A 70-year-old woman visited our hospital complaining of anemia. Laboratory testing
revealed a peripheral blood hemoglobin concentration of 9.4 g/dL. Upper and lower
gastrointestinal endoscopic examinations were performed to investigate the cause of
the anemia. The findings of the upper endoscopic examination were normal. However,
the lower endoscopic examination revealed a semipedunculated polyp with a flat elevated
lesion in the transverse colon ([Fig. 1]). The surface of the broad-based polyp was erythematous and eroded. The pathological
analysis of the biopsy specimen from the polyp suggested inflammatory fibroid polyp
(IFP). It was considered that the polyp was the cause of the anemia and that excision
was therefore indicated.
Fig. 1 The lower endoscopic examination revealed a semipedunculated polyp with flat elevated
lesion in the transverse colon.
The polyp was resected by the endoscopic mucosal resection (EMR) technique, with injection
of physiologic saline solution into the submucosal layer followed by clipping. The
resected specimen measured 20 × 10 × 10 mm. The cut surface was whitish ([Fig. 2]). Histologically the polyp consisted of loosely structured fibroblastic tissue composed
of fibroblastic cells intermingled with numerous inflammatory cells. The fibroblasts
were vaguely arranged in a whorl structure, and the inflammatory cells consisted of
eosinophils, lymphocytes, and plasma cells ([Fig. 3 a]). Erosion was observed on the surface of the polyp ([Fig. 3 b]). These features were compatible with the diagnosis of IFP. After removal of the
polyp, the patient’s anemia was alleviated.
Fig. 2 The resected specimen measured 20 × 10 × 10 mm in size. The cut surface was whitish.
Fig. 3 a Histologically the polyp consisted of loosely structured fibroblastic tissue composed
of fibroblastic cells intermingled with numerous inflammatory cells. The fibroblasts
were vaguely arranged in a whorl structure, and the inflammatory cells consisted of
eosinophils, lymphocytes, and plasma cells. b Erosion was observed on the surface of the polyp.
With regard to pathogenesis and etiology, it has been recently proposed that IFP is
caused by an allergic reaction to bacterial, chemical, traumatic, and/or neurogenic
stimuli, or is a reactive lesion of fibroblastic or myofibroblastic nature [1]
[2]. Over the past decades, surgical excision has been the main treatment of choice
for colonic IFPs, because of their relatively large size and the difficulty of differentiating
them from malignant polyps endoscopically or even pathologically. If, however, the
diagnosis of IFP is confirmed, polyps of the large intestine can best be removed endoscopically
as they are clinically and histologically benign [3]. Based on a literature review, six cases of colonic IFP treated by endoscopic resection
including the present case are summarized in [Table 1] [3]
[4]
[5]
[6]
[7]. Our case is the first reported case of a large, broad-based, semipedunculated-type
IFP where EMR was performed successfully. EMR may be the treatment of a choice even
in large pedunculated and semipedunculated polyps with a thick stalk.
Table 1
Summary of colonic inflammatory fibroid polyps treated by endoscopic resection
|
Authors
|
Year
|
Patient age and sex
|
Polyp location
|
Polyp size, mm
|
Gross appearance of polyp
|
Resection method
|
|
Niv and Hurwitz [3]
|
1985
|
71 M
|
Cecum
|
40
|
Pedunculated
|
Polypectomy
|
|
Nakase et al. [4]
|
2000
|
45 F
|
Cecum
|
5
|
Sessile
|
EMR
|
|
Sakamoto et al. [5]
|
2005
|
40 M
|
Asc.
|
35
|
Pedunculated
|
Polypectomy
|
|
Park et al. [6]
|
2007
|
28 M
|
Sig.
|
40
|
Pedunculated
|
Polypectomy
|
|
Kim et al. [7]
|
2008
|
23 F
|
Des.
|
45
|
Pedunculated
|
Polypectomy
|
|
Present case
|
|
70 F
|
Trans.
|
20
|
Semipedunculated
|
EMR
|
M, male; F, female; Asc., ascending colon; Sig., sigmoid colon; Des., descending colon;
Trans., transverse colon; EMR, endoscopic mucosal resection.
Endoscopy_UCTN_Code_TTT_1AQ_2AD
