Inflammatory Fibroid Polyp of the Papilla of Vater; A Case Report

Tsunehiro Yoshimura, Suguru Hasegawa, Hajime Kida¹⁾, Gen Honjo²⁾, Shinya Okumura, Yuki Masano, Masato Kondo, Masato Naito, Yoshito Asao and Hiroaki Furuyama

Department of Abdominal Surgery, Department of Gastroenterology¹⁾ and Department of Pathology²⁾, Tenri Hospital

We report a rare case of inflammatory fibroid polyp. A 41-year-old man seen for recurrent obstructive jaundice and abdominal pain following 5 months of elevated hepatobiliary enzymes, was found in endoscopic ultrasonography, computed tomography, magnetic resonance imaging, and FDG-positron-emission tomography to have a small tumor in the intrapancreatic bile duct just above the papilla of Vater. The oval tumor had a smooth surface and protruded from the bile duct wall. The pancreas, main pancreatic duct, other portions of the bile duct, regional lymph nodes, and distant organs were not involved. Biliary cytology was class 1 and the biopsy specimen showed normal biliary epithelium. A submucosal tumor such as gastrointestinal stromal tumor was highly suspected, but the possibility of a malignant biliary tumor could be completely excluded, because almost all elevated biliary lesions are malignant and the tumor had probably been growing for several months, so we conducted pancreaticoduodenectomy. Macroscopically, the peduncular hard elastic tumor originated in the papillary portion of the bile duct was incarcerated in the inferior bile duct. Histopathologically, the result was inflammatory fibroid polyp. We briefly review cases of very rare duodenal inflammatory fibroid polyps and analyze the feature.

Key words
inflammatory fibroid polyp, duodenum, papilla of Vater

Reprint requests
Tsunehiro Yoshimura Department of Abdominal Surgery, Tenri Hospital
200 Mishimacho, Tenri, 632-8552 JAPAN

Accepted
November 18, 2009

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