inflammatory fibroid polyp

Early Gastric Carcinoma
Associated With an
Inflammatory Fibroid Polyp
서울대학교병원
이희은
Case presentation
• 62/M
• C.C.; 외부 EGD bx 상 adenocarcinoma 진단받고 내원
• EGD and EUS
– 1cm-sized polypoid lesion in greater curvature side
of mid antrum
– EGC confined to mucosa
• Abdomen CT
– 5mm-sized polypoid lesion in antrum
– No involved lymph nodes
• Endoscopic submucosal dissection was performed.
Case Presection
• 62/M
• 외부 EGD 상 EGC (bx; adenocarcinoma, well
differentiated)
• EGD
– 1cm-sized polypoid lesion in greater curvature side
of mid antrum
• Abdomen CT
– 5mm-sized polypoid lesion in antrum
– No perigastric infiltration and involved LNs
Diagnosis
Stomach, endoscopic submucosal dissection:
EARLY GASTRIC CARCINOMA
- Histologic type:
tubular adenocarcinoma, well differentiated
- Location: antrum, greater curvature
- Gross type: EGC type I+IIa
- Histologic type by Lauren: intestinal
- Size: 1.9 x 1.8 x 0.1cm
- Depth of invasion: invades mucosa (muscularis mucosa) (pT1a)
- Resection margin: free from carcinoma
safety margin: proximal, 0.6cm; distal, 1.5cm;
anterior wall, 1cm; posterior wall, 0.8cm; deep, 350μm
- Lymphatic invasion: not identified
- Venous invasion: not identified
- Perineural invasion: not identified
- Tumor border by Ming classification: infiltrative
- Stromal reaction: none
- Pre-existing adenoma: not identified
- Associated findings:
inflammatory fibroid polyp (size: 1.0 x 0.8 x 0.7cm)
- Separate lesions: none
Gastric carcinoma concomitant with
inflammatory fibroid polyp (IFP)
• Review of the literature
– To date, 12 cases were reported.
• 10 cases, carcinoma
– 3 cases, overlying mucosa
– 4 cases, adjacent mucosa
– 3 cases, overlying or adjacent mucosa
• 2 cases, adenoma in overlying mucosa
– Inflammatory fibroid polyps of the gastrointestinal tract. Cancer.
1983;51:1682-1690.
• 1 case; carcinoma in overlying mucosa
– Concomitant presence of inflammatory fibroid polyp and carcinoma
or adenoma in the stomach. Arch Pathol Lab Med. 1988;112:829-832.
• 2 cases; carcinoma in overlying mucosa
• 2 cases; carcinoma in adjacent mucosa
• 2 cases; adenoma in overlying mucosa
– Non-polypoid inflammtory fibroid polyps concomitant with early
carcinoma in the stomach. Eur J Surg Oncol. 1992;18:632-635.
• 1 case; carcinoma in overlying mucosa
– Inflammatory fibroid polyp of the stomach. Am J Surg Pathol.
1993;17:1159-1168
• 3 cases; carcinoma in overlying or adjacent mucosa
– Gastric cancer concomitant with inflammatory fibroid polyp treated
with endoscopic mucosal resection. Intern Med. 2003;42:259-262.
• 1 case; carcinoma in adjacent mucosa
• Possible pathogenetic relationships of IFP with
adenocarcinoma
1) IFP represents a reaction against adenocarcinoma.
2) adenocarcinoma occurs via stimulation of IFP.
3) IFP and adenocarcinoma arise independently.
IFP case review - SNUH
Location
Location
Number
Stomach
94
Colon
24
Small bowel
9
Rectum
4
Duodenum
3
Appendix
2
GEJ
1
Unknown
1
Total; 138 cases
1% 1% 1%
3% 2%
7%
17%
68%
Stomach
Colon
Small bowel
Rectum
Duodenum
Appendix
GEJ
Unknown
Overlying mucosa
• Stomach (n=57)
–
–
–
–
Adenocarcinoma: 1
HP-CAG: 22
CAG: 5
CG: 29
• Other GI tract (n=19)
– 1 Small bowel: Crohn’s disease
– 1 Small bowel: Tubular adenoma, low grade
– Nonspecific change: 17 cases