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Zhu L, Li J, Liu C, Ding W, Lin F, Guo C, Liu L. Pulmonary inflammatory myofibroblastic tumor versus IgG4-related inflammatory pseudotumor: differential diagnosis based on a case series. J Thorac Dis 2017; 9:598-609. [PMID: 28449468 DOI: 10.21037/jtd.2017.02.89] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pulmonary inflammatory myofibroblastic tumor (IMT) has been considered as a synonym for inflammatory pseudotumor (IPT) for a long time. Recent studies have indicated that IMT and IgG4-related IPT are distinct diseases. However, no consensus criteria have been recommended. Here we propose a set of criteria for the differential diagnosis. METHODS Twenty-six archived IMT and IgG4-related IPT samples were examined for histological characteristics and the expression of IgG, IgG4, SMA and ALK-1. Based on our proposed criteria, we reclassified the cases into either IMT or IgG4-related IPT group and compared the clinicopathological features, laboratory findings, overall survivals (OS) and disease-free survivals between groups to validate the effectiveness and dependability of the diagnostic criteria. RESULTS The average age of IgG4-related IPT group was higher than IMTs (48.82 vs. 39.22 years, P=0.031). In IMT group, tumors were characterized by bigger tumor sizes (3.47 vs. 2.22 cm, P=0.007), diffuse and total destroyed alveoli (88.89% vs. 17.65%, P=0.002), fewer lymphoid follicles (1.6/HPF vs. 3.0/HPF, P=0.045) and lower expression of IgG (74.7/HPF vs. 149.1/HPF; P<0.001). As an exclusion criterion of IgG4-related IPT, ALK-positivity was correlated with the higher cytological atypia (mean 3.7/HPF, P<0.001) and lesser lymphoid follicles (mean 1.2/HPF, P=0.021). And it's the first study to show the liner positive correlation between the lymphocytes + plasma cells count and IgG4-positive plasma cells count in these lesions (r=0.914, P<0.001). The negative correlation between the IgG4-positive plasma cells count and the expression of ALK-1 are reported for the first time as well (rs=-0.632, P=0.001). However, despite two patients with recurrence or metastasis were divided into IMT group, only borderline values were detected in the survival analysis (OS 88.89% vs. 100%, P=0.197, DFS 77.78% vs. 100.00%; P=0.056). CONCLUSIONS The significant differences of clinicopathological characteristics between the IMTs and IgG4-related IPTs indicated that a combination of lymphocytes + plasma cells count, cytological atypia, IgG4 and ALK-1 staining will be helpful in differential diagnosis.
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Affiliation(s)
- Longfei Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wenshuang Ding
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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302
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Degheili JA, Kanj NA, Koubaissi SA, Nasser MJ. Indolent lung opacity: Ten years follow-up of pulmonary inflammatory pseudo-tumor. World J Clin Cases 2017; 5:61-66. [PMID: 28255550 PMCID: PMC5314263 DOI: 10.12998/wjcc.v5.i2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 11/30/2016] [Accepted: 12/14/2016] [Indexed: 02/05/2023] Open
Abstract
Inflammatory pseudotumor (IPT) has always been considered a diagnostic challenge. Its rarity and resemblance to other more common pathological entities imposes that neither clinical nor radiological characteristics can lead to a definitive diagnosis. The surgical excision of the lesion is the ultimate approach for accurate diagnosis and cure. Moreover the true nature of IPT, its origin as a neoplastic entity or an over-reactive inflammatory reaction to an unknown trigger, has been a long debated matter. Surgery remains the treatment of choice. IPT is mostly an indolent disease with minimal morbidity and mortality. Local invasion and metastasis predict a poor prognosis. We hereby present a unique case of pulmonary IPT that was surgically excised, but recurred contralaterally, shortly thereafter. Despite no medical or surgical treatment for ten years, the lesion has remained stable in size, with neither symptoms nor extra-pulmonary manifestations.
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303
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Dagur G, Gandhi J, Kapadia K, Inam R, Smith NL, Joshi G, Khan SA. Neoplastic diseases of the spermatic cord: an overview of pathological features, evaluation, and management. Transl Androl Urol 2017; 6:101-110. [PMID: 28217455 PMCID: PMC5313312 DOI: 10.21037/tau.2017.01.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Extracellular tumors found with the spermatic cord, known as neoplasms, are usually identified to be benign. However, the accurate and timely diagnosis of spermatic cord masses is highly crucial, especially when most results are often overlooked or unclear. In this review, we discuss the anatomy and embryology of the spermatic cord. Upon rooting these fundamental concepts, we discuss an array of benign and malignant neoplastic tumors, including their origin, pathological features, clinical evaluation and management, as well as other case-specific characteristics of unique presentation. Many of these neoplasms are based on local neurological, vascular, muscular, bone, soft tissue, or lymphatic origin, while others have metastasized from particular areas of the body.
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Affiliation(s)
- Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Kailash Kapadia
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Rafid Inam
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA;; Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Abstract
PURPOSE The aim of the study was to describe the clinical, radiographic, and pathologic features of inflammatory myofibroblastic tumor (IMT) to enhance the recognition of this rare disease. MATERIALS AND METHODS The clinical, imaging, and pathologic findings were retrospectively reviewed in 54 patients with IMT lesions, which were conformed by biopsy or surgical pathology. Of 54 patients, 51 had preoperative computed tomography (CT) examination and 13 had preoperative magnetic resonance imaging records. RESULTS The clinical appearances of these 54 patients had some relationship with the locations of lesions. Of 54 IMT patients, 87.0% cases (47/54) had solitary lesion. The mean long diameter of the lesions located at the sites of chest, abdomen, and pelvic regions was bigger than that of other locations (F = 3.025, P = 0.038). On plain CT images, soft tissue mass was found in all IMT lesions, except for 3 lesions that arose in the intestine tract, appearing as focal or diffuse thickening in the bowel wall. After contrast administration, all lesions were persistently enhanced; 72.7% cases (24/33) demonstrated heterogeneous enhancement with various cystic regions. Comparing the CT features with different anatomic lesions, ill-defined margin on the plain CT images and calcification were seen more frequently in the lesions of the head and neck (P = 0.010 and 0.035); however, the other radiological findings had no significant differences (all P > 0.05). Twelve of 51 IMT patients showed invasion into adjacent structures. On magnetic resonance imaging, 92.3% lesions (12/13) showed soft tissue masses demonstrating isointense to hypointense contrast compared with skeletal muscle on T1-weighted images and heterogeneously high signals on T2-weighted images; 85.7%(6/7) of lesions were heterogeneously enhanced with cystic changes. Immunohistochemistry showed that the percentage of positive staining for SMA, vimentin, anaplastic lymphoma kinase, CD68, CD34, CD99, B-cell lymphoma/leukemia-2, cytokeratin, Desmin, and S-100 protein were 88.9%, 87.0%, 44.4%, 59.3%, 53.7%, 29.6%, 42.6%, 28.5%, 13.0%, and 24.1%, respectively. CONCLUSIONS Inflammatory myofibroblastic tumor can involve any part of the body, and the clinical and radiological appearances are various owing to different anatomic sites. An ill-defined soft tissue mass heterogeneous enhancement with or without invasion into adjacent structures on computed tomographic or magnetic resonance images and positive staining for SMA and vimentin on immunohistochemical examination could suggest the diagnosis.
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305
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Guffey Johnson J, Margo CE. Intraocular inflammatory mass associated with lens-induced uveitis. Surv Ophthalmol 2017; 62:541-545. [PMID: 28069494 DOI: 10.1016/j.survophthal.2016.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/30/2023]
Abstract
Intraocular inflammatory tumefactions large enough to simulate neoplasms are uncommon. We report a patient with a large intraocular inflammatory mass composed of cells with features of histiocytes and myofibroblasts that was associated with lens-induced uveitis. The spindle cell mass appears to have arisen as an exaggerated response to exposed lens fibers. Although information from immunohistochemistry and cytogenetics has advanced the classification of inflammatory tumefactions, this case highlights the challenges in establishing the nature of these lesions.
