Inflammatory myofibroblastic tumor of the esophagus presenting with hematemesis and melaena: a case report and review of literature

Management of Esophageal Inflammatory Myofibroblastic Tumor With Endoscopic Submucosal Dissection

Inflammatory myofibroblastic tumors are rare tumors that have been described in virtually all organs. Even though they are extremely rare in the esophagus, several cases have been described in the literature. Surgical resection has been the therapeutic modality used in most of those cases. In this report, we describe a case of inflammatory myofibroblastic tumor that was successfully managed endoscopically for the first time with the endoscopic submucosal dissection technique.

Inflammatory myofibroblastic tumor from molecular diagnostics to current treatment

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with intermediate malignancy characterized by a propensity for recurrence but a low metastatic rate. Diagnostic challenges arise from the diverse pathological presentation, variable symptomatology, and lack of different imaging features. However, IMT is identified by the fusion of the anaplastic lymphoma kinase (ALK) gene, which is present in approximately 70% of cases, with various fusion partners, including ran-binding protein 2 (RANBP2), which allows confirmation of the diagnosis. While surgery is the preferred approach for localized tumors, the optimal long-term treatment for advanced or metastatic disease is difficult to define. Targeted therapies are crucial for achieving sustained response to treatment within the context of genetic alteration in IMT. Crizotinib, an ALK tyrosine kinase inhibitor (TKI), was officially approved by the US Food and Drug Administration (FDA) in 2020 to treat IMT with ALK rearrangement. However, most patients face resistance and disease progression, requiring consideration of sequential treatments. Combining radiotherapy with targeted therapy appears to be beneficial in this indication. Early promising results have also been achieved with immunotherapy, indicating potential for combined therapy approaches. However, defined recommendations are still lacking. This review analyzes the available research on IMT, including genetic disorders and their impact on the course of the disease, data on the latest targeted therapy regimens and the possibility of developing immunotherapy in this indication, as well as summarizing general knowledge about prognostic and predictive factors, also in terms of resistance to systemic therapy.

Large Inflammatory Myofibroblastic Tumor of the Esophagus: A Case Report and Literature Review

Inflammatory myofibroblastic tumor (IMT) is a rare tumor composed of myofibroblasts with inflammatory blood cell infiltration. It commonly occurs in the lungs and rarely in the esophagus. We herein report a valuable case of IMT originating in the esophagus. A 60-year-old Japanese woman with dysphagia had a large subepithelial lesion in the cervical esophagus, which was 15 cm in length. Surgical resection was performed to confirm the pathological diagnosis and improve the symptoms. The postoperative diagnosis was IMT composed of multiple nodules. There was no recurrence or metastasis within one year after surgery.

Renal inflammatory myofibroblastic tumour presenting with a large retroperitoneal abscess

Inflammatory myofibroblastic tumour arising from the kidney is a rare occurrence. In this case report, we present a rare case of inflammatory myofibroblastic tumour arising from the kidney diagnosed after the presentation with a large retroperitoneal abscess for the first time in literature. A 55-year-old woman with diabetes mellitus presented to us with painful lump in the left lumbar region of the back for 1-week duration. On examination, there was a firm, diffuse lump in the left lumbar region of the back. Her inflammatory markers were high, but the serum creatinine and blood urea were within the normal range. Abdominal ultrasonography showed a distorted left kidney with a heterogeneous mass consisting cystic and solid components measuring approximately 7 × 9 × 8 cm in size. A contrast-enhanced computed tomography scan showed an 11 × 9 × 9 cm-sized low-density mass posterior to the left kidney with multiple contrast-enhancing septations which appeared posterior to but separate from the left kidney within the left renal fascia. There was breeching of the Gerota’s fascia with extension posteriorly up to subcutaneous tissue. Since the radiological opinion was in favour of a complex perinephric abscess, open drainage of the abscess was performed after failed attempts of ultrasound-guided drainage. The biopsy of the abscess wall was suggestive of a renal cell carcinoma and radical nephrectomy was planned. Due to tumour invasion, the radical nephrectomy was combined with a splenectomy and the specimen sent for histology. It showed an inflammatory myofibroblastic tumour or pseudotumour with the periphery showing ulceration and abscess formation. The patient had an uneventful recovery following surgery. Thus, we report the first case of renal inflammatory myofibroblastic tumour presenting with a large retroperitoneal abscess extending to the subcutaneous tissue plane. Final diagnosis was made only after radical surgery which was curative.

A rare cause of chronic dysphagia: pulmonary inflammatory myofibroblastic tumor with distal esophagus invasion

Background

Inflammatory myofibroblastic tumor (IMT) is rare intermediate tumor, which happens mostly in children and young adults.

Case presentation

Reported is the successful treatment of a 29-year-old man presented with progressively dysphagia and weight loss. No other abnormal symptoms were observed. The contrast enhanced computed tomography (CT) revealed a dumbbell-shaped lesion between lung and esophagus. Finally, it was pathologically diagnosed as pulmonary IMT invading to the distal esophagus after operation. The patient underwent partial esophagectomy and left lower lobectomy, and was discharged on 10th postoperative day.

Conclusions

IMT is a rare lesion that usually occurs in the lung, but pulmonary IMT with distal esophagus invasion has not been described previously. Discriminating untypical symptom, completed resection, pathological expertise and closed follow-up will reach the successful diagnosis and treatment.

Inflammatory myofibroblastic tumor of the esophagus presenting with hematemesis and melaena: a case report and review of literature

Esophageal inflammatory myofibroblastic tumors (IMT) are extremely rare, and the understanding on the clinical presentation is limited. IMT of esophagus should be considered as a differential diagnosis in the context of unexplained upper gastrointestinal bleeding and rapidly progressing dysphagia in young patients.