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Tautiva C, Loria G, Soto ME. Mediastinal Myofibroblastic Inflammatory Tumor Compressing the Airway: An Unusual Cause of Dyspnea in a 12-Year-Old. Cureus 2023; 15:e34596. [PMID: 36883081 PMCID: PMC9985906 DOI: 10.7759/cureus.34596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
A healthy 12-year-old presented with wheezing and progressive dyspnea over a 10-month period. He had several general physician consultations and emergency visits during this time and was treated as an asthma exacerbation with no clinical response. He was referred to the pediatric pulmonologist and a tracheal deviation in his previous two chest X-rays was noted, therefore further studies were performed. A severe extrinsic tracheal compression due to a mediastinal mass was documented. He was taken into surgery where a partial resection of the tumor was made. The biopsy of the tumor reported an inflammatory myofibroblastic tumor (IMT), a rare tumor with an atypical presentation, which made this case a diagnostic challenge.
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Affiliation(s)
- Camila Tautiva
- Pediatrics, Hospital Nacional de Niños, Dr Carlos Saenz Herrera, San José, CRI
| | - Gloriana Loria
- Pediatric Pulmonology, Hospital Nacional de Niños, Dr Carlos Sáenz Herrera, San José, CRI
| | - Manuel E Soto
- Pediatric Pulmonology, Hospital Nacional de Niños, Dr Carlos Sáenz Herrera, San José, CRI
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Lourdesamy Anthony AI, Satnam Singh TK, Ng KL, Abdul Rahaman JA. Endotracheal inflammatory myofibroblastic tumour: A rare cause of central airway occlusion in adults. Respirol Case Rep 2022; 10:e0984. [PMID: 35702693 PMCID: PMC9174595 DOI: 10.1002/rcr2.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) is an unusual myofibroblastic spindle cell neoplasm that is rarely discovered in the airway of adults. Previously, it was regarded as a reactive lesion and was infamously known as inflammatory pseudotumour before recent insights revealed that significant majority of cases harboured neoplastic genes. Diagnosis is difficult as clinical presentation and imaging findings are non-specific. Diagnosis and a favourable prognosis require the complete resection of the tumour. Detection of the anaplastic lymphoma kinase expression via immunohistochemistry expedites diagnosis. We report a young adult with an endotracheal mass occluding the central airway. The patient successfully underwent bronchoscopic resection using interventional techniques. IMT was diagnosed. No recurrence was seen after a year of surveillance. Due to the rarity of the disease, the recurrence rates for large airway disease is unknown. Recurrence rates for pulmonary lesions is reported to be lower compared to extrapulmonary IMTs and recurrence is unlikely if compete surgical excision is achieved.
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Affiliation(s)
| | | | - Khai Lip Ng
- Department of MedicineHospital MelakaMelakaMalaysia
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3
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Zarrouki S, Marouf R. Mini-invasive endoscopic approach to tracheal inflammatory myofibroblastic tumor in a young woman: A case report. Ann Med Surg (Lond) 2022; 73:103208. [PMID: 35070283 PMCID: PMC8767228 DOI: 10.1016/j.amsu.2021.103208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) of the trachea is rare tumor mostly found in children and young adults. CASE REPORT We report a case of a 28 year-old woman who presented chronic isolated coughing. Chest CT scan showed a tracheal tumor. Rigid bronchoscopy allowed the complete removal of the tumor, and histology confirmed the diagnosis of IMT. 12 months follow-up found no recurrence. DISCUSSION IMT is a rare tumor exhibiting both benign and aggressive behaviour. The endoscopic approach of tracheal should be considered when there is a minimal tracheal wall invasion. CONCLUSION Through this case, we want to emphasise the role of rigid bronchoscopy in the complete removal of endotracheal IMT.
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Affiliation(s)
- Sara Zarrouki
- Thoracic Surgery Departement, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Marouf
- Thoracic Surgery Departement, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
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Inflammatory Myofibroblastic Tumor of the Upper Airways Harboring a New TRAF3-ALK Fusion Transcript. CHILDREN-BASEL 2021; 8:children8060505. [PMID: 34203606 PMCID: PMC8232338 DOI: 10.3390/children8060505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare disease that mainly involves the lung and the abdomen with an intermediate clinical course but a recurrence rate between 15–30%. Radical surgery represents the gold standard of treatment, while chemotherapy and radiotherapy are considered for unresectable lesions. The identification of ALK translocations in IMT opened the option for the use of target therapies. Indeed, the ALK inhibitors have changed the treatment approach for aggressive lesions, improving the prognosis. Intraluminal upper-way IMT is extremely rare and represents a medical challenge. We reported an endotracheal IMT case presenting a previously unknown TRAF3-ALK fusion transcript.