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Affiliation(s)
- Jean Guffey Johnson
- Department of Pathology, James A. Haley Veterans Affairs Hospital, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA; Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
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306
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O'Neill AC, Jagannathan JP, Ramaiya NH. Evolving Cancer Classification in the Era of Personalized Medicine: A Primer for Radiologists. Korean J Radiol 2017; 18:6-17. [PMID: 28096714 PMCID: PMC5240478 DOI: 10.3348/kjr.2017.18.1.6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/26/2016] [Indexed: 01/04/2023] Open
Abstract
Traditionally tumors were classified based on anatomic location but now specific genetic mutations in cancers are leading to treatment of tumors with molecular targeted therapies. This has led to a paradigm shift in the classification and treatment of cancer. Tumors treated with molecular targeted therapies often show morphological changes rather than change in size and are associated with class specific and drug specific toxicities, different from those encountered with conventional chemotherapeutic agents. It is important for the radiologists to be familiar with the new cancer classification and the various treatment strategies employed, in order to effectively communicate and participate in the multi-disciplinary care. In this paper we will focus on lung cancer as a prototype of the new molecular classification.
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Affiliation(s)
- Ailbhe C O'Neill
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | | | - Nikhil H Ramaiya
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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307
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Mir MH, Dar W, Aejaz Aziz S, Mohamad G, Wani B. Clinico-radiological and Pathological Characteristics of Inflammatory Myofibroblastic Tumors in Children: A Retrospective Study. Indian J Med Paediatr Oncol 2017; 38:261-265. [PMID: 29200670 PMCID: PMC5686963 DOI: 10.4103/ijmpo.ijmpo_178_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Inflammatory myofibroblastic tumors (IMTs) are rare, benign lesions most often seen in the lung of young adults but can occur in children, in various sites. They mimic, clinically and radiologically, malignant tumors - especially sarcomas and lymphomas. The aim was to review the clinical, radiological, and pathological data of children with a diagnosis of IMT referred to our department. Materials and Methods This retrospective study was conducted at the Department of Medical and Paediatric Oncology, Regional Cancer Centre, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India from January 2014 to December 2015. Results Among 288 pediatric tumors registered during the study, 5 (1.73%) had the diagnosis of IMTs. The main symptoms were abdominal distension and pain in 60% (three cases), breathlessness and cough in 20% (one case), and right axillary area swelling in 20% (one case). In three patients, complete surgical excision was done, whereas another patient with retroperitoneal mass had the residual disease and received chemotherapy followed by complete second surgery. In the case of mediastinal IMT, surgery was followed by local radiotherapy. At present, four patients are disease-free and one patient with mediastinal IMT has the residual progressive disease. Conclusion On presentation, IMT can constitute a formidable challenge, from diagnosis through to treatment.
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Affiliation(s)
- Mohamad Hussain Mir
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Waseem Dar
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sheikh Aejaz Aziz
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Gul Mohamad
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Burhan Wani
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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308
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Lee JC, Li CF, Huang HY, Zhu MJ, Mariño-Enríquez A, Lee CT, Ou WB, Hornick JL, Fletcher JA. ALK oncoproteins in atypical inflammatory myofibroblastic tumours: novel RRBP1-ALK fusions in epithelioid inflammatory myofibroblastic sarcoma. J Pathol 2016; 241:316-323. [PMID: 27874193 DOI: 10.1002/path.4836] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/15/2016] [Accepted: 10/20/2016] [Indexed: 12/29/2022]
Abstract
ALK oncogenic activation mechanisms were characterized in four conventional spindle-cell inflammatory myofibroblastic tumours (IMT) and five atypical IMT, each of which had ALK genomic perturbations. Constitutively activated ALK oncoproteins were purified by ALK immunoprecipitation and electrophoresis, and were characterized by mass spectrometry. The four conventional IMT had TPM3/4-ALK fusions (two cases) or DCTN1-ALK fusions (two cases), whereas two atypical spindle-cell IMT had TFG-ALK and TPM3-ALK fusion in one case each, and three epithelioid inflammatory myofibroblastic sarcomas had RANBP2-ALK fusions in two cases, and a novel RRBP1-ALK fusion in one case. The epithelioid inflammatory myofibroblastic sarcoma with RRBP1-ALK fusion had cytoplasmic ALK expression with perinuclear accentuation, different from the nuclear membranous ALK localization in epithelioid inflammatory myofibroblastic sarcomas with RANBP2-ALK fusions. Evaluation of three additional uncharacterized epithelioid inflammatory myofibroblastic sarcomas with ALK cytoplasmic/perinuclear- accentuation expression demonstrated RRBP1-ALK fusion in two cases. These studies show that atypical spindle-cell IMT can utilize the same ALK fusion mechanisms described previously in conventional IMT, whereas in clinically aggressive epithelioid inflammatory myofibroblastic sarcoma we identify a novel recurrent ALK oncogenic mechanism, resulting from fusion with the RRBP1 gene. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Bone and soft tissue study group, Taiwan Society of Pathology
| | - Chien-Feng Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.,Bone and soft tissue study group, Taiwan Society of Pathology
| | - Hsuan-Ying Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Bone and soft tissue study group, Taiwan Society of Pathology
| | - Mei-Jun Zhu
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, the United States
| | - Adrián Mariño-Enríquez
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, the United States
| | - Chung-Ta Lee
- Department of Pathology, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Wen-Bin Ou
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, the United States.,Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences, Zhejiang Sci-Tech University, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, the United States
| | - Jonathan A Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, the United States
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309
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Liu L, Kong X, Lu X, Cao D. Pediatric Endobronchial Inflammatory Myofibroblastic Tumor: A Case Report and Review of the Literature. Clin Pract 2016; 6:853. [PMID: 28174621 PMCID: PMC5294928 DOI: 10.4081/cp.2016.853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) belongs to the group of soft tissue tumor and could occur at any anatomical site from the central nervous system to gastrointestinal tract. The lung and abdomen are commonly affected sites, however, pulmonary IMT is predominantly located within the parenchyma rather than presenting as endobronchial lesion. IMTs may occur in any age group, but they are observed most commonly in children and adolescents. Here, we present a case of IMT arising from the left main stem bronchus in a 10-year-old girl.
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Affiliation(s)
- Leilei Liu
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
| | - Xianglei Kong
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
| | - Xiaoqian Lu
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
| | - Dianbo Cao
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
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310
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Tameron AM, Kelley SR. Malignant Transformation of an Extrapulmonary Inflammatory Myofibroblastic Tumor. Am Surg 2016. [DOI: 10.1177/000313481608201212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Scott R. Kelley
- Mayo Clinic Division of Colon and Rectal Surgery Rochester, Minnesota
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311
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Kansara S, Bell D, Johnson J, Zafereo M. Head and neck inflammatory pseudotumor: Case series and review of the literature. Neuroradiol J 2016; 29:440-446. [PMID: 27650653 PMCID: PMC5131759 DOI: 10.1177/1971400916665377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.
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Affiliation(s)
- Sagar Kansara
- Department of Head and Neck Surgery, MD Anderson Cancer Center, The University of Texas Medical School at Houston, USA
| | - Diana Bell
- Department of Pathology, MD Anderson Cancer Center, USA
| | - Jason Johnson
- Department of Diagnostic Radiology, MD Anderson Cancer Center, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, USA
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312
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Tateishi Y, Okudela K, Kawai S, Suzuki T, Umeda S, Matsumura M, Kioi M, Ohashi K. Intraosseous inflammatory myofibroblastic tumor of the mandible with a novel ATIC-ALK fusion mutation: a case report. Diagn Pathol 2016; 11:132. [PMID: 27846861 PMCID: PMC5111215 DOI: 10.1186/s13000-016-0586-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 11/09/2016] [Indexed: 11/29/2022] Open
Abstract
Background Inflammatory myofibroblastic tumor (IMT) is a rare low-grade malignant neoplasm with a predilection for children and young adults, and typically arises in the lung, abdominopelvic region, and retroperitoneum. IMTs in the maxillofacial region are extreme rare. Approximately 50% of IMT harbor rearrangements of the anaplastic lymphoma kinase (ALK) gene at 2p23 with various fusion partners. Case presentation We herein report a case of intraosseous IMT of the mandible with a novel ATIC-ALK fusion. Tooth 43 did not erupt after the loss of tooth 83 in an 11-year-old girl with no previous history of trauma. Panoramic tomography showed a unilocular radiolucent lesion in the right anterior mandible resorbing the root of tooth 42 and the medial side of the root of tooth 44. Computed tomography revealed a well- circumscribed 3-cm osteolytic lesion of the right anterior mandible eroding the buccal cortical plate. The entire lesion was curetted out. A histopathological examination revealed the proliferation of plump spindle cells with a storiform architecture and lymphocytes scattered around spindle cells. The spindle cells showed diffuse cytoplasmic staining for ALK by immunohistochemistry. A fluorescence in situ hybridization analysis revealed the translocation of a part of the ALK gene locus at chromosome 2p23. A rapid amplification of cDNA ends analysis confirmed the rearrangement of ALK and identified ATIC as a partner of this ALK fusion mutant. Conclusion To the best of our knowledge, this is the first case of intraosseous IMT of the mandible with a novel ATIC-ALK fusion. We also herein reviewed similar tumors reported in the literature.
