Gastrointestinal kanalda inflamatuvar fibroid polip: Tek merkeze ait 10 yıllık deneyimin değerlendirilmesi

Yıl 2022, Cilt: 21 Sayı: 1, 21 - 27, 26.04.2022

Funda Canaz Evrim Yılmaz Deniz Arık Erkin Öztaş Adnan Şahin

https://doi.org/10.17941/agd.1105857

Öz

Giriş ve Amaç: İnflamatuvar fibroid polip gastrointestinal kanalda nadir gelişen benign bir lezyondur. Çalışmamızda 10 yılda hastanemizde gastrointestinal kanalda bildirilen inflamatuvar fibroid polip olgularının klinik, morfolojik ve immünohistokimyasal özelliklerini tartışmayı amaçladık. Gereç ve Yöntem: Bu çalışmada 22 inflamatuvar fibroid polip olgusu klinik, morfolojik ve immünohistokimyasal özellikleri ile sunulmuştur. Olguların yaşı, cinsiyeti, inflamatuvar fibroid polip için uygulanan tedavi şekli, tümörün çapı, lokalizasyonu ve morfolojik özellikleri ile immünohistokimyasal boya sonuçları kaydedilmiştir. Bulgular: Olguların 19’u (%86.4) kadın, 3’ü (%13.6) erkekti. Olguların yaşları 44 - 74 arasında değişmekte olup, ortalama yaş 60 ± 6.9 yıldı. Lezyon boyutları 0.7 - 5.5 cm arasında değişmekte olup, ortalama 1.9 cm idi. İnflamatuvar fibroid polip en sık mide (n: 13) lokalizasyonunda idi, bunu ince barsak (n: 8) ve kolon (n: 1) takip etmekteydi. Olguların tümünde tipik morfolojik özellikler olan ince ve kalın duvarlı damarların eşlik ettiği iğsi hücre proliferasyonu ve eozinofil infiltrasyonu izlendi. Vimentin tüm olgularda diffüz pozitif bulundu. 21 olguda CD34, 3 olguda düz kas aktin pozitifti. 4 olguda östrojen reseptörü fokal boyanma, 1 olguda progesteron reseptörü fokal boyanma gösterdi. Olguların tümünde S100, desmin, CD117, androjen reseptör negatifti. Sonuç: İnflamatuvar fibroid polip submukozada lokalize olup sıklıkla mukozaya ilerleyebilmektedir. Regüler vasküler patern, iğsi hücre proliferasyonu, eozinofilik infiltrasyon tipik morfolojik bulgularıdır. Gastrointestinal kanalda iğsi hücreli tümörlerin ayırıcı tanısında inflamatuvar fibroid polip yer almalıdır. Klasik mikroskopik görünümü dışında morfolojik bulgular gözlendiğinde ayırıcı tanının zor olabileceği akılda tutulmalı ve tanının immünohistokimyasal belirteçlerle desteklenmesi gerektiği unutulmamalıdır.

Anahtar Kelimeler

İnflamatuvar fibroid polip, gastrointestinal kanal, histopatoloji

Inflammatory fibroid polyp of the gastrointestinal tract: An evaluation of 10 years of experience at a single center

Öz

Background and Aims: Inflammatory fibroid polyp is a rare benign lesion in the gastrointestinal tract. This study aimed to discuss the clinical, morphological, and immunohistochemical features of inflammatory fibroid polyp in the gastrointestinal tract that were reported at our hospital over 10 years. Materials and Method: This study presents 22 cases of inflammatory fibroid polyp with their clinical, morphological, and immunohistochemical features. Age, gender, inflammatory fibroid polyp treatment method, tumor diameter, localization, morphological features, and immunohistochemical staining results were recorded. Results: Of the cases, 19 (86.4%) were women and 3 (13.6%) were men, with ages 44–74 years (mean age, 60 ± 6.9 years). The lesion sizes were 0.7–5.5 cm (mean size, 1.9 cm). Inflammatory fibroid polyp was most common in the stomach (n: 13), followed by the small intestine (n: 8) and colon (n: 1). Spindle cell proliferation and eosinophil infiltration accompanied by thin- and thick-walled vessels were observed in all cases. Vimentin was diffusely positive in all cases. CD34 was positive in 21 cases, and smooth muscle actin was positive in 3 cases. Estrogen receptor focal staining was performed in four cases and progesterone receptor focal staining in one case. S100, desmin, CD117, and androgen receptor were negative in all cases. Conclusions: Inflammatory fibroid polyp is localized in the submucosa, which often extends into the mucosa. Regular vascular pattern, spindle cell proliferation, and eosinophilic infiltration are typical morphological findings. Inflammatory fibroid polyp should be included in the differential diagnosis of spindle cell tumors in the gastrointestinal tract. With morphological findings other than its classical microscopic appearance, differential diagnoses should be acknowledged as difficult and diagnosis should be supported by immunohistochemical markers.