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5
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Laser Treatment of a Tracheal Inflammatory Myofibroblastic Tumor. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chauhan RS, Sodhi KS, Nada R, Virk R, Mathew J. Pediatric inflammatory myofibroblastic tumor of the trachea: Imaging spectrum and review of literature. Lung India 2018; 35:516-519. [PMID: 30381563 PMCID: PMC6219126 DOI: 10.4103/lungindia.lungindia_405_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inflammatory myofibroblastic tumor of the airway is a very uncommon benign primary neoplasm in pediatric age group with increased local recurrence rate and potential metastatic spread. We describe a case of a 6-year boy who was brought to the pediatric emergency with severe respiratory distress, dry cough, and stridor. Contrast-enhanced computed tomography and magnetic resonance imaging (MRI) of the neck showed a polypoidal mass lesion in the right anterolateral trachea causing significant airway narrowing. Bronchoscopic findings correlated with the imaging. The lesion was confirmed at surgery and was completely removed by surgical excision. Histopathology revealed an inflammatory myofibroblastic tumor. MRI findings of this entity in a child have not been reported before.
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Affiliation(s)
- Richa Singh Chauhan
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhara Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Virk
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Joseph Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Camela F, Gallucci M, di Palmo E, Cazzato S, Lima M, Ricci G, Pession A. Pulmonary Inflammatory Myofibroblastic Tumor in Children: A Case Report and Brief Review of Literature. Front Pediatr 2018; 6:35. [PMID: 29535991 PMCID: PMC5835069 DOI: 10.3389/fped.2018.00035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear etiology and variable clinical course, consisting of a proliferation of fibroblasts and myofibroblasts, mixed with inflammatory cells. Synonyms of IMT are inflammatory pseudotumor and plasma cell granuloma reflecting the alleged inflammatory nature attributed to this lesion, even though this heterogeneity in the disease denomination is probably involved in a dispersion of the literature data. Among primary pulmonary neoplasms, it represents the most frequent endobronchial tumor of childhood and beyond the lung it has been described mainly in the bladder, mediastinum and mesentery. Despite having a tendency for local recurrence, the risk of distant metastasis is low. Clinical presentation depends on localization therefore lung peripheral lesions are often asymptomatic resulting in a delayed diagnosis. Radiological findings can suggest the diagnosis that must be confirmed by histopathology assessment. The tumor has been characterized by the application of immunohistochemical techniques, molecular biology and cytogenetics, which are very precious for the diagnosis. The therapeutic approach consists in the complete surgical excision of the lesion that normally ensures excellent survival. Due to the potential risk of recurrence, close clinical trial is indicated. To date only 24 cases of pulmonary IMT have been described, although the prevalence is probably higher. We present a case report of a 3-year-old girl with pulmonary IMT and a brief review of known literature cases in order to highlight the most common clinical presentations, the most useful diagnostic tools and therapeutic approach.
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Affiliation(s)
- Federica Camela
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Mario Lima
- Department of Pediatric Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Inflammatory myofibroblastic tumor of the trachea in the pediatric age group: case report and systematic review of the literature. J Bronchology Interv Pulmonol 2015; 22:58-65. [PMID: 25590486 DOI: 10.1097/lbr.0000000000000105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inflammatory myofibroblastic tumors are uncommon tumors, which present as solitary masses in the pulmonary parenchyma. Tracheal involvement by these tumors is extremely rare and can be misdiagnosed as asthma. The closest histologic differential diagnoses are IgG4-related sclerosing pseudotumors, which are differentiated by IgG4 positivity. Fifty percent of inflammatory myofibroblastic tumors are positive for anaplastic lymphoma kinase gene rearrangements. The treatment modality of choice is surgical resection with therapeutic bronchoscopy reserved for patients presenting with acute airway obstruction or in those unwilling for surgery. New and upcoming treatments include anaplastic lymphoma kinase inhibitors like crizotinib.
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Özgül MA, Toru Ü, Acat M, Özgül G, Çetinkaya E, Dinçer HE, Omaygenç DÖ, Ürer HN. A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment. Respir Med Case Rep 2014; 13:57-60. [PMID: 26029563 PMCID: PMC4246357 DOI: 10.1016/j.rmcr.2014.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.
