Grgov Sasa, Katić Vuka, Hattori Takanori
Srp Arh Celok Lek. 2009 Sep-Oct;137(9-10):545-9. doi: 10.2298/sarh0910545g.
An inflammatory fibroid polyp is a rare condition with frequent localisation in the antrum of the stomach. Because of the localisation in the bottom parts of the mucosa and submucosa, a histological diagnosis is difficult to establish at endoscopic biopsies. So, a correct diagnosis is histologically possible after surgical excision which is a common manner of treatment. Many authors have shown that endoscopic removal of an inflammatory fibroid polyp is possible.
We are presenting a case of complete endoscopic resection of an inflammatory fibroid polyp of the stomach antrum in a 72-year-old patient. He comllained of nausea, vomiting and loss of appetite. The polyp endoscopically looked like flat elevation with central umbilication, 16 mm in diameter and it was localised praepylorically. Pathohistologically, areas of severe epithelial dysplasia were verified at endoscopic biopsies which suggested early gastric cancer. Helicobacter pylori (H. pylori) infection was verified histologically and with rapid urease test. The patient was treated with triple eradication H. pylori therapy. Two months after the therapy, we decided to perform endoscopic resection of the polyp. We applied a suction technique of mucosal resection by which the polyp was completely resected. After complete endoscopic removal, the final diagnosis of an inflammatory fibroid polyp localised in the submucosa and mucosa of the antrum of the stomach was histologically made. On follow-ups, after 3, 6 and 12 months, there were no endoscopic and histological signs of either inflammatory fibroid polyp relapse, or recurrence of H. pylori infection. The patient had no dyspeptic symptoms.
We recommend an endoscopic method of resection as a therapy of choice for an inflammatory fibroid polyp of the stomach.
炎性纤维瘤性息肉是一种罕见疾病,常位于胃窦部。由于其位于黏膜和黏膜下层的深部,在内镜活检时难以做出组织学诊断。因此,手术切除后进行组织学诊断才有可能做出正确诊断,手术切除是常见的治疗方式。许多作者已表明内镜下切除炎性纤维瘤性息肉是可行的。
我们报告一例72岁患者胃窦部炎性纤维瘤性息肉完全内镜切除的病例。他主诉恶心、呕吐和食欲不振。该息肉在内镜下表现为中央有脐凹的扁平隆起,直径16毫米,位于幽门前。病理组织学检查显示,内镜活检证实有重度上皮发育异常区域,提示早期胃癌。组织学检查及快速尿素酶试验证实有幽门螺杆菌(H. pylori)感染。患者接受了幽门螺杆菌三联根除治疗。治疗两个月后,我们决定对息肉进行内镜切除。我们采用黏膜切除吸引技术,将息肉完全切除。内镜完全切除后,组织学最终诊断为胃窦部黏膜下层和黏膜层的炎性纤维瘤性息肉。在3个月、6个月和12个月的随访中,没有炎性纤维瘤性息肉复发或幽门螺杆菌感染复发的内镜及组织学迹象。患者没有消化不良症状。
我们推荐内镜切除方法作为胃炎性纤维瘤性息肉的首选治疗方法。