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Small bowel (small intestine)

Benign tumors and tumor-like conditions

Inflammatory fibroid polyp


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 21 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Uncommon, benign polypoid submucosal mass with CD34+ spindle cells and granulation tissue, usually in distal stomach or terminal ileum (Arch Pathol Lab Med 2011;135:1311)
● Presents as obstructive mass or causing intussusception (Radiographics 1999;19:539)
● True neoplasms, usually with PDGFRA mutation (Pathologe 2009;30:117)

Case reports
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● 35 year old woman with concurrent appearance of Crohn's disease and inflammatory fibroid polyp (Ann Ital Chir 2005;76:395)
● 39 year old woman presenting with small intestinal obstruction (Case of the Week #86)

Treatment
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● Excision (does not recur)

Gross description
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● Polypoid (without stalk), submucosal mass, dumbbell shape in small intestine due to intussuception, mucosal ulceration and splitting and atrophy of muscularis propria

Gross images
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Case of the Week #86


Inflamatory fibroid polyp

Micro description
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● Submucosal mixture of prominent capillaries, spindle cells (occasionally concentrically arranged around vessels / onion-skinning) and inflammatory cells (particularly eosinophils, plasma cells and mast cells) in granulation tissue-like stroma (Arch Pathol Lab Med 2010;134:378)
● May be transmural
● May have lymphoid follicles
● Rare multinucleated giant cells, no atypia, no/rare mitotic figures
Histologic patterns: classical, edematous, fibrovascular, nodular, sclerotic

Micro images
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Various images


Case of the Week #86

Positive stains
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● CD34+ spindle cells
● Variable calponin, cyclin D1, fascin, smooth muscle actin, vimentin, CD35

Negative stains
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● CD117 (although mast cells are positive)

Differential diagnosis
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Inflammatory myofibroblastic tumor: usually children, may recur, plasma cells and lymphocytes with few eosinophils, mitotic activity in cellular areas, less prominent blood vessels, smooth muscle actin+, desmin+, ALK+/-, CD34- (Hum Pathol 2002;33:307)
GIST: malignant in 30-50%, plump spindle cells with eosinophilic cytoplasm, variable skenoid fibers and muscular infiltration, CD117+ (Mod Pathol 2000;13:1134, Mod Pathol 2003;16:366)
Inflammatory polyp of Crohn’s or ulcerative colitis: similar histology but different clinical history and findings in remainder of bowel

End of Small bowel (small intestine) > Benign tumors and tumor-like conditions > Inflammatory fibroid polyp


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