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Faraj C, Imrani K, Essetti S, Chait F, Lahlou C, M Billah N, Nassar I, A Babana A, O Touhami Y, El Malki HO, Ifrine L, Belkouchi A, Belkouchi O, El Mohtarim R, Derqaoui S, Bernoussi Z. Mesenteric inflammatory pseudotumor: A rare case report and review of the literature. Radiol Case Rep 2024; 19:4945-4949. [PMID: 39247479 PMCID: PMC11378093 DOI: 10.1016/j.radcr.2024.07.124] [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: 07/09/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 09/10/2024] Open
Abstract
Inflammatory pseudotumor (IP) is a rare type of benign tumor. Although initially identified in the lung, it has now been identified in a number of somatic and visceral sites, but mesenteric presentation is uncommon and has a variable clinical presentation. As inflammatory pseudotumor mimic malignancy both clinically and radiologically, the radiologist should be familiar with this entity. The only effective treatment is complete surgical resection. We present the case of a 55-year-old woman who presented with chronic abdominal pain and was diagnosed with a mesenteric inflammatory pseudotumor, in an attempt to illustrate the different imaging aspects of this benign condition in ultrasound, computed tomography and magnetic resonance imaging, and to simplify the description of these tumors.
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Affiliation(s)
- Chaymae Faraj
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Kaoutar Imrani
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Sara Essetti
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Fatima Chait
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Chaimae Lahlou
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Nabil M Billah
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Ittimade Nassar
- Department of Radiology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Amina A Babana
- Department of Surgery « A », Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Youssef O Touhami
- Department of Surgery « A », Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Hadj Omar El Malki
- Department of Surgery « A », Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Lahcen Ifrine
- Department of Surgery « A », Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelkader Belkouchi
- Department of Surgery « A », Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Omar Belkouchi
- Department of Surgery « A », Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Rihane El Mohtarim
- Department of Pathology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Sabrine Derqaoui
- Department of Pathology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
| | - Zakiya Bernoussi
- Department of Pathology, Ibn Sina Hospital, Faculty of medicine and pharmacy, Mohammed V University, Rabat, Morocco
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Tong M, Zhang BC, Jia FY, Wang J, Liu JH. Hepatic inflammatory myofibroblastic tumor: A case report. World J Clin Cases 2023; 11:4318-4325. [PMID: 37449218 PMCID: PMC10336984 DOI: 10.12998/wjcc.v11.i18.4318] [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: 02/02/2023] [Revised: 04/15/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Hepatic inflammatory myofibroblastic tumor (HIMT) is a rare type of hepatic tumor. It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation, and its imaging findings are diverse.
CASE SUMMARY Here, we report a case of HIMT that was initially diagnosed as liver malignancy but was confirmed as HIMT by histopathology after hepatectomy. Mostly, HIMTs are infiltrated with plasma cells and stain positively for anaplastic lymphoma kinase on immunohistochemistry as well as for some other kinases.
CONCLUSION HIMT can be treated with single nonsteroidal anti-inflammatory drugs and without surgery when it is diagnosed accurately. Because the etiology of HIMT is unknown and the diagnosis is difficult, the pathogenesis and clinical process need to be further studied.
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Affiliation(s)
- Meng Tong
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Bo-Cheng Zhang
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Fei-Yu Jia
- Graduate Management Office, Education and Teaching Department, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Jing Wang
- Department of Radiology, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Jing-Hua Liu
- Department of Hepatobiliary Surgery and Minimally Invasive Institute of Digestive Surgery and Prof. Cai’s Laboratory, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
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Papanikolas MJ, Chen MZ, Preda TC. Inflammatory myofibroblastic tumour presenting with the acute abdomen: an uncommon cause of a mesenteric mass. ANZ J Surg 2019; 90:1519-1520. [PMID: 31880062 DOI: 10.1111/ans.15617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/11/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Michelle Z Chen
- Department of Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Tamara C Preda
- Department of Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
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Toner K, Srinivasalu H, Guerrera M, Shirron K, Bandarkar A, Diamond C, Chokshi B. A 17-Year-Old Girl With Weight Loss and Elevated Inflammatory Markers. Pediatrics 2018; 142:peds.2017-2959. [PMID: 30287592 DOI: 10.1542/peds.2017-2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/24/2022] Open
Abstract
A 17-year-old girl presented to her primary care physician with a history of unintentional weight loss and vague sensory symptoms, including tingling of her lower extremities. She had a nonrevealing neurology workup and a largely normal rheumatology workup apart from mild elevation in her inflammatory markers. She also had a nonfocal examination apart from a posterior cervical lymph node (2 × 1 cm). Given that she was well appearing, with a nonfocal examination and only mild laboratory abnormalities, she was told to follow-up with rheumatology in 3 months. Around that time, she re-presented to her medical home for a well-child visit, during which she was noted to have continued weight loss, now amounting to 17 lb in 1 year, and marked further elevation in her inflammatory markers. Her laboratory results were also significant for a profound microcytic anemia requiring inpatient admission for blood transfusion. During her admission, she was seen by the rheumatology, gastroenterology, and oncology subspecialty teams. Despite imaging studies and extensive laboratory workup, there was no unifying diagnosis at the time of her hospital discharge. Ultimately, an outpatient imaging study revealed the etiology.
