Esophageal inflammatory fibroid polyp (IFP) is a rare benign submucosal lesion of the gastrointestinal tract, also known as Vanek tumor. It can occur at any level of the GIT but is most commonly located in the gastric antrum (70-80%); esophageal localization is very rare, comprising <1% of all IFPs. Histologically characterized by eosinophilic infiltration, capillary proliferation, and myofibroblast-like spindle cell proliferation within a fibrovascular stroma. PDGFRA mutation has been detected in some cases. Typically presents as a pedunculated or sessile polypoid mass and may cause dysphagia or obstruction symptoms. Treatment with endoscopic polypectomy or surgical resection is curative; recurrence is extremely rare.
Age Range
40-80
Peak Age
60
Gender
Equal
Prevalence
Rare
Inflammatory fibroid polyp originates from reactive or neoplastic myofibroblast proliferation in the submucosal layer. Gain-of-function mutations in the PDGFRA (platelet-derived growth factor receptor alpha) gene have been detected in some cases, and although this is a genetic feature shared with GIST, the biological behavior of IFP is entirely benign. Histopathologically, dense eosinophilic infiltration is found within a fibrovascular stroma — cytokines released from eosinophils (IL-5, eotaxin) stimulate fibroblast/myofibroblast proliferation, and this cyclical process contributes to lesion growth. The rich capillary network forms the basis of enhancement on imaging. The polypoid growth pattern leads to protrusion from submucosal origin into the lumen, which appears as an intraluminal filling defect on barium studies. Pedunculated lesions may cause intussusception through mechanical traction.
Prominently homogeneously enhancing, well-defined, pedunculated or sessile polypoid mass in the esophageal lumen on CT. Enhancement is intense due to the rich fibrovascular stroma and shows a persistent pattern. Intact mucosal covering and submucosal origin are characteristic features of IFP.
Prominently, homogeneously enhancing, well-defined, intraluminal polypoid mass in the arterial phase. The degree of enhancement reflects the rich fibrovascular stroma. A feeding vascular stalk may be identified in pedunculated lesions. Lesion size is variable (1-5 cm) but homogeneous enhancement pattern is maintained even in large lesions.
Report Sentence
A well-defined polypoid mass with prominent homogeneous enhancement is seen in the esophageal lumen; inflammatory fibroid polyp (Vanek tumor) should be considered as the leading diagnosis.
On non-contrast CT, a soft tissue density (30-50 HU), well-defined, intraluminal polypoid mass. Does not contain calcification or fat density. Esophageal wall thickening is not prominent; the lesion grows toward the lumen and extraluminal growth is extremely rare.
Report Sentence
Non-contrast CT shows a soft tissue density, well-defined polypoid mass in the esophageal lumen; no calcification or fat is present.
EUS demonstrates a moderately hypoechoic, heterogeneous internal structure, polypoid mass arising from the submucosal layer (3rd layer). Feeding vessels in the stalk can be demonstrated with Doppler. Muscularis propria is usually intact. In large lesions, heterogeneous echo pattern may be seen due to vascular areas and eosinophilic infiltration.
Report Sentence
EUS demonstrates a moderately hypoechoic polypoid mass with heterogeneous internal structure arising from the esophageal submucosal layer; feeding vessels are demonstrated with Doppler.
On T2-weighted images, the lesion shows heterogeneous, moderately hyperintense signal. Hyperintense areas reflect the vascular component of the fibrovascular stroma and edema areas, while relatively hypointense areas represent dense fibrous tissue. In pedunculated lesions, the stalk structure may be seen as a vascular channel containing flow voids on T2.
Report Sentence
A polypoid mass showing heterogeneous, moderately hyperintense signal on T2-weighted sequence is seen in the esophageal lumen.
On T1-weighted images, the lesion shows isointense or mildly hypointense signal to muscle. Post-contrast images demonstrate prominent, progressive enhancement — reflecting the rich capillary architecture of the fibrovascular stroma. Enhancement pattern may be homogeneous or mildly heterogeneous.
Report Sentence
The lesion shows isointense signal to muscle on T1-weighted sequence with prominent progressive post-contrast enhancement.
In the portal venous phase, the lesion maintains or slightly increases its enhancement. Washout pattern is not observed. This progressive/persistent enhancement pattern is characteristic of benign fibrovascular lesions. The feeding vascular stalk may be identified as an enhancing linear structure.
Report Sentence
The mass maintains its enhancement in the portal venous phase without washout pattern; persistent enhancement is consistent with a benign fibrovascular lesion.
Criteria
Polyp connected to submucosal origin by a stalk, hanging into the lumen. Carries intussusception risk. Usually removable by endoscopic polypectomy.
Distinct Features
Feeding vascular stalk identifiable on CT; presents as mobile filling defect on barium study; intussusception complication especially at small bowel location.
Criteria
Broad-based, submucosal, protruding into the lumen. Stalk structure is not prominent. May require endoscopic submucosal resection (ESD) or surgery.
Distinct Features
Wall-based, sessile mass on CT; broad-based submucosal location on EUS; endoscopic resection is more difficult and surgery may be needed.
Criteria
Lesions >4 cm are classified as giant IFP. Obstruction symptoms are prominent. Surgical resection is usually required. Malignancy should be considered in the differential.
Distinct Features
Large polypoid mass with luminal obstruction on CT; heterogeneous enhancement areas may be present; differential diagnosis with GIST is important (c-KIT negative, CD34 positive).
Distinguishing Feature
Leiomyoma arises from muscularis propria (4th layer), is usually larger and enhances less; IFP arises from submucosa (3rd layer), grows polypoid and enhances prominently.
Distinguishing Feature
GIST is larger (>5 cm), may show necrosis and cystic degeneration, and is c-KIT (CD117) positive; IFP is c-KIT negative, CD34 positive, and usually <5 cm.
Distinguishing Feature
Adenomatous polyp arises from the mucosal layer (1st-2nd layer); IFP arises from submucosa (3rd layer). Adenomatous polyps are common in the setting of Barrett esophagus.
Distinguishing Feature
Granular cell tumor is usually smaller (<2 cm), enhances less, and is S-100 positive; IFP may be larger, enhances more prominently, and is CD34 positive, S-100 negative.
Urgency
routineManagement
surgicalBiopsy
NeededFollow-up
no-follow-upInflammatory fibroid polyp is a completely benign lesion with no malignant potential. Treatment with endoscopic polypectomy (pedunculated lesions) or endoscopic submucosal resection (sessile lesions) is curative. Surgical resection may be needed for large lesions. Recurrence is extremely rare and routine follow-up after complete resection is generally not required. Urgent evaluation is recommended if dysphagia or obstruction symptoms are present.
Inflammatory fibroid polyps are benign with no risk of malignant transformation. Endoscopic polypectomy is curative. Recurrence is rare. PDGFRA mutation shares genetic features with GIST but biological behavior is entirely benign.