İnflamatuar fibroid poliplerin histopatolojik özellikleri ve kanser gelişme riski: bir vaka serisi

Öz

Amaç: İnflamatuar fibroid polip (IFP) gastrointestinal sistemde görülür. Çoğu vakada PDGFRA geninde somatik mutasyonlar gözlenmiş ve bu antitenin gerçek neoplastik kökeni anlaşılmıştır. Benign mezenkimal bir tümördür ve nadiren tekrarlar. Çalışmanın amacı, IFP olgularımızın histopatolojik özelliklerini ortaya koymak ve kanser riskini araştırmaktır. Gereç ve yöntem: 2012-2022 yılları arasında IFP olarak bildirilen hastaların (n=12) retrospektif klinikopatolojik analizini gerçekleştirdik. Olguların formaline fikse, parafine gömülü ve hematoksilen-eozin (H&E) boyalı preparatları iki patolog tarafından mikroskobik olarak yeniden incelendi. Bulgular: Tüm hastalar yetişkin olup yaşları 30 ile 85 arasında değişmekteydi. Erkek/kadın oranı 1:2 idi. Bir polip ince bağırsakta, biri kolonda ve diğerleri midede lokalizeydi. Histolojik olarak, IFP'lere eşlik eden hiperplastik epitelyal değişiklikler (7/12), düşük dereceli (3/12) ve yüksek dereceli displazi (1/12) görüldü. Bir vakada ise erken gastrik adenokarsinom gelişmişti. Sonuç: IFP benign bir mezenkimal tümör gibi görünsede, bu lezyona displazi ve nadiren karsinomun eşlik edebileceği akılda tutulmalıdır. IFP ile ilişkili displazi ve karsinom gelişim mekanizmalarını aydınlatmak için daha geniş vaka serilerine ihtiyaç vardır.

Anahtar Kelimeler

• İnflamatuar fibroid polip
• gastrointestinal
• displazi
• karsinom
• histopatoloji

Histopathologic features of inflammatory fibroid polyps and risk of cancer development: a case series

Öz

Purpose: Inflammatory fibroid polyp (IFP) is seen in the gastrointestinal tract. In most cases, somatic mutations in PDGFRA gene were observed and the true neoplastic origin of this entity was understood. It is a benign mesenchymal tumor and rarely recurs. The aim of the study was to reveal the histopathologic features of our IFP cases and to investigate the risk of cancer in one case. Materials and methods: We performed a retrospective clinicopathological analysis of patients (n=12) who were reported as IFP between 2012 and 2022. Formalin-fixed, paraffin-embedded and hematoxylin-eosin (H&E)- stained slides of the cases were re-examined by two pathologists microscopically. Results: All patients were adults and ranged in age from 30 to 85. Male to female ratio was 1:2. One polyp was localized in small intestine, one in colon, and the others in stomach. Histologically, there were hyperplastic epithelial changes (7/12), low-grade (3/12), and high-grade dysplasia (1/12) accompanying IFPs. One case was associated with early gastric adenocarcinoma. Discussion: Although IFP appears as a benign mesenchymal tumor, it should be kept in mind that dysplasia and rarely carcinoma may accompany this lesion. Larger case series are needed to elucidate the mechanisms of dysplasia and carcinoma development associated with IFP.

Anahtar Kelimeler

• Inflammatory fibroid polyp
• gastrointestinal
• dysplasia
• carcinoma
• histopathology

Kaynakça

1. 1. Garmpis N, Damaskos C, Garmpi A, et al. Inflammatory fibroid polyp of the gastrointestinal tract: A systematic review for a benign tumor. In Vivo (Brooklyn) 2021;35:81- 93. https://doi.org/10.21873/INVIVO.12235
2. 2. Vanek J. Gastric submucosal granuloma with eosinophilic infiltration. Am J Pathol 1949;25:397-411.
3. 3. Sy AM, Vo D, Friedel D, Grendell J, Hanna I. Incidental finding of inflammatory fibroid polyp of the appendix in a patient with acute appendicitis. Turkish J Gastroenterol 2020;31:831-834. https://doi. org/10.5152/TJG.2020.19730
4. 4. Calderon MG, Caivano VC, Bagnaresi S, et al. A unique case of inflammatory fibroid polyp in the duodenum of a female adolescent. Case report and literature review. Med (United States) 2017;96:6131. https://doi. org/10.1097/MD.0000000000006131
5. 5. Martini M, Santoro L, Familiari P, Costamagna G, Ricci R. Inflammatory fibroid polyp of the gallbladder bearing a: platelet-derived growth factor receptor alpha mutation. Arch Pathol Lab Med 2013;137:721-724. https://doi.org/10.5858/arpa.2012-0218-CR
6. 6. De Petris G, Leung ST. Pseudoneoplasms of the gastrointestinal tract. Arch Pathol Lab Med 2010;134:878-92. https://doi.org/10.5858/134.3.378
7. 7. Mucientes P, Mucientes F, Klaassen R. Inflammatory fibroid polyp associated with early gastric carcinoma: a case report. Ann Diagn Pathol 2012;16:148-151. https://doi.org/10.1016/j.anndiagpath.2011.01.001
8. 8. 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;7:337-347. https://doi. org/10.1016/j.anndiagpath.2003.09.003