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Affiliation(s)
- Keri Toner
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and
| | - Hemalatha Srinivasalu
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and
| | - Michael Guerrera
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and
| | - Kelley Shirron
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and
| | - Anjum Bandarkar
- Division of Radiology, Mid-Atlantic Permanente Medical Group, Mclean, Virginia
| | - Carrie Diamond
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and
| | - Binny Chokshi
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia; and
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Torres US, Matsumoto C, Maia DR, de Souza LRMF, D'Ippolito G. Computed Tomography and Magnetic Resonance Imaging Findings of Inflammatory Pseudotumors in the Abdomen and Pelvis: Current Concepts and Pictorial Review. Semin Ultrasound CT MR 2018; 39:220-229. [PMID: 29571557 DOI: 10.1053/j.sult.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The group of inflammatory pseudotumors (IPTs) encompasses a variety of rare neoplastic and nonneoplastic entities described to occur in almost every location in the body and whose clinical features and aggressive imaging findings (varying from infiltrative to mass-forming lesions), frequently mimic those of malignant tumors. The radiologic features of IPTs are variable and nonspecific, the imaging findings depending on the body location and involved organ. Abdominopelvic IPTs are rare and the purposes of this review, therefore, are to familiarize the radiologist with the wide spectrum of computed tomography and magnetic resonance imaging findings of IPTs in various locations throughout the abdomen and pelvis, discussing the imaging features that allow consideration of IPTs in the differential diagnosis of soft-tissue masses within the pertinent clinical setting. Radiologists should be aware of this group of entities, as a preoperative histopathologic diagnosis upon radiological suspicion may help to differentiate IPTs from malignancy and to allow the most appropriate clinical work-up for these patients.
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Affiliation(s)
| | - Carlos Matsumoto
- Grupo Fleury, São Paulo, Brazil; Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, Brazil; Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil
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Lopes VN, Alvarez C, Dantas MJ, Freitas C, Pinto-de-Sousa J. Mesenteric inflammatory pseudotumor: A difficult diagnosis. Case report. Int J Surg Case Rep 2017; 32:1-4. [PMID: 28199882 PMCID: PMC5310168 DOI: 10.1016/j.ijscr.2017.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022] Open
Abstract
Inflammatory pseudotumor is a very rare benign neoplasm. Definitive diagnosis is usually made only after surgery. Mesenteric location is rare. Surgical resection can cure the disease. Close follow-up is advised to identify recurrences.
Introduction Inflammatory pseudotumor (IP) is an uncommon benign neoplasm. It was first described in the lung but it has been recognized in several somatic and visceral locations. Mesenteric presentation is rare and its clinical presentation is variable but patients can be completely asymptomatic. Complete surgical resection is the only curable treatment. Rational follow-up protocols have not been established yet. Presentation of case A 57 years-old man, with no relevant comorbidities and completely asymptomatic, apart from a lump on the right hypochondrium, was submitted to surgical resection of a large mesenteric mass. The preoperative Computed Tomography suggested gastrointestinal stromal tumor as the most probable diagnosis. Definitive histological examination of the completely resected surgical specimen confirmed the diagnosis of IP. The patient has been on follow-up for four years, without no evidence of recurrence. Discussion The preoperative diagnosis of IP may be difficult to establish mainly due to the lack of a typical clinical presentation. It is a rare entity, particularly in the adult population. These two aspects make it easier to neglect this entity in the differential diagnosis of an abdominal mass on asymptomatic adults. Although there are no formal guidelines on follow-up, close follow-up seems to be advisable in these patients as recurrence is frequent. Conclusion IP should be present as a possible differential diagnosis in an abdominal mass. Complete excision of the lesion can be curable but close follow-up seems to be required.
