Patients with inflammatory bowel disease and post-inflammatory polyps have an increased risk of colorectal neoplasia:A metaanalysis

BACKGROUND Longstanding intestinal inflammation increases the risk of colorectal neoplasia in patients with inflammatory bowel disease(IBD).Accurately predicting the risk of colorectal neoplasia in the early stage is still challenging.Therefore,identifying visible warning markers of colorectal neoplasia in IBD patients is the focus of the current research.Post-inflammatory polyps(PIPs)are visible markers of severe inflammation under endoscopy.To date,there is controversy regarding the necessity of strengthened surveillance strategies for IBD patients with PIPs.AIM To determine whether IBD patients with PIPs carryan increased risk of colorectal neoplasia.METHODS Researchers searched the following databases up to July 31,2021:MEDLINE(PubMed),MEDLINE(Ovid),EMBASE,Cochrane Library,China National Knowledge Infrastructure,Wan-Fang Data,China Science and Technology Journal Database and Chinese BioMedical Literature Database.Cohort and casecontrol studies that compared the risk of colorectal neoplasia between IBD patients with or without PIPs and published in English or Chinese were included.Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool.The outcomes of interest were the rates of various grades of colorectal neoplasia.The pooled risk ratio(RR)and 95%confidence interval(95%CI)were calculated using the random-effects model.Begg’s test and Egger’s test were used to calculate the publication bias.Sensitivity and subgroup analyses were performed to verify the robustness of the results.The Grading of Recommendations,Assessment,Development and Evaluation approach was used to assess the overall quality of evidence supporting the outcomes of interest.RESULTS Nine studies involving 5424 IBD patients(1944 with PIPs vs 3480 without PIPs)were included.The overall bias in each included study ranged from moderate to serious.Compared with nonconcurrent PIPs,patients with PIPs had a higher risk of colorectal neoplasia(RR=1.74,95%CI:1.35-2.24,P<0.001,I2=81.4%;aHR=1.31,95%CI:1.01-1.70,P=0.04,I2=26.2%;aOR=2.62,95%CI:1.77-3.88,P<0.001,I2=0%),advanced colorectal neoplasia(RR=2.07,95%CI:1.49-2.87,P<0.001,I2=77.4%;aHR=1.63,95%CI:1.05-2.53,P=0.03,I2=10.1%)and colorectal cancer(RR=1.93,95%CI:1.32-2.82,P=0.001,I2=83.0%).Publication bias was not observed in Begg’s test or Egger’s test.Sensitivity and subgroup analyses showed that the results are robust.The overall quality of evidence was assessed as moderate to low.CONCLUSION IBD patients with PIPs may have an increased incidence of colorectal neoplasia.

INFLAMMATORY FIBROID POLYPS OF GASTRO-INTESTINAL TRACT

Objective: To review the diagnosis and differential diagnosis of inflammatory fibroid polyp (IFP) of gastrointestinal tract. Methods: The clinical symptoms, histopathologic features and immunohistochemical (ABC method) staining in 9 cases were observed. Results: IFP presented either as a solitary pedunculated or sessile lesion arising from the submucosa and protroding into the lumen; composed of a background of fibroblasts and blood vessels infiltrated by a variable number of inflammatory cells, often numerous eosinophilias leukocytes. Immunohistochemical staining: the spindle cells of all cases reacted with Vimentin. The partial cells of several cases react with Actin, NSE, a -AT. 7 cases were follow-up. No patients had a recurrence of the lesion. Conclusion: IFP are rare lesions, and may represent an exaggerated response to inflammatory or other injury process. The prognosis is good when treated by segmental resections of endoscopic removals.

Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach

Inflammatory fibroid polyp(IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography(CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.

Ileo-Ileal Intussusception Caused by an Inflammatory Fibroid Polyp: A Case Report

Inflammatory fibroid polyps (IFP) are a rare benign entity that arises from the submucosa of the gastrointestinal tract and protrudes into the lumen. The clinical presentation depends on the size and localization. They are particularly found in the ileum, where they are frequently present as an ileal intussusception. We report the case of a 56-year-old female patient who presented with periumbilical pain along with multiple episodes of vomiting and chronic constipation. An abdominal CT scan revealed an ileo-ileal intussusception of an endoluminal hypodense lesion with mesenteric lymphadenopathy. Surgical treatment consisted of segmental ileal resection with primary anastomosis. The histopathological analysis revealed an inflammatory fibroid polyp in the ileum. Although these tumors have no malignant potential, surgery is always indicated in ileo-ileal intussusception to ascertain the histological nature of the lesion.

Syndromic and sporadic inflammatory/hyperplastic small-bowel polyps:a comparative study

Background:Inflammatory/hyperplastic small-bowel polyps(SBPs)occur either sporadically or in patients with a polyposis syndrome;however,comparison between these two settings of the histological features of SBPs has not been reported and the etiology of sporadic inflammatory/hyperplastic SBPs remains unclear.Method:Twenty-eight cases of sporadic inflammatory/hyperplastic SBPs and nine cases of syndromic SBPs were retrieved from the Department of Anatomic Pathology at the Cleveland Clinic.Clinico-demographics and histological features were compared between the two groups.Results:Patients with syndromic inflammatory/hyperplastic SBPs were younger(48 vs.63 years;P=0.007)and had higher rates of hemorrhagic telangiectasia(55.6%vs.0%;P=0.000),gastric polyps(87.5%vs.21.4%;P=0.001),and family history of colon cancer(62.5%vs.11.1%;P=0.014).Sporadic cases were more frequently associated with gastro-esophageal reflux(35.7%vs.0%;P=0.079)and anti-reflux medication use(55.6%vs.11.1%;P=0.026).Histologically,the syndromic SBPs were more often of pure intestinal type(45.4%vs.3.8%;P=0.005)and had prominent vessels(81.8%vs.42.3%;P=0.036).Conclusions:Patients with syndromic SBPs are younger and have higher rates of hemorrhagic telangiectasia,gastric polyps,and family history of colon cancer.Histologically,syndromic inflammatory/hyperplastic SBPs are more likely to be of pure intestinal type and to have prominent vessels.

表现为透壁生长的局部侵袭性回肠炎性纤维样息肉

Morphologically,an inflammatory fibroid polyp(IFP)is usually centred in the submucosa.Extension of an IFP to the subserosa with destruction of the muscularis propria is exceedingly rare.Herein,we describe a 70-year-old woman who presented with right lower abdominal pain but was finally diagnosed with an IFP.Contrast-enhanced computed tomography revealed a target-like structure with a hypovascular mass at the leading edge,which was consistent with intussusception due to a tumour.Following surgery,the resected specimen displayed a mass measuring 4×3×3 cmthat was protruding into the lumen.Microscopically,the mass was centred in the submucosa,extending up to the mucosal surface and down to the subserosa and serosa.The muscularis mucosae and muscularis propria were destroyed focally.A PDGFRA gene mutation in exon 2(1837_1851 del)that was found in this case,as well as a highly infiltrative growth pattern,strongly supported the neoplastic nature of IFP.