June 2016 Case of the Month

63 year-old woman with dysphagia and abdominal pain undergoes an upper endoscopy, revealing a gastric antral ulcer.  A biopsy is performed.  What is your diagnosis?

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Low power view shows fragments of antral-type gastric mucosa with focal erosion and pale stromal area.

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The pale stromal area (circled) is underneath the eroded area (arrow).

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Dense eosinophilic infiltrate within the lamina propria.

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Low power view shows fragments of antral-type gastric mucosa with focal erosion and pale stromal area.

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June 2016 Case of the Month

   Answer: Inflammatory Fibroid Polyp

The gastric biopsy shows sampling of the surface of an inflammatory fibroid polyp (IFP).  These lesions usually show some degree of mucosal ulceration as seen in this example.  Characteristically, IFP is a stromal lesion with bland spindle cells, myxoid appearance, frequent eosinophils, and perivascular onion skin arrangement of stromal spindle cells.  IFP shows a wide age range of occurence, but most often arises in the sixth decade with a male predominance.  The pre-pyloric region of the gastric antrum is the most common location.  Historically, these lesions were considered to be inflammatory/reactive in nature; however, recent advances in genomic testing have revealed an activating mutation in the PDGFRA gene in roughly 70% of cases.  Thus, these lesions are clonal or neoplastic in nature, though behave in a rather indolent manner.  Resection is typically curative.