Rare case of gastric inflammatory fibroid polyp located at the fornix of the stomach and mimicking gastric cancer: a case report

Abstract

Background Gastric inflammatory fibroid polyp (IFP) is a rare polypoid lesion of the stomach that is characterized pathologically by the presence of spindle cells, a prominent network of blood vessels, and inflammatory infiltration of eosinophils. IFP is mainly located in the gastric antrum and is usually semi-pedunculated and covered with normal mucosa. There have been several reports of large IFPs with ulceration on the surface, at the apex, but no report of the IFP with ulceration at the fornix of the stomach. We report a case of IFP with ulceration that was suggested to be gastric cancer and was resected for diagnostic treatment. Case presentation A 79-year-old woman presented to our hospital. During mass screening for cancer, stomach fluoroscopy revealed an abnormal shadow. Endoscopy showed an ulcerated tumor at the fornix of stomach; hence, gastric cancer was suggested because of the polypoid lesion with irregular ridges and ulceration. Pathological diagnosis of gastric biopsy specimens revealed an inflammation of the gastric mucosa, and specific findings for gastric cancer were not obtained. Because we could not exclude gastric malignancies such as cancer or gastrointestinal stromal tumor, we performed a partial resection of the stomach with a 2-cm margin using the laparoscopic-assisted method. Pathological examination of the resected specimen revealed that the tumor was present in the submucosal layer and consisted of collagen fiber containing inflammatory cell infiltration of mainly eosinophils. A prominent network of blood vessels was also found in the specimens. Immunohistochemical staining revealed mild positivity for CD34, and α-SMA and was negative for c-kit, DOG-1, s-100, desmin, ALK, and IgG4. The lesion was thus diagnosed as an IFP. The postoperative course was uneventful. The patient is currently asymptomatic and has shown no recurrence. Conclusion IFPs have variable locational, morphological, histological, pathological, and immunohistochemical features. We reported that the gastric IFP was located at the fornix of the stomach and was similar in morphology to gastric cancer. This case is clinically significant to avoid over-surgery.

A Rare Cause of Subepithelial Tumor in the Gastric Fundus

“…1 Although the pathogenesis and etiology of IFPs remain unclear, an association with local inflammatory response caused by injury, infection, or metabolic triggers has been suggested. 2 The typical endoscopic findings are semi-pedunculated, subepithelial tumors covered by normal mucosa, often with ulceration, in the gastric antrum. Although IFPs are generally considered benign lesions, it is challenging to diagnose before resection, similar to other mesenchymal tumors located in the submucosa or muscularis propria.…”

“…IFPs are rare, benign, mesenchymal tumors occurring throughout the gastrointestinal tract, and they are most commonly found in the gastric antrum [ 1 ]. Although the pathogenesis and etiology of IFPs remain unclear, an association with local inflammatory response caused by injury, infection, or metabolic triggers has been suggested [ 2 ]. The typical endoscopic findings are semi-pedunculated, subepithelial tumors covered by normal mucosa, often with ulceration, in the gastric antrum.…”

An Inflammatory Fibroid Polyp of the Stomach

“…Despite their benign nature, IFPs can mimic other malignant conditions, making an accurate diagnosis crucial for appropriate management [6][7][8][9]. Typical endoscopic findings are solitary intraluminal masses or intramural sessile lesions [10]. Differentiating between gastric intramural tumors may be difficult because of overlapping appearances, and it is important to assess the combination of features, such as tumor location, margin, growth pattern, attenuation, and enhancement, to suggest a diagnosis [11,12].…”