Benign Gastrointestinal Tumors Disguised as Malignancies along with Review of Literature

Abstract Introduction: Mimickers of malignancy in the gastrointestinal (GI) tract pose diagnostic challenges for pathologists and clinicians. These conditions can exhibit alarming clinical, endoscopic, radiological, and at times histological features on small biopsy, leading to unnecessary aggressive treatments. Aim: The aim of this study is to highlight the diagnostic dilemmas, the clinicopathological profile of such cases so as to what enables a correct diagnosis in such cases which mimic malignancy. Materials and Methods: The study was a retrospective study where data of all GI biopsies which were sent for histopathology at a tertiary care center in West India during a period of 18 months from July 2023 to December 2024 were retrieved. Special attention was paid to study the cases with mass lesions which had a suspicion of malignancy on clinical, endoscopic, or radiological study and finally had a histologically proven benign diagnosis. The clinicopathological profile of these cases was studied in detail. Results: A total of 173 GI biopsies were received of which 128 (74%) were nonneoplastic and 45 (26%) were neoplastic. Of the 45 neoplastic cases, 18 (40%) were benign and 27 (60%) were dysplastic/malignant. We found seven patients who were initially suspected of having GI malignancies but were ultimately diagnosed with benign or nonneoplastic conditions on histopathological examination. These cases were leiomyoma esophagus, inflammatory fibroid polyp duodenum, gastric lipoma, GI stromal tumor jejunum, filamentous mycosis pancreas, necrotizing granulomatous lesions in two cases, and mucosal prolapse polyp with submucosal vascular ectasia, rectum. Conclusion: This study highlights the importance of careful histo-pathological evaluation to avoid misdiagnosis and inappropriate management. The study also highlights the unusual/rare benign mimickers, the possibility of dual neoplasms, and the role of intraoperative frozen analysis in discrepant cases. Review of literature revealed few studies highlighting the clinic-radiological and histopathological profile of such cases of GI mimickers of malignancy; however, such studies are far less and encompass only isolated single case reports. To our knowledge, this is one of the largest case series with seven cases highlighting the clinic-pathological details and the diagnostic dilemmas.