An Inflammatory Fibroid Polyp in the Hepatic Flexure of the Colon Treated with Argon Plasma Coagulation, Endoscopic Clipping and Polypectomy

Abstract

Inflammatory fibroid polyp (IFP) is a rare benign polypoid lesion of the gastrointestinal tract. Most IFPs occur in the stomach and colonic occurrence is very rare. Histologically IFP is characterized by a mixture of numerous small vessels, fibroblasts and edematous connective tissue associated with marked inflammatory infiltration by eosinophils. We present a rare case of a pedunculated IFP in the hepatic flexure of the colon treated successfully with a combination of argon plasma coagulation, endoclipping and polypectomy. A 74-year-old asymptomatic female underwent a screening colonoscopy in our hospital. A 12-mm pedunculated polyp was found at the hepatic flexure of the colon. After saline injection, we attempted to remove the polyp with a hot snare. However the polyp stalk was extremely difficult to resect despite several attempts with the hot snare. We placed an endoclip at the base of the stalk and then applied argon plasma coagulation at 1.0 l/min and 40 W. After these measures we were able to resect the stalk and the polyp was retrieved. Histologically the polyp was located in the submucosa of the gastrointestinal tract. Proliferation of spindle cells and infiltration of inflammatory cells such as plasma cells and eosinophils were observed. The spindle cells were positive for CD34 and S100 but negative for c-kit and muscle markers. These findings are consistent with a histopathological diagnosis of IFP.

Inflammatory fibroid polyp (Vanek's tumour) of the ileum causing ileocolic intussusception

“…IFPs can arise from any part of the gastrointestinal tract, but gastric antrum is the commonest site, accounting for 70% of the cases followed by small intestine in 20%. It rarely affects the oesophagus and colorectum [3]. There are cases of IFP affecting gallbladder reported as well [1].…”

“…Even though endoscopic resection is a justifiable treatment approach due to the benign nature of IFP, use of therapeutic endoscopy for IFP is rare due to the size of the lesion, failure of preoperative confirmation of the diagnosis, and the urgency of symptoms [3].…”

“…Microscopically the IFP comprises of numerous small vessels, fibroblasts in an oedematous stroma, infiltrated by inflammatory cells mainly eosinophils and plasma cells [3]. The fibroblasts are arranged in a concentric "onion-skin" pattern centered on blood vessels giving rise to frequently seen whorled appearance.…”

“…Positivity to CD35 and Fascin has been presented as evidence of dendritic cell origin. Negativity to CD117, Bcl-2 and c-kit differentiate IFPs from Gastrointestinal Stromal Tumours (GIST) [3].…”

Colon Polyps and the Prevention of Colorectal Cancer

“…Although it is believed to be a localized pattern of eosinophilic gastroenteritis, its etiology remains unknown [ 261 ].…”