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Gastrointestinal: Endoscopic submucosal dissection for gastric inflammatory fibroid polyp

A 61-year-old woman was referred from a local clinic for treatment of a gastric submucosal tumor found during upper gastrointestinal endoscopy. The lesion had been observed for 18 months and an increase in size and surface ulceration were noted (Figure 1A). The patient had no symptom of dyspepsia, abdominal pain, weight loss or melena. Previous test for H. pylori was negative. Endoscopic ultrasound with a miniprobe (SP-702, Fujinon, sonoprobe) showed that the lesion, 1.0 cm in size, was hypoechoic, homogeneous with indistinct margin originating from the submucosal layer without musclularis propria layer involvement (Figure 1B). Endoscopic submucosal dissection (Figure 1C) was performed for complete removal of the lesion. Upon histological examination, the lesion was composed of proliferative spindle cells, small vessels and marked eosinophils infiltration involving the mucosal and submucosal layers (Figure 2). A diagnosis of inflammatory fibroid polyp was made. Gastric inflammatory fibroid polyp is a rare and benign disorder accounting for 0.1% of gastric polyps. The antrum is the most common involved site. The diagnosis is made with histological findings of fibrous tissue, blood vessels with inflammatory infiltrate dominated by eosinophils. Endoscopically it may present as a polypoid or submucosal lesion. The typical endoscopic ultrasound features are of a homogeneous, hypoechogenic lesion with indistinct margin involving in the 2nd and/or 3rd gastric wall layer. The differential diagnosis includes carcinoid tumor and leiomyoma. Compared with inflammatory fibroid polyps, these true tumors usually have a distinctive margin. Endoscopic treatment with polypectomy, endoscopic mucosal resection or submucosal dissection is the treatment of choice for this benign lesion. Rarely, surgical resection may be required for a rapidly growing lesion.