Kawai Akimasa, Matsumoto Hideo, Haruma Ken, Kanzaki Tomoko, Sugawara Yuji, Akiyama Takashi, Hirai Toshihiro
Department of Surgery, Mitsugi General Hospital, 124, Ichi, Mitsugi-cho, Onomichi, Hiroshima, 722-0393, Japan.
Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama, Okayama, 700-8505, Japan.
Surg Case Rep. 2020 Nov 23;6(1):292. doi: 10.1186/s40792-020-00980-0.
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.
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.
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.
胃炎性纤维性息肉（IFP）是一种罕见的胃息肉样病变，其病理特征为存在梭形细胞、显著的血管网络以及嗜酸性粒细胞炎症浸润。IFP主要位于胃窦部，通常为半蒂状，表面覆盖正常黏膜。已有数例关于表面或顶端有溃疡的大型IFP的报道，但未见胃穹窿部有溃疡的IFP的报道。我们报告一例有溃疡的IFP病例，该病例最初被怀疑为胃癌并接受了诊断性切除治疗。
一名79岁女性到我院就诊。在癌症大规模筛查期间，胃荧光镜检查发现异常阴影。内镜检查显示胃穹窿部有一个溃疡肿瘤；因此，由于息肉样病变伴有不规则隆起和溃疡，怀疑为胃癌。胃活检标本的病理诊断显示胃黏膜炎症，未获得胃癌的特异性表现。由于我们不能排除癌症或胃肠道间质瘤等胃部恶性肿瘤，我们采用腹腔镜辅助方法对胃进行了切缘为2厘米的部分切除术。切除标本的病理检查显示肿瘤位于黏膜下层，由含有主要为嗜酸性粒细胞炎症细胞浸润的胶原纤维组成。标本中还发现了显著的血管网络。免疫组织化学染色显示CD34、α-SMA轻度阳性，c-kit、DOG-1、s-100、结蛋白、ALK和IgG4阴性。因此，该病变被诊断为IFP。术后病程顺利。患者目前无症状，未出现复发。
IFP具有可变的位置、形态、组织学、病理和免疫组织化学特征。我们报告的胃IFP位于胃穹窿部，形态与胃癌相似。该病例对于避免过度手术具有临床意义。