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Affiliation(s)
- Yoko Tateishi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeo Kawai
- Department of Pathology, Japanese Red-Cross Musashino Hospital, Tokyo, Japan
| | - Takehisa Suzuki
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeaki Umeda
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mai Matsumura
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mitomu Kioi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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313
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Kumar E, Patel NR, Demicco EG, Bovee JV, Olivera AM, Lopez-Terrada DH, Billings SD, Lazar AJ, Wang WL. Cutaneous nodular fasciitis with genetic analysis: a case series. J Cutan Pathol 2016; 43:1143-1149. [DOI: 10.1111/cup.12828] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/29/2016] [Accepted: 09/25/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Erica Kumar
- Department of Pathology; Regional Medical Laboratory; Tulsa OK, USA
| | - Nimesh R. Patel
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital; Brown University; Providence USA
| | - Elizabeth G. Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital; New York NY USA
| | | | - Andre M. Olivera
- Department of Pathology and Laboratory Medicine, Mayo Clinic; Rochester MN USA
| | - Dolores H. Lopez-Terrada
- Department of Pathology, Immunology and Pediatrics, Texas Children's Hospital/Baylor College of Medicine; Houston TX USA
| | | | - Alexander J. Lazar
- Department of Pathology and Translational Molecular Pathology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Wei-Lien Wang
- Department of Pathology and Translational Molecular Pathology; The University of Texas MD Anderson Cancer Center; Houston TX USA
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314
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Abstract
Primary heart tumors are extremely rare, constituting approximately 0.02% of all malignancies. Inflammatory myofibroblastic tumor (IMT) constitutes <5% of primary heart tumors. Until now, IMT of the heart has been described in 21 infants below 1 year of age. Its etiology remains unknown. IMT usually develops within the right atrial and ventricular endocardium. The main clinical symptoms reported in the affected infants involved increasing respiratory failure, cyanosis, and heart murmurs. Histopathologically, IMT is characterized by the myofibroblast proliferation with inflammatory infiltrates composed of plasmocytes, lymphocytes, and histiocytes. Tumor resection is the treatment of choice in IMT. Such tumor location is associated with the high risk of perioperative failure. Steroid therapy and chemotherapy is reported in the literature as a nonsurgical treatment alternative. Here, we present a review of clinical symptoms, diagnostic and treatment options, based on published case reports of IMT in infants, including our 11-month-old patient with IMT located within the pericardium.
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315
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de Menezes S, Mar A, Dowling J, Wright A. A Case of Cutaneous Inflammatory Myofibroblastic Tumor. Pediatr Dermatol 2016; 33:e377-e380. [PMID: 27653445 DOI: 10.1111/pde.12970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) rarely occurs as a primary cutaneous lesion. We report a case of cutaneous IMT in an 8-year-old girl presenting with an ulcerated nodule on the cheek. Although cutaneous IMT poses a diagnostic challenge because of its rarity, excision of the lesion is likely to be curative.
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Affiliation(s)
- Sara de Menezes
- Department of Dermatology, Monash Medical Centre Clayton, Clayton, VIC, Australia
| | - Adrian Mar
- Department of Dermatology, Monash Medical Centre Clayton, Clayton, VIC, Australia
| | - John Dowling
- Department of Pathology, Monash Medical Centre Clayton, Clayton, VIC, Australia
| | - Annaliesa Wright
- Department of Dermatology, Monash Medical Centre Clayton, Clayton, VIC, Australia
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316
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Aggressive Metastatic Inflammatory Myofibroblastic Tumor After Allogeneic Stem Cell Transplant With Fatal Pulmonary Toxicity From Crizotinib. J Pediatr Hematol Oncol 2016; 38:642-645. [PMID: 27271810 DOI: 10.1097/mph.0000000000000594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare tumors with an intermediate spectrum of biological behavior. IMTs are uncommon secondary malignancies after hematopoietic stem cell transplant. The presence of anaplastic lymphoma kinase rearrangements in 50% of IMTs has led to therapeutic trials with crizotinib, although limited experience remains with crizotinib use in children. We describe the first reported case of a highly aggressive and metastatic IMT (secondary malignancy) in an 8-year-old girl following umbilical cord blood transplant. Although tumor response was demonstrated with anaplastic lymphoma kinase inhibition, she later developed fatal pulmonary toxicity from diffuse alveolar damage, a feature felt most likely to be due to crizotinib.
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317
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Kichenaradjou A, Barrett AW, Norris P, Rowell N, Newman L. Inflammatory pseudotumour of the maxilla. Oral Maxillofac Surg 2016; 20:309-312. [PMID: 27052813 DOI: 10.1007/s10006-016-0553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
Inflammatory pseudotumour (IP), also known as inflammatory myofibroblastic tumour (IMT), is a rare lesion of the maxillofacial skeleton and a diagnosis by exclusion. We describe three cases which affected the maxilla, two women and one man of ages 67, 56 and 70 years at presentation. All showed the typical, rather non-specific histopathological features. IgG4-positive plasma cells varied greatly in prominence, and none of the three lesions expressed ALK-1. Both women responded to steroids and radiotherapy, though one also required azathioprine. Despite maxillectomy, radiotherapy, steroids and cyclophosphamide, the man suffered intracranial spread and succumbed to persistent disease. The cases described here demonstrate the clinicopathological difficulties presented by this entity and its aggressive, unpredictable behaviour.
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Affiliation(s)
- A Kichenaradjou
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK.
- , 6 Smeeds Close, East Grinstead, West Sussex, RH19 3AL, UK.
| | - A W Barrett
- Department of Histopathology, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK
| | - P Norris
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK
| | - N Rowell
- Kent Oncology Centre, Maidstone Hospital, Maidstone, ME16 9QQ, UK
| | - L Newman
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK
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318
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D'Cunha A, Jehangir S, Thomas R. Inflammatory Myofibroblastic Tumor of Common Bile Duct in a Girl. APSP J Case Rep 2016; 7:28. [PMID: 27672578 PMCID: PMC5027059 DOI: 10.21699/ajcr.v7i4.445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare, low grade malignant lesion which can occur anywhere in the body. In children it is usually found in the visceral soft tissues with a potential for local invasion and recurrence, and rarely distant metastasis. We report the diagnostic dilemma faced in the management of a 12-year old girl who presented with obstructive jaundice with a mass lesion at the distal end of the common bile duct. She underwent a tumor resection with a bilio-enteric bypass followed by a course of oral steroids and celecoxib.
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Affiliation(s)
- Aureen D'Cunha
- Department of Pediatric Surgery, Christian Medical College, Vellore,INDIA
| | - Susan Jehangir
- Department of Pediatric Surgery, Christian Medical College, Vellore,INDIA
| | - Reju Thomas
- Department of Pediatric Surgery, Christian Medical College, Vellore,INDIA
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319
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Abstract
While initially controversial, the proposal that a subset of inflammatory pseudotumours were myofibroblastic neoplasms is now acknowledged. Inflammatory myofibroblastic tumour is a spindle cell neoplasm of intermediate biological potential that may arise in a wide range of anatomic sites but has a particular propensity for the lung and abdominal soft tissues. Depending on its location, IMT may present with a variety of clinical symptoms and it may also express a variable pathologic phenotype, leading to a broad range of clinical and pathological differentials. Recent discoveries about the molecular signatures of IMT not only provide additional tools to assist in their diagnosis, they also point to possible therapeutic interventions that may transform the management algorithms for patients with this condition.