9. 9. Wang J, Tian X, Ning BF, et al. Clinical characteristics and prognosis of inflammatory fibroid polyp in the gastrointestinal tract: A series of nine cases and a literature review. J Dig Dis 2020;21:737-740. https:// doi.org/10.1111/1751-2980.12947
10. 10. Kim YI, Kim WH. Inflammatory fibroid polyps of gastrointestinal tract. Evolution of histologic patterns. Am J Clin Pathol 1988;89:721-727. https://doi. org/10.1093/ajcp/89.6.721
11. 11. Huss S, Wardelmann E, Goltz D, et al. Activating PDGFRA mutations in inflammatory fibroid polyps occur in exons 12, 14 and 18 and are associated with tumour localization. Histopathology 2012;61:59-68. https://doi.org/10.1111/j.1365-2559.2012.04203.x
12. 12. Schildhaus HU, Merkelbach Bruse S, Binot E, Büttner R, Wardelmann E. Inflammatorischer fibroider Polyp. Pathologe 2010;31:109-114. https://doi.org/10.1007/ s00292-009-1254-9
13. 13. Ricci R, Martini M, Cenci T, et al. PDGFRA-mutant syndrome. Mod Pathol 2015;28:954-964. https://doi. org/10.1038/modpathol.2015.56
14. 14. Anthony PP, Morris DS, Vowles KDJ. Multiple and recurrent inflammatory fibroid polyps in three generations of a Devon family: a new syndrome. Gut 1984;25:854-862. https://doi.org/10.1136/gut.25.8.854
15. 15. Harima H, Kimura T, Hamabe K, et al. Invasive inflammatory fibroid polyp of the stomach: A case report and literature review. BMC Gastroenterol 2018;18:74. https://doi.org/10.1186/s12876-018-0808-9
16. 16. Mori M, Tamura S, Enjoji M, Sugimachi K. Concomitant presence of inflammatory fibroid polyp and carcinoma or adenoma in the stomach. Arch Pathol Lab Med 1988;112:829-832.
17. 17. Mori M, Kakeji Y, Adachi Y, Korenaga D, Sugimachi K. Non-polypoid inflammatory fibroid polyps concomitant with early carcinoma in the stomach. Eur J Surg Oncol 1992;18:632-635.
18. 18. Hirasaki S, Endo H, Nishina T, Masumoto T, Tanimizu M, Hyodo I. Gastric cancer concomitant with inflammatory fibroid polyp treated with endoscopic mucosal resection using an insulation-tip diathermic knife. Intern Med 2003;42:259-262. https://doi.org/10.2169/ internalmedicine.42.259
19. 19. Kolodziejczyk P, Yao T, Tsuneyoshi M. Inflammatory fibroid polyp of the stomach: a special reference to an immunohistochemical profile of 42 cases. Am J Surg Pathol 1993;17:1159-1168. https://doi. org/10.1097/00000478-199311000-00009
20. 20. Shimer GR, Helwig EB. Inflammatory fibroid polyps of the intestine. Am J Clin Pathol 1984;81:708-714. https://doi.org/10.1093/ajcp/81.6.708
21. 21. Hirasaki S, Matsubara M, Ikeda F, Taniguchi H, Suzuki S. Gastric inflammatory fibroid polyp treated with Helicobacter pylori eradication therapy. Intern Med 2007;46:855-858. https://doi.org/10.2169/ internalmedicine.46.6445
22. 22. Guérit E, Arts F, Dachy G, Boulouadnine B, Demoulin JB. PDGF receptor mutations in human diseases. Cell Mol Life Sci 2021;78:3867-3881. https://doi. org/10.1007/s00018-020-03753-y
23. 23. Allibone RO, Nanson JK, Anthony PP. Multiple and recurrent inflammatory fibroid polyps in a Devon family (‘Devon polyposis syndrome’): an update. Gut 1992;33:1004-1005. https://doi.org/10.1136/ gut.33.7.1004
24. 24. Lee JH, Yoo JS, Jung HY, et al. A case of ınvasion of muscularis propria of gastric ınflammatory fibroid polyp. Korean J Helicobacter Up Gastrointest Res 2015;15:254-257. https://doi.org/10.7704/ kjhugr.2015.15.4.254
25. 25. Hirasaki S, Tanimizu M, Tsubouchi E, Nasu J, Masumoto T. Gastritis cystica polyposa concomitant with gastric inflammatory fibroid polyp occurring in an unoperated stomach. Intern Med 2005;44:46-49. https://doi.org/10.2169/internalmedicine.44.46