Anahtar Kelimeler

Inflammatory fibroid polyp, gastrointestinal tract, histopathology

Kaynakça

• 1- Ivanis N, Tomas V, Vranic L, et al. Inflammatory fibroid polyp of the small intestine: a case report and systematic literature review. J Gastrointestin Liver Dis 2020;29:455-60.
• 2- Romano-Munive AF, Barreto-Zuñiga R, Rumoroso-García JA, Ramos-Martínez P. Inflammatory fibroid polyp of the gastrointestinal tract: 10 years of experinece at the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Rev Gastroenterol Mex 2016;81:134-40.
• 3- Ricci R, Giustiniani MC, Gessi M, et al. Telocytes are the physilogical counterpart of inflammatory fibroid polyps and PDGFRA- mutant GIST. J Cell Mol Med 2018;22:4856-62.
• 4- Ozolek JA, Sasatomi E, Swalsky PA, et al. Inflammatory fibroid polyps of the gastrointestinal tract clinical, pathologic and molecular characteristics. Appl Immunohistochem Mol Morphol 2004;12:59-66.
• 5- Kolodziejczyk P, Yao T, Tsuneyoshi M. Inflammatory fibroid polyp of the stomach a special reference to an immunohistochemical profile of the 42 cases. Am J Surg Pathol 1993;17:1159-68.
• 6- Navas-Palacios JJ, Colina-Ruizdelgado F, Sanchez-Larrea MD, Cortes-Cansino J. Inflammatory fibroid polyps of the gastrointestinal tract. An immunohistochemical and electron microscopic study. Cancer 1983;51:1682-90.
• 7- Daum O, Hes O, Vanecek T, et al. Vanek's tumor (inflammatory fibroid polyp). Report of 18 cases and comparison with three cases of original Vanek's series. Ann Diagn Pathol 2003;7:337-47.
• 8- Liu TC, Lin MT, Montgomery EA, Singhi AD. Inflammatory fibroid polyps of the gastrointestinal tract: spectrum of clinical, morphologic, and immunohistochemistry features. Am J Surg Pathol 2013;37:586-92.
• 9- Kim YI, Kim WH. Inflammatory fibroid polyps of gastrointestinal tract. Evolution of histologic patterns. Am J Clin Pathol 1988;89:721-7.
• 10- Pantanowitz L, Antonioli DA, Pinkus GS, et al. Inflammatory fibroid polyps of the gastrointestinal tract: evidence for a dendritic cell origin. Am J Surg Pathol 2004;28:107-14.
• 11- Wysocki AP, Taylor G, Windsor JA. Inflammatory fibroid polyps of the duodenum: a review of the literature. Dig Surg 2007;24:162-8.
• 12- Vanek J. Gastric submucosal granuloma with eosinophilic infiltration. Am J Pathol 1949;25:397-412.
• 13- Ishikura H, Sato F, Naka A, et al. Inflammatory fibroid polyp of the stomach. Acta Pathol Jpn 1986;36:327-35.
• 14- Radulović P, Fučić A, MijićA , Krušlin B. Estrogen receptor positive cells in gastric and duodenal ulcer: a pilot study. Acta Clin Croat 2012;51:169-88.
• 15- Jukic Z, Ferencic Z, Radulovic P, et al. Estrogen and androgen receptors in inflammatory fibroid polyp (Vanek’s Tumor): Case report. Anticancer Research 2014;34:7203-6.
• 16- Turner Jr, Odze RD. Polyps of the Stomach. In: Odze RD, Goldblum JR, Editors. Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas. 2nd ed. Philadelphia. Saunders Elsevier 2009:439-42.
• 17- Shi H, Wei L, Sun L, Guo A. Primary gastric inflammatory myofibroblastic tumor: A clinicopathologic and immunohistochemical study of 5 cases. Pathol Res Pract 2010;206:287-91.
• 18- Rossi P, Montuori M, Balassone V, et al. Inflammatory fibroid polyp. A case report and review of the literatüre. Ann Ital Chir 2012;83:347-51.
• 19- Pradhan D, Schoedel K, McGough RL, et al. Pseudomyogenic hemangioendothelioma of skin, bone and soft tissue a clinicopathological, immunohistochemical, and fluorescence in situ hybridization study. Hum Pathol 2018;71:126-34.
• 20- Makhlouf HR, Sobin LH. Inflammatory myofibroblastic tumors (Inflammatory pseudotumors) of the gastrointestinal tract: How closely are they related to inflammatory fibroid polyps? Hum Pathol 2002;33:307-15.