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Affiliation(s)
- Michael McDermott
- Dept of Paediatric Laboratory Medicine, Our Lady׳s Children׳s Hospital, Crumlin, Dublin 12, Ireland.
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320
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Devic P, Gallay L, Streichenberger N, Petiot P. Focal myositis: A review. Neuromuscul Disord 2016; 26:725-733. [PMID: 27726926 DOI: 10.1016/j.nmd.2016.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022]
Abstract
Amongst the heterogeneous group of inflammatory myopathies, focal myositis stands as a rare and benign dysimmune disease. Although it can be associated with root and/or nerve lesions, traumatic muscle lesions and autoimmune diseases, its triggering factors remain poorly understood. Defined as an isolated inflammatory pseudotumour usually restricted to one skeletal muscle, clinical presentation of focal myositis is that of a rapidly growing solitary mass within a single muscle, usually in the lower limbs. Electromyography shows spontaneous activity associated with a myopathic pattern. MRI reveals a contrast enhanced enlarged muscle appearing hyper-intense on FAT-SAT T2 weighted images. Adjacent structures are spared and there are no calcifications. Serum creatine kinase (CK) levels are usually moderately augmented and biological markers of systemic inflammation are absent in most cases. Pathological histological features include marked variation in fibre size, inflammatory infiltrates mostly composed of T CD4+ lymphocytes and macrophages, degenerating/regenerating fibres and interstitial fibrosis. Differential diagnoses are numerous and include myositis of other origin with focal onset. Steroid treatment should be reserved for patients who present with major pain, nerve lesions, associated autoimmune disease, or elevated C reactive protein or CK.
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Affiliation(s)
- P Devic
- Department of Functional Neurology and Epileptology, Pierre Wertheimer Neurology University Hospital, 69 Bdv Pinel, 69677 Bron-Cedex, France; University Claude Bernard Lyon-I, France.
| | - L Gallay
- University Claude Bernard Lyon-I, France; Department of Clinical Immunology, Pavillon O, Edouard Herriot University Hospital, 5 place d'Arsonval, 69437 Lyon Cedex 03, France; NeuroMyoGen Institute, CNRS UMR 5310 - INSERM U1217, France
| | - N Streichenberger
- University Claude Bernard Lyon-I, France; NeuroMyoGen Institute, CNRS UMR 5310 - INSERM U1217, France; Department of Pathology, Lyon East University Hospital, 69 Bdv Pinel, 69677 Bron-Cedex, France
| | - P Petiot
- Department of Neurology, Croix-Rousse University Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
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321
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Al Sannaa G, Wimmer JL, Ayala AG, Ro JY. An isolated inflammatory myofibroblastic tumor of adrenal gland. Ann Diagn Pathol 2016; 25:33-36. [PMID: 27806843 DOI: 10.1016/j.anndiagpath.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 01/25/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon lesion that shows a wide range of anatomic distribution. The adrenal gland, however, is a distinctly rare site of occurrence. To date, only a few cases of IMT arising in the adrenal gland have been reported in the English literature. Here, we report another case of isolated adrenal IMT. A 34-year-old man presented to the emergency department with a complaint of a sudden severe right-sided back pain. Subsequent computed tomographic scan imaging studies demonstrated a large right adrenal mass associated with a hematoma. The right adrenal gland was resected. Microscopic examination revealed an encapsulated cellular spindle cell proliferation with a prominent inflammatory infiltrate. Immunohistochemically, those spindle cells were diffusely and strongly positive for anaplastic lymphoma kinase-1, and focally and weakly positive for smooth muscle actin. S-100 protein and cytokeratin were negative. The findings were consistent with IMT arising from the adrenal gland. Although IMTs in the adrenal gland are rare, they should be considered in the differential diagnosis of adrenal masses. The clinical behavior of IMTs in general is currently indeterminate and a close clinical follow-up is recommended. The behavior of adrenal IMTs remains uncertain because of rare reported cases and lack of long-term follow-up. Further follow-up of reported cases and recognition of additional new cases is warranted to unmask the true biological behavior of adrenal IMTs.
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Affiliation(s)
- Ghadah Al Sannaa
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jana L Wimmer
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Alberto G Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.
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322
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ALK-positive inflammatory myofibroblastic tumor harboring ALK gene rearrangement, occurring after allogeneic stem cell transplant in an adult male. Pathol Res Pract 2016; 212:743-6. [DOI: 10.1016/j.prp.2016.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/03/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
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323
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Suzuki S, Hanata K, Toyoma S, Nanjo H, Saito H, Iikawa N, Ishikawa K. Carcinosarcoma of the larynx consisting of squamous cell carcinoma and inflammatory myofibroblastic tumor components. Auris Nasus Larynx 2016; 43:460-3. [DOI: 10.1016/j.anl.2015.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
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324
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Chen M, Zhang L, Cao G, Zhu W, Chen X, Fang Q. Partial response to chemotherapy in a patient with retroperitoneal inflammatory myofibroblastic tumor. Mol Clin Oncol 2016; 5:463-466. [PMID: 27699044 DOI: 10.3892/mco.2016.967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/26/2016] [Indexed: 11/06/2022] Open
Abstract
Retroperitoneal inflammatory myofibroblastic tumor (IMT) is a rare lesion of unknown etiology. The management of IMT may be challenging due to its intermediate malignant potential, the possibility of local recurrence after surgical resection and its unique anatomic location, which makes radical resection impossible due to its proximity to vital structures. Thus, treatment for recurrence and metastasis mainly relies on chemotherapy. We herein report a case of a 60-year-old man with an IMT sized 6.7×5.1 cm, located in the left adrenal area, which was identified by a computed tomography (CT) scan of the abdomen. Radical surgical resection of the tumor was not feasible, as it was fixed to the left renal artery. After 5 months, the patient underwent CT-guided radiofrequency ablation of the re-growing tumor. An unresectable mass was detected in the patient's rectum by a CT scan of the pelvis. Subsequently, the patient underwent chemotherapy for the recurring and metastatic tumors. The chemotherapeutic regimens included epirubicin, dacarbazine and docetaxel. Over the last 6 months, after three cycles of therapy, the sizes of the primary and metastatic tumors had decreased on the follow-up CT scan. Thus, chemotherapy effectively controlled the disease in this case, following unsuccessful surgical resection and radiofrequency ablation. The present case report highlights the complexity of treatment in such cases and the significance of designing a clinical protocol for the treatment of IMT.
