C0729 - Vanek Tumor, a Rare Gastrointestinal Tumor: Culprit or Innocent Bystander?

Lyla Saeed, MD¹, Juan Castano, MD¹, Himabindu Kolli, MD², Asif Zamir, MD, FACG^3
1UTRGV at DHR Gastroenterology Fellowship, Edinburg, TX; ²UTRGV, Weslaco, TX; ³University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX

Introduction: Vanek tumor or inflammatory fibroid polyp (IFP) is a rare submucosal tumor of the gastrointestinal tract. It is most commonly found in gastric antrum and ileum. This is a benign tumor and only a few cases have been reported so far in the literature. We present a case of a large Vanek tumor with a coincidental finding of adenocarcinoma of the colon while undergoing evaluation for iron deficiency anemia.

Case Description/Methods: A 61-year-old female with past medical history of hypertension, diabetes mellitus type 2, hypothyroidism was referred for evaluation of anemia requiring blood transfusions. No prior history of endoscopic evaluation. Hemoglobin was noted to be 9.5 gm/dl with iron deficiency. Esophagogastroduodenoscopy showed a giant ulcerated 8 cm pedunculated polyp with a large thick stalk in the antrum, protruding through the pylorus into the duodenal bulb. Using a 33 mm Captivator II extra-large stiff snare, the polyp was brought from the duodenum to the antrum, an Endo loop was secured to the base of the stalk where epinephrine was injected. Piece-meal polypectomy was done with no bleeding noted, leaving behind a fibrotic stalk. Colonoscopy revealed a 6 cm pedunculated polyp at the sigmoid colon which was removed with cautery snare polypectomy and approximation of the edges with clips x 2. Pathology of the antral polyp showed inflammatory fibroid polyp and the sigmoid polyp was poorly differentiated adenocarcinoma.

Discussion: Vanek tumor is a benign inflammatory tumor with unknown etiology and no clear evidence of malignant potential. Despite its benign nature, it can cause gastrointestinal bleeding, intussusception, rarely can also cause intestinal necrosis and perforation. Treatment involves endoscopic resection of small sized polyps however large polyps historically have been treated with surgical resection. To our knowledge our case is the largest documented Vaneks tumor of the stomach which was successfully removed without need for surgery. The case also high lights the importance of adhering to guidelines for evaluation of iron deficiency anemia and performing bi-directional endoscopy as in our case the ulcerated polyp was most likely the culprit behind iron deficiency in addition to the adenocarcinoma of the sigmoid colon.



Disclosures:


Lyla Saeed, MD¹, Juan Castano, MD¹, Himabindu Kolli, MD², Asif Zamir, MD, FACG³. C0729 - Vanek Tumor, a Rare Gastrointestinal Tumor: Culprit or Innocent Bystander?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.