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Affiliation(s)
- Vítor Neves Lopes
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
| | - César Alvarez
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - M Jesus Dantas
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Carla Freitas
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Pinto-de-Sousa
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal; Faculty of Medicine of the University of Porto, Porto, Portugal
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Tierney C, Dinkelspiel HE, Bass AR, Cimic A, Katzen J, Holcomb K. Sclerosing mesenteritis mimics gynecologic malignancy. Gynecol Oncol Rep 2015; 12:49-51. [PMID: 26076158 PMCID: PMC4442657 DOI: 10.1016/j.gore.2015.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/19/2015] [Indexed: 12/19/2022] Open
Abstract
•Sclerosing mesenteritis, and associated inflammatory conditions of the retroperitoneum, may mimic malignancy or infection.•Attempted surgical excision of sclerosing mesenteritis and other retroperitoneal conditions often lead to a morbid and unsuccessful surgery.•These conditions are immune-mediated, and respond remarkably well to immunosuppression.
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Affiliation(s)
- Christina Tierney
- Department of Obstetrics & Gynecology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
- Corresponding author at: 525 East 68th St, J-130, New York, NY 10021, United States.
| | - Helen E. Dinkelspiel
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
| | - Anne R. Bass
- Department of Medicine, Weill Cornell Medical College - Hospital for Special Surgery, United States
| | - Adela Cimic
- Department of Pathology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
| | - Janine Katzen
- Department of Radiology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
| | - Kevin Holcomb
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College - New York Presbyterian Hospital, United States
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Voluminous omental inflammatory myofibroblastic tumor in an elderly man: a case report and literature review. Case Rep Surg 2015; 2015:873758. [PMID: 25688324 PMCID: PMC4320915 DOI: 10.1155/2015/873758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 12/29/2014] [Accepted: 01/01/2015] [Indexed: 12/22/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential, with uncertain etiology. This tumor occurs primarily in the lung, but the tumor may affect any organ system. A 75-year-old male was evaluated for voluminous palpable high abdominal mass with continuous and moderately abdominal pain, associated with abdominal distension for the last two months. Abdominal computed tomography showed a large (32 × 29 × 15 cm) heterogeneously enhanced mass with well-defined margins. At surgery, the mass originated from the greater omentum was completely excised. Histologically the tumor was a mesenchymal neoplasm in smooth muscle differentiation and was characterized by spindle-cell proliferation with lymphocytes, plasma cells, and rare eosinophils. Immunohistochemically, the tumor cells were positive for vimentin and smooth muscle actin and negative for anaplastic lymphoma kinase. Complete surgical resection of IMTs remains the mainstay of treatment associated with a low rate of recurrence. Final diagnosis should be based on histopathological and immunohistochemical findings. Appropriate awareness should be exercised by surgeons to abdominal IMTs in combination with constitutional symptoms, abnormal hematologic findings, and radiological definition, to avoid misdiagnosed.
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Inflammatory myofibroblastic tumor of the breast. Case Rep Surg 2015; 2015:705127. [PMID: 25767734 PMCID: PMC4341847 DOI: 10.1155/2015/705127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/03/2015] [Indexed: 02/08/2023] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) of the breast represent extremely rare lesions. Due to the scarcity of reports, their natural history, recurrence, and metastatic potential remain poorly defined. We report on a case of a primary breast IMT in a postmenopausal female patient treated successfully with breast conserving surgery and review the literature pertaining to this rare entity.
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Akbulut S, Yagmur Y, Gumus S, Sogutcu N, Demircan F. Actinomyces-induced inflammatory myofibroblastic tumor of the colon: A rare cause of an abdominal mass: Akbulut et al. inflammatory myofibroblastictumor due to actinomyces spp. Int J Surg Case Rep 2015; 9:15-8. [PMID: 25704558 PMCID: PMC4392327 DOI: 10.1016/j.ijscr.2015.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumors (IMFTs) are neoplastic lesions that are either benign or have low-grade malignancy potential. Although the etiopathogenesis is not entirely clear, many factors play a role in their development, including trauma, autoimmune disorders, and infectious and inflammatory processes. However, IMFTs caused by Actinomyces spp. infection are rare, with a limited number of cases reported in the literature. PRESENTATION OF CASE A 30-year-old woman was admitted to our clinic with abdominal pain and a palpable abdominal mass. Contrast-enhanced computed tomography revealed a tumoral lesion (11×10×7cm) in the right colon. A right hemicolectomy and ileocolic anastomosis were performed, during which almost complete obstruction of the lumen by the 7.5×7.0×5.0cm tumor was observed. Histopathology and immunohistochemical findings revealed that the tumor was consistent with an IMFT that developed from an Actinomyces infection. The patient was then placed on amoxicillin and doxycycline therapy. CONCLUSION This case demonstrates that the development of IMFT secondary to actinomycosis is difficult to predict in the preoperative period. Once an exact diagnosis is confirmed by histopathologic examination, affected patients should receive prolonged antibiotherapy.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey.
| | - Yusuf Yagmur
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Serdar Gumus
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Nilgun Sogutcu
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Firat Demircan
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
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