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Affiliation(s)
- Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Lihua Zhang
- Department of Pathology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Guochun Cao
- Department of Internal Medicine, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Weidong Zhu
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Xuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Quan Fang
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
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325
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Yu L, Liu J, Lao IW, Luo Z, Wang J. Epithelioid inflammatory myofibroblastic sarcoma: a clinicopathological, immunohistochemical and molecular cytogenetic analysis of five additional cases and review of the literature. Diagn Pathol 2016; 11:67. [PMID: 27460384 PMCID: PMC4962498 DOI: 10.1186/s13000-016-0517-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/19/2016] [Indexed: 12/04/2022] Open
Abstract
Background To explore the clinical characteristics and pathological features of epithelioid inflammatory myofibroblastic sarcoma (EIMS) with emphasis on the diagnostic spectrum. Methods The clinical data and histological features in 5 additional cases of EIMS were retrospectively reviewed. Immunohistochemical study and interphase fluorescence in situ hybridization (FISH) analysis were carried out. Results There were 2 males and 3 females with age at presentation ranging from 15 to 58 years (mean, 37 years). All 5 tumors were intra-abdominal with 2 arising in the mesentery and 1 each in the omentum, rectum and transverse colon. The tumor size ranged from 5 to 20 cm in maximum diameter (mean, 10.7 cm). Histologically, all 5 tumors were composed predominantly of large epithelioid cells possessing vesicular nuclei, prominent nucleoli, and amphophilic cytoplasm. Mitotic figures were easily identified (mean, 20/10HPF). Tumor cells were arranged in clusters or sheets embedded in a myxoid stroma containing prominent neutrophils. A minor component of spindle cells was present in focal areas. By immunohistochemistry, all 5 cases were positive for anaplastic lymphoma kinase (ALK) with a nuclear membrane pattern in 4 and cytoplasmic staining with perinuclear accentuation in 1. Besides ALK, tumor cells stained variably for desmin (4/5), alpha smooth muscle actin (2/5), muscle-specific actin (1/2) and pan-cytokeratin (1/4). FISH analysis demonstrated the presence of ALK rearrangement in all 5 cases. Of 5 patients, 3 developed local recurrence, 1 died of disease 8 months after surgery. Conclusion EIMS represents a highly aggressive variant of inflammatory myofibroblastic tumor characterized by epithelioid morphology, prominent neutrophilic infiltrate, and nuclear membrane staining of ALK with ALK rearrangement. As patients with ALK-rearrangement tumors may benefit from targeted therapy, accurate diagnosis of EIMS is very important. Familiar with the characteristic features of EIMS will help pathologists avoid misdiagnosing the tumor as other malignancies.
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Affiliation(s)
- Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jinguo Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University and Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, 270 Dong An Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, 270 Dong An Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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326
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Inflammatory pseudotumor (IPT)-surgical cure of an inflammatory syndrome. Eur J Pediatr 2016; 175:903-8. [PMID: 27073061 DOI: 10.1007/s00431-016-2718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/07/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED We report on four female adolescents, who presented with inflammatory symptoms. Extensive diagnostic workup revealed tumors on different locations. After surgical removal, clinical and laboratory signs of inflammation disappeared rapidly. On histology, the tumors showed a mixture of inflammatory cells characteristic of inflammatory pseudotumors in three of the patients. CONCLUSION In patients with unclear inflammatory symptoms, inflammatory pseudotumor should be added to the differential diagnosis. WHAT IS KNOWN • The inflammatory pseudotumor (IPT) is a mostly benign myofibroblastic tumor of the soft tissue and causes inflammatory symptoms. What is new: • IPTs have may wider than hitherto defined histologic features. Removal of IPT is curative.
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327
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Wang X, Zhao X, Chin J, Zhu L, Wang Z, Zhong Z. Recurrent retroperitoneal inflammatory myofibroblastic tumor: A case report. Oncol Lett 2016; 12:1535-1538. [PMID: 27446466 DOI: 10.3892/ol.2016.4767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 06/07/2016] [Indexed: 01/25/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT), which was previously known as inflammatory pseudotumor, is characterized by myofibroblastic spindle cells accompanied by inflammatory infiltrates. IMT is a rare lesion of unclear etiology, which induces non-specific clinical symptoms. The present case report describes a 74-year-old female patient with recurrent IMT, which was successfully re-resected 30 months subsequent to initial surgical removal. The patient presented with left hydroureteronephrosis and a 10-cm paravertebral mass which, upon surgery, was found to involve the descending colon. Successful, complete en bloc re-resection was achieved, and at 24 months follow-up, the patient remained clinically free of disease. Complete surgical extirpation, where feasible, is the recommended treatment for primary and recurrent IMT lesions.
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Affiliation(s)
- Xinjun Wang
- Department of Urology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Joseph Chin
- Department of Surgery, Division of Urology, London Health Sciences Centre, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Liang Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zijian Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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328
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For staining of ALK protein, the novel D5F3 antibody demonstrates superior overall performance in terms of intensity and extent of staining in comparison to the currently used ALK1 antibody. Virchows Arch 2016; 469:345-50. [DOI: 10.1007/s00428-016-1969-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/09/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022]
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329
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Mohammad Hoseini-Azar M, Mokhtare M, Zare-Mirzaie A, Gholami A, Agah S, Ghafoori SMS. Fever,Weight Loss and Early Satiety due to Gastric Inflammatory Myofibroblastic Tumor; Case Report and Literature Review. Middle East J Dig Dis 2016; 8:138-42. [PMID: 27252821 PMCID: PMC4885613 DOI: 10.15171/mejdd.2016.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Gastric inflammatory myofibroblastic tumor (IMT) is a rare tumor with and
unpredictable prognosis usually find in young adults. We present an 18-yearold
man with gastric IMT. He complained of epigastric pain, intermittent fever
and night sweating associated with weight loss since two years ago. Physical
examination showed anemic and cachestic features with mild abdominal tenderness
in palpitation as well as an abdominal mass in epigastrium. Abdominal
CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy
revealed a submucosal lesion in fundus of stomach of approximately
8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous
fundal mass with areas of calcification. The patient underwent laparoscopic
partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed
an IMT.
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Affiliation(s)
| | - Marjan Mokhtare
- Assistant Professor, Colorectal Research center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zare-Mirzaie
- Associate Professor,Department of Pathology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Gholami
- Assistant Professor,Department of Internal Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Agah
- Professor, Colorectal Research center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Sadegh Ghafoori
- Medical student, Colorectal Research center, Medical Student Research Committee (MSRC), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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330
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Kiratli H, Uzun S, Varan A, Akyüz C, Orhan D. Management of anaplastic lymphoma kinase positive orbito-conjunctival inflammatory myofibroblastic tumor with crizotinib. J AAPOS 2016; 20:260-3. [PMID: 27312965 DOI: 10.1016/j.jaapos.2016.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/13/2016] [Indexed: 11/25/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a distinct mesenchymal neoplasm of myofibroblastic spindle cells associated with an inflammatory infiltrate formed by lymphocytes, eosinophils, and plasma cells in a myxoid or collagenous stroma. This tumor has a predilection for children and young adults and most commonly occurs in the lungs, retroperitoneum, abdomen, and pelvis. Ocular and orbital involvement is exceedingly rare. We describe a case of IMT in a 7-year-old girl involving the cornea, conjunctiva, and the anterior orbit treated with crizotinib, resulting in complete tumor remission.
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Affiliation(s)
- Hayyam Kiratli
- Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey.
| | - Salih Uzun
- Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
| | - Ali Varan
- Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
| | - Canan Akyüz
- Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
| | - Diclehan Orhan
- Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
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331
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Deepak J, Aravind KL, Gowrishankar, Ramesh S. A Case of Rare Small Bowel Tumor in a Child and Review of Literature. Indian J Surg Oncol 2016; 6:292-5. [PMID: 27217683 DOI: 10.1007/s13193-015-0417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/19/2015] [Indexed: 01/25/2023] Open
Affiliation(s)
- J Deepak
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India ; No.1247, 8th cross, Chandra layout, Vijayanagar Bangalore, 560040 India
| | - K L Aravind
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| | - Gowrishankar
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| | - S Ramesh
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
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332
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Dhuria S, Kwatra KS, Ghosh DN. Inflammatory myofibroblastic tumour of sigmoid mesocolon in a child. ANZ J Surg 2016; 88:E674-E676. [PMID: 27193458 DOI: 10.1111/ans.13625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/09/2016] [Accepted: 04/04/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Sumit Dhuria
- Department of Pediatric Surgery, Christian Medical College & Hospital, Ludhiana, India
| | | | - Dhruva Nath Ghosh
- Department of Pediatric Surgery, Christian Medical College & Hospital, Ludhiana, India
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333
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Complete and Repeated Response of a Metastatic ALK-rearranged Inflammatory Myofibroblastic Tumor to Crizotinib in a Teenage Girl. J Pediatr Hematol Oncol 2016; 38:308-11. [PMID: 26808369 DOI: 10.1097/mph.0000000000000498] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inflammatory myofibroblastic tumors (IMT) are rare tumors in children and young adults, considered by the World Health Organization to be intermediate malignancies and rarely metastasizing, with the presence of an anaplastic lymphoma kinase rearrangement in about 50% of the cases. We report the case of a teenager who presented with a metastatic aggressive IMT that was life-threatening despite multiple treatments, and which responded repeatedly to anaplastic lymphoma kinase-targeted crizotinib therapy. Crizotinib induced drastic primary tumor regression, which was sufficient to allow surgical resection and to control distant disease. This case shows that crizotinib is a promising therapy in IMT, even in adolescents and young adults.