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Affiliation(s)
- Mehmet Akif Özgül
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, İstanbul 34020, Turkey
| | - Ümran Toru
- Dumlupınar University Faculty of Medicine, Department of Chest Diseases, Kütahya 43100, Turkey
| | - Murat Acat
- Karabük University Faculty of Medicine, Department of Chest Diseases, Karabük 78050, Turkey
| | - Güler Özgül
- Bağcılar Education and Research Hospital, Department of Chest Diseases, İstanbul 34200, Turkey
| | - Erdoğan Çetinkaya
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, İstanbul 34020, Turkey
| | - H Erhan Dinçer
- University of Minnesota Division of Pulmonary, Allergy, Sleep and Critical Care, MN OH 43210, United States
| | - Derya Özden Omaygenç
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul 34020, Turkey
| | - Halide Nur Ürer
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pathology, İstanbul 34020, Turkey
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Ray A, Suri JC, Bhattacharya D, Gupta A. Bronchoscopic resection of endobronchial inflammatory myofibroblastic tumor: A case report and systematic review of the literature. Lung India 2014; 31:172-5. [PMID: 24778486 PMCID: PMC3999683 DOI: 10.4103/0970-2113.129866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) is a rare tumour affecting the tracheo-bronchial tree in the adult population. The clinical presentation of this tumour is diverse and diagnosis can be definitively clinched by histopathological examination. Treatment of this tumour usually requires surgical resection with bronchoscopic resection being described in few cases. We describe a 32 year old male presenting with hemoptysis who was diagnosed to have IMT. Resection of the tumour was done with the help of rigid bronchoscopy. Post-resection, hemoptysis stopped and no recurrence of tumour was noted on subsequent follow-up. We also present a systematic review of literature of all the cases of tracheo-bronchial IMT treated with bronchoscopic resection and conclude it to be a useful alternative to surgery in such cases.
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Affiliation(s)
- Animesh Ray
- Department of Pulmonary Critical Care and Sleep Medicine, VMMC and Safdarjang Hospital, New Delhi, India
| | - J C Suri
- Department of Pulmonary Critical Care and Sleep Medicine, VMMC and Safdarjang Hospital, New Delhi, India
| | - Dipak Bhattacharya
- Department of Pulmonary Critical Care and Sleep Medicine, VMMC and Safdarjang Hospital, New Delhi, India
| | - Ayush Gupta
- Department of Pulmonary Critical Care and Sleep Medicine, VMMC and Safdarjang Hospital, New Delhi, India
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11
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Brodlie M, Barwick SC, Wood KM, McKean MC, Welch A. Inflammatory myofibroblastic tumours of the respiratory tract: paediatric case series with varying clinical presentations. J Laryngol Otol 2011; 125:865-8. [PMID: 21481297 DOI: 10.1017/s0022215111000648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To highlight the clinical importance of inflammatory myofibroblastic tumours of the respiratory tract in children, and to present a case series of three children which illustrates this tumour's variable clinical presentation. CASE HISTORY The series includes: a nine-year-old girl with a diagnosis of juvenile idiopathic arthritis, who presented with finger clubbing and was found to have an inflammatory myofibroblastic tumour in her right upper lobe; a 15-year-old adolescent with a left main stem bronchial inflammatory myofibroblastic tumour, who presented with breathlessness and chest pain; and a 12-year-old girl with a tracheal inflammatory myofibroblastic tumour who presented with stridor. In each case, the tumour was resected surgically. CONCLUSION Inflammatory myofibroblastic tumour are a rare but clinically important and pathologically distinct lesion of the respiratory tract in children. The cases in this series highlight some of the varied clinical presentations of inflammatory myofibroblastic tumours, and illustrate some of this tumour's different anatomical locations within the paediatric respiratory tract.
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MESH Headings
- Adolescent
- Anaplastic Lymphoma Kinase
- Antirheumatic Agents/therapeutic use
- Arthralgia/etiology
- Arthritis, Juvenile/diagnosis
- Bronchoscopy
- Child
- Dyspnea/etiology
- Female
- Granuloma, Plasma Cell/diagnosis
- Granuloma, Plasma Cell/metabolism
- Granuloma, Plasma Cell/surgery
- Histiocytoma, Benign Fibrous/diagnosis
- Histiocytoma, Benign Fibrous/surgery
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/metabolism
- Lung Neoplasms/surgery
- Methotrexate/therapeutic use
- Neoplasms, Muscle Tissue/diagnosis
- Neoplasms, Muscle Tissue/metabolism
- Neoplasms, Muscle Tissue/surgery
- Osteoarthropathy, Secondary Hypertrophic/etiology
- Receptor Protein-Tyrosine Kinases/metabolism
- Recurrence
- Respiratory Sounds/etiology
- Respiratory Tract Diseases/diagnostic imaging
- Respiratory Tract Diseases/metabolism
- Respiratory Tract Diseases/surgery
- Skin Neoplasms/surgery
- Staining and Labeling
- Thigh/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- M Brodlie
- Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.
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12
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Abstract
This report described a 2-year-old boy who was presented with severe respiratory distress and stridor. Bronchoscopy and CT revealed a mass in the left anterolateral tracheal wall and histopathology showed a tracheal inflammatory myofibroblastic tumor. Initial removal by rigid bronchoscopy resulted in prompt recurrence of the tumor. Therefore, he underwent tracheal surgical resection. A bronchoscopy at 12 months after surgery did not show any recurrence sign.
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Endotracheal Inflammatory Pseudotumor: The Role of Interventional Bronchoscopy. Ann Thorac Surg 2010; 90:e36-7. [DOI: 10.1016/j.athoracsur.2010.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 11/23/2022]
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