67 yo lady with a previous history of nephrectomy
for a renal cell carcinoma (T2 N0 M0), 2 years ago. Complains of abdominal
pain with melena.
Treated for hypertension. Takes aspirin.
Scan reveals an intestinal mass.
Surgery: Segmental resection of the small intestin.
resected segment discloses a firm polypoid mass mesuring 3.5 cm
inserted on the intestinal wall protruding thru ulcerative changes
of the surrounding mucosa from the submucosa (click on slide mount).
The surface is gritty, greenish. Cut surface is whitish, slightly
The mass is mesenchymatous, with a main vascular component,
granulation tissue like, with a myxoid background. The latter is scattered
by myofibroblastic, repair type, cells and a more less abundant leucocytic
infiltrate, with plasma cells and varying amounts of eosinophils.
myofibroblastic cells and eosinophils.
The mass is extending by its vascular component thru
the muscularis propria and some inflammatory changes are noted on the
The mucosa distant to the lesion is unremakable, but
on higher magnifications a moderate eosiphilic infiltrate is noted with
few cryptic intraepithelial degranulation.
Inflammatory pseudotumor (Inflammatory fibroid polyp)
Comments: The histological pattern is reminiscent
of a florid granulation tissue (pyogenic granuloma) or in some areas with
abundant eosinophils, a "nasal inflammatory polyp".
Ackerman's Surgical Pathology: Inflammatory pseudotumor,
Inflammatory fibroid polyp
The process occasionally extends to the entire thickness
of the wall. Despite some similarities, this entity is probably unrelated
to eosinophilic enterities....the principal mesenchymal cell has the features
of the myofibroblast, but the immunohistochemical profile is more in keeping
with a histiocytic/fibrohistiocytic nature. The lesion is benign and the
pathogenesis is unknown....Obstruction and intusseption are two well-known
complications of this entity.
The description of the inflammatory pseudo-tumor (no
eosinophils) and its clinical setting (child, with a mass, fever, growth
failure, weight loss, anemia, thrombocytosis, elevated ESR and polyclonal
hypergammaglobulinemia, resolving after surgical removal of the mass)
vary with the authors (see GastroIntestinal Pathology, 2nd Ed. Fenoglio-Preiser)
and considered different from the inflammatory fibroid polyp, more common
in the stomach.