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334
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Oeconomopoulou A, de Verney Y, Kanavaki K, Stefanaki K, Pavlakis K, Salakos C. Inflammatory myofibroblastic tumor of the small intestine mimicking acute appendicitis: a case report and review of the literature. J Med Case Rep 2016; 10:100. [PMID: 27094797 PMCID: PMC4837596 DOI: 10.1186/s13256-016-0880-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/22/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor is a rare tumor of a borderline malignancy. Although it is commonly seen in children, the number of childhood cases in the current literature is limited. The lung is the most commonly affected location. However, cases that have been documented in the mesentery-omentum have mostly been located in the mesentery of the small bowel and not in the antimesenteric edge as in our patient. CASE PRESENTATION A 6-year-old Greek boy was referred to our hospital with acute abdominal pain mimicking appendicitis. Ultrasound and computed tomography revealed a solid mass in the abdomen. The patient underwent laparoscopic resection of the tumor, and histopathology and immunohistochemical analysis favored an omental-mesenteric myxoid hamartoma, which is a variant of an inflammatory myofibroblastic tumor. The patient's postoperative course was uneventful, and he has been asymptomatic during follow-up. CONCLUSIONS Inflammatory myofibroblastic tumor of the small intestine is a rare, benign neoplasm in children that should be considered as a possible cause of acute abdomen. A precise diagnosis can be made on the basis of histologic findings. Surgical excision is the treatment of choice.
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Affiliation(s)
- Alexandra Oeconomopoulou
- />Pediatric Department, “IASO” Maternity and Children’s Hospital, 37-39 Kifisias Street, 15123 Marousi, Athens Greece
| | - Yvelise de Verney
- />Pediatric Department, “IASO” Maternity and Children’s Hospital, 37-39 Kifisias Street, 15123 Marousi, Athens Greece
| | - Katerina Kanavaki
- />Pediatric Radiology Department, “IASO” Maternity and Children’s Hospital, 37-39 Kifisias Street, 15123 Marousi, Athens Greece
| | - Kalliopi Stefanaki
- />Department of Pathology, Children’s Hospital “Aghia Sophia”, Thivon & Levadias, 11527 Goudi, Athens Greece
| | - Kitty Pavlakis
- />Department of Pathology, “IASO” Maternity and Children’s Hospital, 37-39 Kifisias Street, 15123 Marousi, Athens Greece
| | - Christos Salakos
- />Pediatric Surgery Department, “ΑΤΤΙΚΟΝ” University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Haidari, Athens Greece
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335
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Sharma S, Gupta N, Rajwanshi A, Saikia UN. Inflammatory myofibroblastic tumour: a diagnostic challenge on fine needle aspiration cytology. Cytopathology 2016; 27:512-516. [DOI: 10.1111/cyt.12337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- S. Sharma
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - N. Gupta
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - A. Rajwanshi
- Department of Cytology and Gynaecological Pathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - U. N. Saikia
- Department of Histopathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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336
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Marylilly S, Subachitra T, Ramya V. Inflammatory Myofibroblastic Tumour of Thyroid with its Prominent Spindle Cell Pattern: A Rare Case Report. J Clin Diagn Res 2016; 10:ED05-7. [PMID: 27190815 DOI: 10.7860/jcdr/2016/15159.7558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/31/2016] [Indexed: 12/26/2022]
Abstract
Inflammatory myofibroblastic tumour of thyroid is very rare. Only 18 cases reported so far. Here we report a case of Inflammatory myofibroblastic tumour with its prominent spindle cell (fibrohistiocytic) pattern in a 61-year-old male patient. The dominant histological pattern in our case was myofibroblastic in contrast to prominent lymphoplasmocytic pattern in other previously reported cases. The tumour was strongly positive for vimentin, Anaplastic lymphoma kinase and showed focal positivity for Smooth Muscle Actin. The patient was treated with total thyroidectomy and he is comfortable after surgery.
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Affiliation(s)
- S Marylilly
- Professor, Department of Pathology, Stanley Medical College , Chennai, Tamil Nadu, India
| | - T Subachitra
- Assistant Professor, Department of Pathology, Stanley Medical College , Chennai, Tamil Nadu, India
| | - V Ramya
- Postgraduate, Department of Pathology, Stanley Medical College , Chennai, Tamil Nadu, India
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337
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Richardsen I, Eckermann C, Schreyer C, Schwab R, Schaaf S, Willms AG. Ein seltener inflammatorisch myofibroblastärer Tumor der Lunge. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-015-0059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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338
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Amouei A, Ehsani F, Vaghefi M, Tabatabai SM, Yazdian Anari P. Inflammatory myofibroblastic tumor of the small intestine: A case report. Int J Surg Case Rep 2016; 22:44-6. [PMID: 27046103 PMCID: PMC4823475 DOI: 10.1016/j.ijscr.2016.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare benign tumor. In this case, a five-year-old child experienced the sudden onset of symptoms and the enlargement of abdominal mass 20 days before referral. In the laparotomy, a large and sticky solid mass, attached to the ileum with the mesenteric origin, sized 10 × 8 cm was observed and completely resected. Despite using some radiographic methods such as medical ultrasound and computerized tomography (CT) scan to diagnose the disease, the definitive diagnosis is merely possible thorough complete surgical resection.
Introduction Inflammatory myofibroblastic tumor (IMT) is a rare benign tumor. Usually seen in children and adolescents, this inflammatory tumor can affect all the organs. Presentation of case In this case, a five-year-old child experienced the sudden onset of symptoms and the enlargement of abdominal mass 20 days before referral. The patient did not have any symptoms of nausea, vomit, and abdominal pain. In the laparotomy, a large and sticky solid mass, attached to the ileum with the mesenteric origin, sized 10 × 8 cm was observed and completely resected. Discussion This tumor rarely emerges in the small intestine, and there are a few patients with intestinal manifestation. In this case report, the tumor had an origin of the small intestine mesenteric and it had invaded to the ileum. Conclusion Despite using some radiographic methods such as medical ultrasound and computerized tomography (CT) scan to diagnose the disease, the definitive diagnosis is merely possible thorough complete surgical resection.
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Affiliation(s)
- Abdolhamid Amouei
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Fatemeh Ehsani
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Marzie Vaghefi
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Pouria Yazdian Anari
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate biological potential with a predilection for the lung and abdominopelvic region. IMT represents the neoplastic subset of the family of inflammatory pseudotumors, an umbrella term for spindle cell proliferations of uncertain histogenesis with a variable inflammatory component. IMTs show characteristic fasciitis-like, compact spindle cell and hypocellular fibrous histologic patterns and distinctive molecular features. Imaging findings reflect pathologic features and vary from an ill-defined, infiltrating lesion to a wellcircumscribed, soft tissue mass owing to variable inflammatory, stromal, and myofibroblastic components.
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341
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Analysis of clinical features and outcomes for inflammatory myofibroblastic tumors in China: 11 years of experience at a single center. Pediatr Surg Int 2016; 32:239-43. [PMID: 26590817 DOI: 10.1007/s00383-015-3840-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. The purpose of this study was to review the clinical characteristics, imaging and pathological features, and outcomes of children with IMTs from a single center in China. METHODS A retrospective file review was conducted involving 23 cases of pathologically confirmed IMTs treated at the Children's Hospital between April 2003 and April 2014. RESULTS The tumor locations included multiple anatomic sites, as follows: abdomen or pelvis (n = 17); lungs (n = 2); head and neck (n = 1); trunk (n = 1); and extremities (n = 2). The tumors were associated with various clinical presentations. The predominant symptoms included an anemic appearance, fevers, and an asymptomatic mass. Computed tomography scanning showed solid, heterogeneous, well-demarcated masses; the appearance of enhancement was variable. MRI appeared hypointense on T1-weighted images and hypointense or hyperintense on T2-weighted images. Immunohistochemical staining revealed anaplastic lymphoma kinase was negative in 11 of 13 cases tested. One patient quit treatment for the unresectable mass after biopsy and died 2 years later, and another patient with incompletely resection is alive at 30 months following chemotherapy. The remaining 21 cases had complete resections; one patient died due to a recurrence, and the other 20 patients survived and were tumor free. The follow-up ranged from 7 to 141 months, with a mean of 56 months. The 3-year OS was 88 % (95 % CI, 57-97 %). CONCLUSIONS IMT is a benign neoplasm that rarely presents with malignant features. Complete resection is curative in most patients. ALK+ is variable for diagnosis. Close follow-up is necessary for patients who undergo surgical resection.
