|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 4 | Page : 541-542
Giant inflammatory fibroid polyp of the terminal ileum presenting with lower urinary tract symptoms: Case report
RB Nerli1, SM Jali2, AK Guntaka1, PR Malur3, B Anita4, MB Hiremath1
1 Department of Urology, KLES Kidney Foundation, Belgaum, Karnataka, India
2 Department of Paediatrics, KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
3 Department of Pathology, KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
4 SRL Diagnostic Laboratory, Mumbai, India
|Date of Web Publication||1-Feb-2016|
R B Nerli
Department of Urology, KLES Kidney Foundation, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nerli R B, Jali S M, Guntaka A K, Malur P R, Anita B, Hiremath M B. Giant inflammatory fibroid polyp of the terminal ileum presenting with lower urinary tract symptoms: Case report. Indian J Cancer 2014;51:541-2
|How to cite this URL:|
Nerli R B, Jali S M, Guntaka A K, Malur P R, Anita B, Hiremath M B. Giant inflammatory fibroid polyp of the terminal ileum presenting with lower urinary tract symptoms: Case report. Indian J Cancer [serial online] 2014 [cited 2019 Sep 15];51:541-2. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/541/175304
A 14-year-old male child presented to pediatric services of the hospital with the complaints of frequency, urgency lower urinary tract symptoms (LUTS), pain in lower abdomen and a slowly growing mass in lower abdomen of 2 months duration. Per-abdominal examination revealed a lower abdominal mass 12 cm × 10 cm with well-made out margins. Abdominal sonography confirmed the presence of a solid mass displacing the urinary bladder anteriorly with the possibility of bladder being the site of origin. Abdominal computed tomography scan [Figure 1] revealed a large well-defined heterogeneously enhancing mass lesion displacing adjacent bowel loops and iliac vessels, causing indentation on the superior wall of the urinary bladder, with ill-defined fat planes between bladder and prostate. Cystoscopic examination revealed a normal bladder mucosa with the mass indenting posteriorly. Tru-cut biopsy of the mass showed tissue containing scattered spindle shaped to stellate cells set in a markedly myxomatous stroma [Figure 2]. The spindle shaped cells showed dark staining nuclei and these cells showed clustering at places. Numerous blood vessels of varying sizes were scattered throughout the lesion. An initial diagnosis of a benign lesion was made.
|Figure 1: Computed tomography scan showing a large well-defined heterogeneously enhancing mass|
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|Figure 2: (a and b) Hisptopathology of the lesion (H and E). Photomicrograph reveals widely scattered spindle and stellate shaped cell with ill-defined cytoplasm|
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The child was explored under general anesthesia by the urological team. The mass [Figure 3] was intra-peritoneal, arising from the anti-mesenteric border of the ileum. The mass was excised along with a segment (7 cm) of ileum. Post-operatively the child recovered uneventfully. Histopathological examination of the mass confirmed the initial histopathological findings. The lesional myofibroblasts expressed smooth muscle actin (SMA) and desmin (focal) on immune-histochemistry and were immunonegative for S-100 protein and CD34 [Figure 4]. A final diagnosis of inflammatory fibroid tumor was made.
|Figure 3: Operative photograph showing the mass arising from the anti-mesenteric border of the ileum|
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|Figure 4: (a and b) Tumor has an appearance similar to inflammatory fibroid tumor of small intestine. The lesions are immune negative for S-100 protein and CD 34. (c and d) The lesion myofibroblast express smooth muscle actin and desmin (focal)|
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Inflammatory fibroid polyps are rare, benign, tumor-like lesions of the gastro-intestinal tract. This lesion was first described by Vanek in 1949. They are frequently localized in the gastric antrum, but can also develop anywhere in the gastrointestinal tract. In the small intestine, the ileum is the most common site where these polyps are known to cause intussusception., Most of these lesions present as semi-pedunculated polyps arising in the submucosa. These lesions are covered with mucosa, which may become eroded. Larger tumors may extend into muscularis propria. These lesions consist of bland, uniform spindle and/or stellate cells within a loose fibromyxoid background. These lesions also have eosinophil rich mixed inflammatory infiltrate, which may include lymphocytes, plasma cells, macrophages and mast cells. Immunohistochemical studies show spindle shaped cells in the circumference of small blood vessels expressing vimentin, but not CD34, CD117 or SMA. The recommended treatment for such lesion is surgical resection.
Our case is unique, in that the lesion presented in a child with LUTS as most reported cases occur in the 6th decade of life. The presentation of this lesion on the anti-mesenteric border of the ileum makes it interesting as no similar presentation has been reported in the literature.
| » Acknowledgment|| |
KLES Kidney Foundation, Belgaum.
| » References|| |
Vanek J. Gastric submucosal granuloma with eosinophilic infiltration. Am J Pathol 1949;25:397-411.
Akbulut S, Sevinc MM, Cakabay B, Bakir S, Senol A. Giant inflammatory fibroid polyp of ileum causing intussusception: A case report. Cases J 2009;2:8616.
Bayle S, Rossi P, Bagneres D, Demoux AL, Ashero A, Dales JP, et al
. Ileum inflammatory fibroid polyp revealed by intussusception. About one familial case. Rev Med Interne 2005;26:233-7.
Tudose I, Andrei F, Calu V, Stăniceanu F, Miron A. Giant inflammatory fibroid polyp. Rom J Intern Med 2012;50:179-85.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]