleman was brought to the A&E with a history of intestinal obstruction. He was examined and admitted to the surgical unit. CBC revealed unique feature of reactive thrombocytosis apart from a low hemoglobin and a raised TLC. His CT scan demonstrated findings of ileo-ileal intussusception. After an informed written consent, patient underwent an exploratory laparotomy and had resection and anastomosis of the bowel. Histopathology of the specimen revealed findings compatible with IFP. Patient made an uneventful recovery post-operatively and was sent home in the next few days. On follow-up, the patient was doing well and had no complaints of abdominal pain or anorexia. CONCLUSION: Vanek's tumor although a rare entity, should be considered in each case of acute abdomen and physicians and surgeons need to have a high degree of suspicion in such cases. Moreover, IFP can cause reactive thrombocytosis that gets resolved after a post-operative period of 6-8 weeks.

Gastric inflammatory fibroid polyp tumor with acute intestinal obstruction-Vanek's tumor can mimick a giant gastrointestinal stromal tumor or a gastric lymphoma.

An inflammatory fibroid polyp (IFP) is a solitary rare benign neoplasm of the gastrointestinal tract, frequently located in the gastric antrum. IFPs account for about 0.1% of all gastric polyps. We report a case of a giant gastric inflammatory polyp of 2.5 cm × 7 cm that determines a gastric outlet obstruction called "ball valve syndrome" mimicking a gastrointestinal stromal tumor (GIST) and a gastric lymphoma, with an intestinal obstruction of high origin. Therefore, due to acute presentation we have decided to submit the patient to a subtotal gastrectomy. The patient was discharged two weeks later, asymptomatic. At 14 months of follow-up, patient is disease free at abdominal CT and OGDS. Depending on their size and location, IFPs can be associated with unspecific symptoms. Giant IFPs of the gastric antrum or the duodenum can determine an intermittent gastric outlet obstruction called "ball valve syndrome". Endoscopic biopsies are unhelpful and right diagnosis can be reached only with resection. In fact, only about 10% of the gastric lesions are diagnosed correctly prior to resection. Surgical treatment with complete resection with safe margins is curative. Giant IFPs are rare benign lesions whose atypical presentation can mimic GISTs, lymphomas or carcinomas. Clinical and radiological findings may not clarify the right diagnosis until histopathological evaluation aided with immunohistochemical analysis. The resection of IFPs with negative margins is curative with a good clinical outcome. In acute presentation, like in our case, surgery is the mainstay of treatment.

Inflammatory fibroid polyp of the gastric antrum presenting as hypovolemic shock: Case report and literature review.

Inflammatory fibroid polyps (IFP) are an extremely rare entity that arise within the submucosa of the gastrointestinal tract, and represent less than 0.1% of all gastric polyps. They are most commonly localized to the gastric antrum, small intestines and recto-sigmoid colon. IFPs are most commonly found incidentally upon endoscopic evaluation in the absence of symptoms. Presenting symptoms depend on the location of the tumor, although polyps located in the stomach most commonly present with epigastric pain and early satiety. Classic histologic features include perivascular onion skinning of spindle cells with an abundance of eosinophilic infiltration. The prompt diagnosis and management of IFP is essential due to its underlying risk for intussusception, outlet obstruction and acute hemorrhage. In addition, recent evidence has shown that IFP is driven by an activating mutation in the platelet derived growth factor receptor alpha (PDGFRA) gene, suggesting a neoplastic etiology. Herein, we discuss a case of a 65-year-old woman with an inflammatory fibroid polyp of the gastric antrum who initially presented with early hypovolemic shock and melena. Diagnosis was made by endoscopic visualization, biopsy and immunohistochemical analysis.

Large inflammatory fibroid polyp of cardia managed laparoscopically - a case report and review of the literature.

Inflammatory fibroid polyp or Vanek's tumor of the gastrointestinal tract is a rare, benign neoplasm. The lesion may occur at any age but is commonest in the sixth and seventh decades and is more often found in women. It is mostly situated in the stomach, especially in the antrum. Symptoms depend on the location and the size of the lesion. We present a case of a 67-year-old woman with a large inflammatory polyp of the cardia with a diameter of 10 cm × 5.5 cm × 7.5 cm imitating gastrointestinal stromal tumor (GIST). The patient complained of abdominal pain, nausea and mild anemia. We performed laparoscopic topical excision of the tumor. The postoperative course was uneventful. The 6-month follow-up did not reveal recurrence. The clinical image of a large Vanek's tumor can imitate symptoms of gastric cancer or GIST. Topical laparoscopic excision with a 1-2 cm healthy wall margin is a sufficient and adequate way of treatment.

Estrogen and androgen receptors in inflammatory fibroid polyp (Vanek's tumor): case report.