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342
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Pan J, Wang S, Zhang Y, Fan Z. Mammary myofibroblastoma in the right lateral abdominal wall. World J Surg Oncol 2016; 14:55. [PMID: 26911514 PMCID: PMC4766690 DOI: 10.1186/s12957-016-0796-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/16/2016] [Indexed: 12/11/2022] Open
Abstract
Background A mammary-type myofibroblastoma is a rare soft tumor; extramammary myofibroblastomas are especially rare. Case presentation A 51-year-old woman presented to our department for evaluation of a mass on the right lower abdominal wall. The mass was then excised completely. Gross examination showed a huge, well-circumscribed soft tissue mass. The pathologic diagnosis was an extramammary myofibroblastoma. There was no recurrence after excision at the 6-month follow-up visit. Conclusions A mammary-type myofibroblastoma is a benign soft tissue neoplasm. No malignant behavior and/or recurrence of mammary-type myofibroblastomas after surgical resection have been described as a function of size and location. The present case aimed to provide a possible differential diagnosis for such abdominal masses.
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Affiliation(s)
- Jiyong Pan
- Department of General Surgery, the Third People's Hospital of Dalian (Dalian Third People's Hospital Affiliated to Dalian Medical University), Dalian, 116033, China
| | - Shuang Wang
- VIP Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Yingyi Zhang
- Department of General Surgery, the Third People's Hospital of Dalian (Dalian Third People's Hospital Affiliated to Dalian Medical University), Dalian, 116033, China
| | - Zhe Fan
- Department of General Surgery, the Third People's Hospital of Dalian (Dalian Third People's Hospital Affiliated to Dalian Medical University), Dalian, 116033, China.
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343
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Dulskas A, Klivickas A, Kilius A, Samalavicius NE, Sumauskas R, Markelis R. Multiple malignant inflammatory myofibroblastic tumors of the jejunum: A case report and literature review. Oncol Lett 2016; 11:1586-1588. [PMID: 26893784 DOI: 10.3892/ol.2015.4060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 11/10/2015] [Indexed: 11/06/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare neoplastic lesions with a tendency for locally aggressive behavior and recurrence. IMTs most frequently occur in the soft tissues of children and young adults, with the lungs being the most commonly affected site; however, it has been recognized that any anatomical location may be involved. IMT in the jejunum is extremely rare, with only one case previously reported in the literature. The current study describes the case of a 42-year-old woman presenting with intermittent abdominal pain and small bowel intussusception that was identified during a laparotomy. Surgical resection of the jejunum, revealing 3 exophytic tumors, provided specimens for analysis. Following histological examination, a diagnosis of IMT was made. A review of the literature regarding this rare disease is also presented to emphasize the risk of local recurrence and the importance of adequate long-term follow-up.
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Affiliation(s)
| | | | | | - Narimantas E Samalavicius
- National Cancer Institute, Vilnius 08406, Lithuania; Centre of Oncosurgery, National Cancer Institute, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius 08406, Lithuania
| | - Romualdas Sumauskas
- Department of Neurosurgery, Republican Vilnius University Hospital, Vilnius 04130, Lithuania
| | - Rytis Markelis
- Department of Surgery, Hospital of Oncology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas 45434, Lithuania
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344
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Mason EF, Fletcher CDM, Sholl LM. 'Inflammatory myofibroblastic tumour'-like dedifferentiation of anaplastic lymphoma kinase-rearranged lung adenocarcinoma. Histopathology 2016; 69:510-5. [PMID: 26880345 DOI: 10.1111/his.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Anaplastic lymphoma kinase (ALK) functions as an oncogenic driver in a subset of haematopoietic, epithelial and mesenchymal neoplasms. Activation of ALK most commonly occurs through gene fusion events, the presence of which predicts response to ALK-targeted inhibitors in some tumour types. Echinoderm microtubule-associated protein-like 4 (EML4)-ALK fusions represent the majority of ALK rearrangements in lung adenocarcinomas and were, until recently, thought to be exclusive to that tumour type. However, recent work has identified EML4-ALK fusions in ~20% of inflammatory myofibroblastic tumours (IMTs), particularly in those arising in the lung. Here, we present a patient with an ALK-rearranged poorly differentiated lung adenocarcinoma with a predominant sarcomatoid component that was morphologically indistinguishable from IMT. METHODS AND RESULTS Targeted next-generation sequencing revealed EML4-ALK rearrangements in both components, with identical fusion sequences. Copy number analysis demonstrated focal gain of the MYC gene in the IMT-like component. The findings support a diagnosis of ALK-rearranged lung adenocarcinoma with IMT-like dedifferentiation. CONCLUSIONS Our findings suggest that ALK-driven epithelial and mesenchymal neoplasms exist on a morphological spectrum, and emphasize the need to consider translocation testing in pulmonary tumours with unusual sarcomatoid morphology.
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Affiliation(s)
- Emily F Mason
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher D M Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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345
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Dong YU, Ren W, Qi J, Jin BO, Li Y, Tao H, Xu R, Li Y, Zhang Q, Han B. EGFR, ALK, RET, KRAS and BRAF alterations in never-smokers with non-small cell lung cancer. Oncol Lett 2016; 11:2371-2378. [PMID: 27073482 PMCID: PMC4812214 DOI: 10.3892/ol.2016.4235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/01/2016] [Indexed: 12/23/2022] Open
Abstract
Non-small cell lung cancer (NSCLC), caused by various mutations in a spectrum of cancer driver genes, may have distinct pathological characteristics and drug responses. Extensive genetic screening and pathological characterization is required for the design of customized therapies to improve patient outcomes. Notably, NSCLC in never-smokers exhibits distinctive clinicopathological features, which are frequently associated with tumorigenic mutations, and thus may be treated as a unique disease entity. However, to the best of our knowledge, these mutations have not been extensively and accurately characterized in an NSCLC study with a large sample size. Therefore, the present study enrolled a large cohort of NSCLC patients, which consisted of 358 never-smokers, for the screening of genetic alterations in the epidermal growth factor receptor (EGFR), ret proto-oncogene (RET), anaplastic lymphoma kinase (ALK), Kirsten rat sarcoma viral oncogene homolog (KRAS) and B-Raf proto-oncogene serine/threonine kinase (BRAF) tumorigenic genes. It was identified that the mutation rate was 47.8, 7.5, 3.6, 1.4 and 0.3% for EGFR, ALK, KRAS, RET and BRAF, respectively. In addition, clinicopathological features associated with these mutations were characterized. EGFR mutations were more frequently observed in female and older patients. By contrast, KRAS mutations were more frequently detected in male patients, and ALK and RET translocations in younger patients. The cancer cells were frequently well-differentiated in carcinoma cases exhibiting EGFR mutations, however, were less differentiated in those with ALK translocations. In conclusion, the present study determined the frequency of oncogenic alterations and associated clinicopathological features in NSCLC exhibited by never-smokers using a large sample size. The results of the present study may enrich our knowledge of NSCLC in never-smokers and provide useful insights for improvement of the outcome of molecularly targeted therapies for the treatment of NSCLC.
