Wednesday, October 14, 2009

1Department of Medicine (MBC 46), Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Saudi

1Department of Medicine (MBC 46), Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Saudi Arabia2Department of Pathology and Laboratory Medicine, Riyadh, Saudi Arabia, BR How to cite this article: Peedikayil MC, AlHindi HN, MS Rezeig . Inflammatory fibroid polyp of the cecum can be treated by endoscopic resection. Saudi J Gastroenterol 2008; 14:2123 br How to cite this URL: Peedikayil MC, AlHindi HN, Rezeig MS. Inflammatory fibroid polyp of the cecum can be treated by endoscopic resection. Saudi J Gastroenterol [serial online] 2008 [cited2009 9 October]; 14:2123. Available at: br www.saudijgastro.com/text.asp2008/14/4/212/43281 Lord, an inflammatory fibroid polyp (IFP) is a rare benign disease, neoplastic polyps in the gastrointestinal tract. A woman aged 66 with hypertension and diabetes was referred to us for evaluation of severe anemia due to iron deficiency. Clinical examination was obese, pale, with stable vital signs and physical did not reveal any abnormality. Laboratory data were normal except for a hemoglobin of 62 g / L, upper endoscopy was normal. Colonoscopy revealed a polypoid lesion of 3 cm sessile in the cecum, and the biopsy was performed [Figure 1]. A CT scan of the abdomen was normal except for small pericecal lymph nodes. Histology of the polypoidal lesion had features of inflammatory fibroid polyps. The patient underwent a second colonoscopy and the polyp was removed by snareandcautery technique without any complications in small pieces. But all the polyp is removed, leaving only its core. Microscopically, the lesion was a mass of fibromuscular tissue and covered by inflammatory polypoid colonic mucosa. The latter is continuous with the underlying tissue and ulceration of the coordination and formation of granulation tissue. The lesion is composed of a highly vascularized tissue Bland fibroblastlike cell inflammatory infiltrate of lymphocytes, eosinophils and plasma cells. In some areas, the inflammation was dense with the formation of reactive lymphoid follicles [Figure 1]. IFP of the colon is rare and has only been a total of 44 cases, including our case reported in the literature. [1], [2] [3] Of the 26 cases of colon cancer IFP reported by Sakamoto et al., 17 have been treated surgically. Different techniques have been described for endoscopic removal of polyps including the technique of one with the clip and cut. [4] In our case, a large polypoid lesion was found in the cecum during colonoscopy performed as part of diagnostic work for iron deficiency anemia. IFP are mainly in the mucosa and submucosa, but rarely may extend into the muscle layer. In this patient, the IFP was predominantly in the mucosa without any extension of the muscular layer and, therefore, decided to remove this from the colonoscopy and snare technique. Followup colonoscopy three months ago and a year later showed no residual lesions or recurrence. As the IFP is a benign polyp and its recurrence is very rare, we believe that endoscopic removal is a form of treatment. With the widespread use of colonoscopy, more cases of IFP, will likely be identified, and awareness of this condition among physicians will help to avoid surgery and resection. br 1.Iwamoto K, Sakashita M, Takahashi T, Obata D, Tanaka S, Fujii M, et al. Depressed type of inflammatory fibroid polyps of the colon. Int J Colorectal Dis 2007; 22:1409. br 2.Ozolek JA, Sasatomi E Swalsky PA, Rao U, Krasinskas A, Finkelstein SD. Inflammatory fibroid polyps of the gastrointestinal tract: clinical, pathological and molecular. Appl Immunohistochem Mol Morphol 2004, 12:5966. Br 3.de RP, Picardo AL, Cuberes R, Jara A, Mart; nezPe; alver I, Villanueva MC, et al. Inflammatory fibroid polyps of the large intestine. Dig Dis Sci 1999; 44:18106. 4.Sakamoto BR T, Kato H, Okabe T, T Ohya, Iesato M, Yokomori T, et al. A large inflammatory fibroid polyp of the colon treated by endoscopic polypectomy assisted endoclip: A case report. Dig Liver Dis 2005; 37:96872. Br Address: Musthafa Chalikandy PeedikayilDepartment of Medicine (MBC 46), Section of Gastroenterology, King Faisal Specialist Hospital and Research Center in Saudi ArabiaSource Support: None, Conflict of interests: NoneDOI: 10.4103/13193767.43281CTRI: None br br br br