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.