BACKGROUND/AIM: Vanek's tumor is an inflammatory fibroid polyp (IFP) of very low incidence, which originates in the submucosa of the stomach, duodenum, jejunum and ileum. The etiology of this tumor is still unknown. Histologically, IFP is characterized by submucosal spindle cell proliferation in fibromyxoid stroma with inflammatory infiltrate. The aim of the present study was to investigate the presence of estrogen and androgen receptors in IFP and compare it with its proliferative loci. PATIENTS AND METHODS: The study analyzed a 79-year-old patient suffering from IFP. Analyses were performed by immunohistochemistry. RESULTS: Androgen-positive spindle cells were detected at the periphery of onion skin-like formations. Estrogen receptor-positive cells were not detected and Ki67 showed low proliferative activity. CONCLUSION: This case report shows for the first time the presence of androgen receptor-positive cells whose location corresponds with the distribution of Ki67-positive cells in IFP.

Intussusception due to inflammatory fibroid polyp: a case report and comprehensive literature review.

AIM: To give an overview of the literature on intussusception due to inflammatory fibroid polyp (IFP). METHODS: We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP, accessed via PubMed and Google Scholar databases. For the search, the keywords used were: intussusception, IFP, intussusception and IFP, intussusception due to IFP, and IFP presenting as intussusception. The search covered all articles from 1976 to November 2011. RESULTS: We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain, vomiting, and nausea. Ultrasonography demonstrated small bowel intussusception. An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy. Partial ileal resection and anastomosis were performed. A diagnosis of ileal IFP was made based on the immunohistochemical findings. In addition, a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review. The patients were aged 4 to 81 years (mean, 49 ±â€…16.2 years); 44 were women (mean, 51.8 ±â€…14.3 years) and 41 were men (mean, 46 ±â€…17.5 years). According to the location of the IFP, ileal intussusception was found in 63 patients, while 17 had jejunal, three had colonic, and two had ileojejunal intussusception. CONCLUSION: Although IFPs are rare and benign, surgery is the only solution in case of intestinal obstruction. Differential diagnosis should be made via immunohistochemical examination.

Intususcepción intestinal debido a un pólipo fibroide inflamatorio (tumor de vanek) / Intestinal intussusception due to an inflammatory fibroid polyp (vanek tumor)

La intususcepción en un adulto debe hacer sospechar un tumor (benigno o potencialmente riesgoso); el diagnóstico certero es crucial para el tratamiento adecuado del paciente1. Alrededor del 90% de estos casos se dan en el intestino delgado y colon, el 10% restante se originan en el estómago y en estomas creados quirúrgicamente2. En los adultos, aproximadamente 90% de los casos de intususcepción son secundarios a una lesión definible3. El tumor de Vanek o pólipo fibroide inflamatorio, se conoce como una lesión benigna, rara, de localización submucosa, no encapsulada, cuya ubicación puede darse a lo largo del tracto digestivo, siendo más común en el antro gástrico (80 %), aunque también se ha descrito en la unión gastroesofágica, duodeno, yeyuno, íleon y colon4.

Intussusception in an adult must make us suspect the presence of a tumor (benign or potentially dangerous) as the most frequent cause. Accurate diagnosis is of great importance in order to provide appropriate treatment and improve patient prognosis1. About 90% of these cases occur in the small intestine and colon, and the remaining 10% originate in the stomach and surgically created ostomas2. In adults, approximately 90% of cases of intussusception are secondary to a definable lesión3. The Vanek's tumor or inflammatory fibroid polyp (IFP) is a rare benign lesion of submucosal location, not encapsulated, that may be located throughout the digestive tract, being more common in the gastric antrum (80%), although it has also been described in the gastroesophageal junction, duodenum, jejunum, ileum and colon4.

Intususcepción intestinal debido a un pólipo fibroide inflamatorio (tumor de vanek) / Intestinal intussusception due to an inflammatory fibroid polyp (tumor vanek)

Presentamos el caso de un hombre de 58 años, quien consultó por cuadro de dolor abdominal de tres meses de evolución. En un periodo de 8 días previo a dicha consulta el dolor se intensificó y asoció vómitos incontables de contenido biliar y fecaloides. Se manejó como un abdomen agudo y se le realizó una laparotomía exploratoria, en la cual se evidenció una masa en yeyuno, con obstrucción distal completa e intosuscepción. El análisis histopatológico de la lesión confirmó un pólipo fibroide inflamatorio (Tumor de Vanek) del yeyuno. En este artículo se discuten las características clínicas e histopatológicas.

We report the case of a man aged 58, who consulted for abdominal pain of three months duration. In a period of 8 days prior to such consultation pain intensified and countless associated vomiting bile and fecaloid content. Was handled as an acute abdomen and was made an exploratory laparotomy, in which a jejunal mass with complete distal obstruction and intosuscepción evidenced. Histological examination of the lesion confirmed an inflammatory fibroid polyp (Vanek tumor) of the jejunum. In this article, the clinical and histopathologic features are discussed.