Albert Einstein Medical Center Philadelphia, Pennsylvania
Introduction: Vanek’s Tumors, otherwise known as Inflammatory fibroid polyps, are a rare type of benign tumor representing less than 0.1% of all gastric or small bowel polyps. Most of these tumors are smaller than 15mm and are usually asymptomatic; however, if the lesion is large or symptomatic with bleeding, chronic anemia, or gastric outlet obstruction, surgical resection can be performed. This case adds to this scarce literature by presenting an asymptomatic 49-year-old gentleman who was found to have a 2cm Vanek’s Tumor at the hepatic flexure on routine colonoscopy for colorectal cancer screening.
Case Description/Methods: Our patient is a 49-year-old male with no significant past medical history that initially presented to for routine colorectal cancer screening. Upon initial screening colonoscopy, patient was found to have sigmoid diverticulosis as well as a 2cm submucosal polypoid lesion at the level of the hepatic flexure. Initial biopsies showed normal mucosa. Follow up CT Abdomen/Pelvis with contrast showed no irregularities. Due to concerning physical features of the initial hepatic flexure lesion, the patient was scheduled for a repeat colonoscopy with biopsies in 3 months. On repeat colonoscopy, the 2cm submucosal appearing polypoid lesion was again appreciated at the hepatic flexure. Hot snare biopsy was used to obtain more tissue and revealed a benign inflammatory fibroid polyp, further classified as a Vanek’s Tumor. Due to the lesion's benign nature and the patient being asymptomatic, a repeat colonoscopy was scheduled in 10 years with no more need for further workup.
Discussion: At 45 years old, the United States Preventative Task Force recommends routine colorectal cancer screening with colonoscopy every 10 years or less depending on pertinent findings. Vanek’s Tumors are rare gastric or small bowel inflammatory fibroid polyps with literature review only describing 5 cases of these tumors within the large bowel. Most Vanek’s Tumors are small (< 15mm) and asymptomatic, therefore fitting the criteria for continued surveillance colonoscopy at 10-year intervals, in concordance with our patient. In rare cases, these tumors can cause symptoms such as gastric outlet obstruction, severe constipation, acute bleeding, or chronic anemia, at which these tumors should be evaluated for surgical resection to alleviate symptoms. When encountering benign polyps, physicians should always be aware of morphology, size, and overall patient symptomatology to make appropriate management decisions for the patient.
