DISCUSSION
Intussusception, while common in children, is a rare surgical condition in adults accounting for 1-5% of intestinal obstructions(1). The aetiology in adults is an identifiable pathology in 90% of cases, whereas it is mostly idiopathic in children (2). Given the risk of underlying neoplasia, resection with oncological surgical principles is advised. However, there is controversy regarding the need for intra-operative reduction versus en-bloc resection without reduction. The former can potentially limit the extent of resection, but other studies concur reduction can promote peritoneal or venous dissemination of tumour cells and bowel perforation (3).
IFP’s are rare and benign mesenchymal tumours arising from the submucosa of the gastrointestinal tract. A total of 119 published cases have been published in the literature. (4, 5). Activating mutations of proto-oncogene platelet derived growth factor alpha (PDGFRA) gene has been suggested as the underlying neoplastic origin (6). Invasive growth or metastatic disease has not been reported.
As these lesions are intramural, mucosal biopsies during endoscopy are often non-diagnostic, as occurred in this case. This case displayed the typical and mostly scattered eosinophilic infiltrate, with spindle shaped and stellate cells displaying a peri-vascular arrangement. Histochemical analysis allowed differentiation from other spindle cell lesions namely GIST, leiomyomas and inflammatory myofibroblastic tumour. GISTs are positive for CD117 and CKIT, leiomyomas are positive for SMA and Desmin, and inflammatory fibroblastic tumour show positive expression for ALK (7). IFPs are typically positive for vimentin and do not demonstrate positivity for ALK. Spindle cells typically express CD34, but negativity, as was seen in this case, can be seen in up to 20% of cases (8). Thus, the features and immunoprofile is consistent with an IFP.
We report a rare case of an adult ileocolic intussusception secondary to an IFP. Given the uncertain aetiology of the lead point, and to avoid complications, surgical intervention of adult intussusception is recommended. Future research should focus on elucidating the optimal surgical approach.