Inflammatory Fibroid Polyp of the Esophagogastric Junction
A 5-year-old girl with slight mental retardation, hypercalcemia (11.7 mg/dL), failure to thrive, and dysphagia was admitted for 2 episodes of hematemesis. Three years before, she underwent percutaneous endoscopic gastrostomy tube placement. Blood sample showed marked anemia (7.8 g/dL). Upper endoscopy showed a lobulated mass arising from the esophagogastric junction, protruding both into the stomach and esophagus (Fig. 1A and B). Multiple biopsies revealed normal gastroesophageal mucosa. Needle biopsies performed during a second endoscopy through the stoma revealed histologic findings consistent with inflammatory fibroid polyp. A computerized tomography scan of both thorax and abdomen confirmed the presence and extent of the mass (Fig. 2), which was surgically removed. Pathologic examination confirmed the diagnosis. Inflammatory fibroid polyp is rare in pediatric patients. Arising from the submucosa, it can occur anywhere along the gastrointestinal tract, rarely from the esophagus or the esophagogastric junction (1%) (1). Its etiology is unknown, and it often represents an incidental find during endoscopic/surgical procedures. Abdominal pain, intussusception, and obstruction are the most frequent symptoms (2). Correct diagnosis is often made after surgery. When possible, preoperative diagnosis with needle biopsy may be useful in differential diagnosis and treatment.