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Affiliation(s)
- Y U Dong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
| | - Weihong Ren
- Department of Laboratory Medicine, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 450000, P.R. China; Department of Histology and Embryology, College of Basic Medicine, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jun Qi
- Department of Thoracic Surgery, Chongqing Cancer Institute, Chongqing 400040, P.R. China
| | - B O Jin
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
| | - Ying Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
| | - Huiqing Tao
- Shanghai Yuanqi Bio-Pharmaceutical Company Ltd., Shanghai 201403, P.R. China
| | - Ren Xu
- Shanghai Yuanqi Bio-Pharmaceutical Company Ltd., Shanghai 201403, P.R. China
| | - Yanqing Li
- Department of Histology and Embryology, College of Basic Medicine, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Qinxian Zhang
- Department of Histology and Embryology, College of Basic Medicine, Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
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346
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Lamas-Pinheiro R, Rodesch G, Devalck C, Segers V, Khelif K, Cappello M, Steyaert H. Pulmonary Myofibroblastic Tumour Involving the Pericardium and Left Atrium in an 18 Month Infant. Ann Thorac Cardiovasc Surg 2016; 22:312-314. [PMID: 26853245 DOI: 10.5761/atcs.cr.15-00360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is the most frequent primary lung tumor in children and it may be locally aggressive. The management of a locally advanced pulmonary IMT in an 18 month-old female child is presented.A left pulmonary mass was incidentally found on the computerized tomography (CT) scan of a child with persistent systemic inflammatory syndrome. Biopsy confirmed the diagnosis; after preoperative corticotherapy, left pneumonectomy was performed. The pericardium and left atrium were invaded and resected, requiring pericardial reconstruction. There is no relapse at four years of follow-up.Steroids play a role in tumor size reduction, but marginal resection is the gold standard. Extended approaches are feasible and often required in advanced cases.
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347
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Tabbara M, Genser L, Bossi M, Barat M, Polliand C, Carandina S, Barrat C. Inguinal Hernia Repair Using Self-adhering Sutureless Mesh: Adhesix™: A 3-Year Follow-up with Low Chronic Pain and Recurrence Rate. Am Surg 2016. [DOI: 10.1177/000313481608200212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To review our experience and outcomes after inguinal hernia repair using the lightweight self-adhering sutureless mesh “Adhesix™” and demonstrate the safety and efficacy of this mesh. This is a 3-year retrospective study that included 143 consecutive patients who underwent 149 inguinal hernia repairs at our department of surgery. All hernias were repaired using a modified Lichtenstein technique. Preoperative, perioperative, and postoperative data were prospectively collected. Incidence of chronic pain, postoperative complications, recurrence, and patient satisfaction were assessed three years postoperatively by conducting a telephone survey. We had 143 patients with a mean age of 58 years (17–84), who underwent 149 hernia repairs using the Adhesix™ mesh. Ninety-two per cent (131 patients) were males. Only 10 patients (7%) had a postoperative pain for more than three years. In our series, neither age nor gender was predictive of postoperative pain. Only one patient had a hematoma lasting for more than one month and only four patients (2.8%) had a recurrence of their hernia within three years of their initial surgery. Ninety per cent of the patient expressed their satisfaction when surveyed three years after their surgery. In conclusion, the use of the self-adhering sutureless mesh for inguinal hernia repair has been proving itself as effective as the traditional mesh. Adhesix™ is associated with low chronic pain rate, recurrence rate, and postoperative complications rate, and can be safely adopted as the sole technique for inguinal hernia repair.
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Affiliation(s)
- Malek Tabbara
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
| | - Laurent Genser
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
| | - Manuela Bossi
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
| | - Maxime Barat
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
| | - Claude Polliand
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
| | - Sergio Carandina
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
| | - Christophe Barrat
- From the Department of Surgery, Jean Verdier Hospital, University Paris XIII, Bondy, France
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348
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Markovic Vasiljkovic B, Plesinac Karapandzic V, Pejcic T, Djuric Stefanovic A, Milosevic Z, Plesinac S. Follow-Up Imaging of Inflammatory Myofibroblastic Tumor of the Uterus and Its Spontaneous Regression. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e12991. [PMID: 27110328 PMCID: PMC4835684 DOI: 10.5812/iranjradiol.12991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 05/17/2014] [Accepted: 06/21/2014] [Indexed: 11/16/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is an aggressive benign mass that may arise from various tissues and organs with a great variability of histological and clinical appearances. Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery. The aim of this paper is to present CT and MRI findings during four-year follow-up of complete, spontaneous regression of IMT of the uterus. The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen. At that time, the organ of origin was not specified. After analysis of the follow-up imaging findings and the mode of tumor regression, the uterus was proclaimed as the probable site of origin. IMT of the uterus is extremely rare and has been reported in ten cases up to now. The gradual, complete regression of uterine IMT documented by CT and MRI may contribute to understanding of its nature.
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Affiliation(s)
- Biljana Markovic Vasiljkovic
- Center for Radiology and MRI, Clinical Center of Serbia, Medical Faculty, Belgrade University, Belgrade, Serbia
- Corresponding author: Biljana Markovic Vasiljkovic, Center for Radiology and MRI, Clinical Center of Serbia, Medical Faculty, Belgrade University, Belgrade, Serbia. Tel: +38-163372956, Fax: +38-1112688553, E-mail:
| | | | - Tomislav Pejcic
- Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Zorica Milosevic
- Institute of Oncology and Radiology, Medical Faculty, Belgrade University, Belgrade, Serbia
| | - Snezana Plesinac
- Gynecological Clinic, Clinical Center of Serbia, Medical Faculty, Belgrade University, Belgrade, Serbia
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349
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Watanabe H, Uruma T, Tazaki G, Tajiri T, Kikuchi R, Itoh M, Aoshiba K, Nakamura H. Remission of ALK-negative primary pulmonary inflammatory myofibroblastic tumor on treatment with clarithromycin: A case report and review of the literature. Oncol Lett 2016; 11:1757-1761. [PMID: 26998073 PMCID: PMC4774465 DOI: 10.3892/ol.2016.4119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 12/23/2015] [Indexed: 01/31/2023] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) belong to an intermediate group of soft-tissue tumors, they are relatively rare but exhibit a wide range of pathologies, from benign to malignant. At present, no standard treatment has been established, however, it is known to be important to determine the grade of malignancy of the tumor, prior to treatment. The present study reports a 73-year-old female patient with no clinical manifestations, who, when examined radiographically at a health check exhibited bilateral thoracic infiltrative shadows and nodular shadows by chest CT. A metastatic tumor or an organizing pneumonia were suspected. Blood examination showed no abnormal findings, and a pathological diagnosis of IMT was given from the histological findings of the tissue extracted by video-assisted thoracic surgery. Histological analysis established the lack of expression of anaplastic lymphoma kinase (ALK1) and immunoglobulin subtype G4 (IgG4). Alteration of the radiological shadows was observed over several weeks, and after concluding that chronic inflammation was worsening the patient's condition, clarithromycin was administered as a long-term macrolide therapy. The IMT decreased in size, and eight months later it had almost resolved. The patient was last reported to be maintaining a stable condition with no relapse. Some IMT cases have malignant pathology, and should be carefully followed-up. However, in the present case, where the IMT is both ALK1-negative and IgG4-negative, its biological immune responsiveness appears to differ from positive cases, and an inflammatory response was predominant. Clarithromycin, has immunomodulatory and anti-inflammatory effects and appeared to be effective in treating the IMT of the patient in the present study.
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Affiliation(s)
- Hidehiro Watanabe
- Department of Respiratory Medicine and Infection Control, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan; Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo 192-0032, Japan
| | - Tomonori Uruma
- Department of Respiratory Medicine and Infection Control, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan; Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo 192-0032, Japan
| | - Gen Tazaki
- Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo 192-0032, Japan
| | - Takuma Tajiri
- Department of Pathology, Tokai University Hachioji Hospital, Tokai University School of Medicine, Hachioji, Tokyo 192-0032, Japan
| | - Ryota Kikuchi
- Department of Respiratory Medicine and Infection Control, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Masayuki Itoh
- Department of Respiratory Medicine and Infection Control, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine and Infection Control, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine and Infection Control, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
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[Abdominal inflammatory myofibroblastic tumor]. Arch Pediatr 2016; 23:210-2. [PMID: 26724981 DOI: 10.1016/j.arcped.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 10/29/2015] [Accepted: 11/13/2015] [Indexed: 11/21/2022]
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