Pinto-Pais Teresa, Fernandes Sónia, Proença Luísa, Fernandes Carlos, Ribeiro Iolanda, Sanches Agostinho, Carvalho João, Fraga José
Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal.
GE Port J Gastroenterol. 2015 Mar 26;22(2):61-64. doi: 10.1016/j.jpge.2014.07.006. eCollection 2015 Mar-Apr.
Inflammatory fibroid polyp (IFP) is an unusual benign gastrointestinal subepithelial tumor (SET). The endosonographic (EUS) features of IFPs were sporadically reported on imaging tips or small case series study. However, the differential diagnosis and optimal treatment of gastric IFP is still challenging. We report an unusual case of a large erosioned and prolapsing gastric submucosal lesion, presenting primarily with obstructive symptoms ("ball valve syndrome") and anemia. On EUS examination, a 50 mm SET in the distal antrum was seen, with hypoechoic but heterogeneous echo-pattern, located in the second and third sonographic layers of the gastric wall (deep mucosal and submucosal). The fourth (muscle) layer was intact; no peri-lesional adenopathies were identified. A decision was made to proceed to endoscopic treatment because of the mentioned symptoms. Histopathologic evaluation of the resected specimen with immunohistochemical staining was consistent with the diagnosis of IFP. IFP rarely reach these large dimensions or cause symptoms. Despite its benign etiology, endoscopic resection was important in both establishing a histologic diagnosis and treatment. EUS was crucial in the differential diagnosis. The literature concerning IFP is also reviewed.
炎症性纤维瘤性息肉（IFP）是一种罕见的胃肠道良性上皮下肿瘤（SET）。IFP的内镜超声（EUS）特征仅在影像学提示或小病例系列研究中有零星报道。然而，胃IFP的鉴别诊断和最佳治疗仍然具有挑战性。我们报告了一例罕见的病例，患者为巨大糜烂性脱垂性胃黏膜下病变，主要表现为梗阻症状（“球阀综合征”）和贫血。在EUS检查中，可见胃窦远端有一个50毫米的SET，呈低回声但回声不均匀，位于胃壁的第二和第三超声层（深层黏膜和黏膜下层）。第四层（肌肉层）完整；未发现病变周围淋巴结肿大。由于上述症状，决定进行内镜治疗。切除标本的组织病理学评估及免疫组化染色结果与IFP的诊断一致。IFP很少达到如此大的尺寸或引起症状。尽管其病因良性，但内镜切除对于确立组织学诊断和治疗都很重要。EUS在鉴别诊断中至关重要。本文还对有关IFP的文献进行了综述。
