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Kakuguchi W, Ashikaga Y, Moritani Y, Nakano S, Ogawa N, Yoshitatsu R, Yanagawa-Matsuda A, Maishi N, Kudo A, Okazaki N, Nakamaru Y, Yabe I, Matsuno Y, Ohiro Y. Nonspecific inflammatory pseudotumor of the maxillary and temporal fossa: a study of seven cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:494-501. [PMID: 38981814 DOI: 10.1016/j.oooo.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/25/2024] [Accepted: 06/01/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Inflammatory pseudotumor (IPT) is a rare, locally aggressive, benign neoplasm of unknown etiology. Because of its aggressive clinical behavior and locally destructive or infiltrative features, it may be mistaken for a malignant tumor. Approximately 5%-44% of extrapulmonary IPT occur in the head and neck, primarily affecting the orbit. STUDY DESIGN Between 2008 and 2021, our hospital received referrals for seven patients (three men and four women, aged 42-73 years) with pain, swelling, mass, and trismus. Computed tomography, magnetic resonance imaging, and biopsy were performed on all patients to diagnose IPT. RESULTS Of the seven patients, four received low-dose prednisolone (PSL), one underwent surgery, and two were left untreated. The IPT disappeared in one of the two untreated cases, whereas it improved and later deteriorated in the other. The surgical patient had no recurrence. Low-dose PSL was effective in two patients; however, high-dose PSL and immunosuppressants were required in the remaining two cases owing to infiltration into each orbit or brain region. CONCLUSIONS Low-dose PSL treatment was applicable in IPT cases affecting the maxillary to temporal fossa region, wherein symptoms did not improve without treatment. However, when low-dose PSL was ineffective, high-dose PSL and immunosuppressants were required.
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Affiliation(s)
- Wataru Kakuguchi
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan.
| | - Yuichi Ashikaga
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuhito Moritani
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan; Department of Dentistry and Oral Surgery, Sapporo City General hospital, Sapporo, Japan
| | - Shintaro Nakano
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Naohiro Ogawa
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan; Department of Dentistry and Oral Surgery, Azabu Kitami Triology Hospital, Kitami, Japan
| | - Rieko Yoshitatsu
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Aya Yanagawa-Matsuda
- Department of Vascular Biology and Molecular Pathology, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Nako Maishi
- Department of Vascular Biology and Molecular Pathology, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiko Kudo
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nanase Okazaki
- Depaetment of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshihiro Matsuno
- Depaetment of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi Ohiro
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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Sicilia Pozo MDLN, García Zoghby L, López de la Osa García A, Sotillo Sánchez R, Poblete García VM. The Potential Utility of 18 F-FDG PET/CT in Monitoring Corticosteroid Therapy in Inflammatory Pseudotumor. Clin Nucl Med 2024; 49:e115-e117. [PMID: 38271259 DOI: 10.1097/rlu.0000000000005038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT A 69-year-old man with suspected gastrointestinal stromal tumor was referred to 18 F-FDG PET/CT. Images showed increased metabolism in a jejunal wall thickening, 2 liver lesions, and hepatic lymph nodes. The patient underwent wedge biopsy of the liver, which revealed inflammatory pseudotumor. The patient was treated with 20 mg/d prednisone, with a gradual dose reduction. A partial metabolic response was achieved after 2 months of therapy, and a final PET/CT showed complete metabolic response after 9 months. This clinical case shows the potential role of PET/CT in the assessment of the response of the inflammatory pseudotumor to corticosteroid therapy.
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Affiliation(s)
| | - Laura García Zoghby
- Department of Nuclear Medicine, University General Hospital of Toledo, Toledo
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Oh JS, Kim HW, Park SB, Kang DH, Choi CW, Kim SJ, Nam HS, Ryu DG. A large and pedunculated inflammatory pseudotumor with pseudosarcomatous change of the cecum mimicking a malignant polyp: a case report and literature review. Clin Endosc 2023; 56:119-124. [PMID: 34275257 PMCID: PMC9902694 DOI: 10.5946/ce.2021.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown etiology that can occur in almost any organ system. It has neoplastic features such as local recurrence, invasive growth, and vascular invasion, leading to the possibility of malignant sarcomatous changes. The clinical presentations of colonic IPT may include abdominal pain, anemia, a palpable mass, and intestinal obstruction. A few cases of colonic IPT have been reported, but colonic IPT with pedunculated morphology is very rare. Furthermore, since it can mimic malignant polyps, understanding the endoscopic findings of colonic IPT is important for proper treatment. Herein, we present a case of colonic IPT with pseudosarcomatous changes, presenting as a large polyp, mimicking a malignant polyp in the cecum, along with a literature review.
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Affiliation(s)
- Jong Suk Oh
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea,Correspondence: Hyung Wook Kim Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea E-mail:
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Al Shenawi H, Al-Shaibani SA, Al Saad SK, Al-Sindi F, Al-Sindi K, Al Shenawi N, Naguib Y, Yaghan R. An extremely rare case of malignant jejunal mesenteric inflammatory myofibroblastic tumor in a 61-year-old male patient: A case report and literature review. Front Med (Lausanne) 2022; 9:1042262. [PMID: 36425100 PMCID: PMC9679529 DOI: 10.3389/fmed.2022.1042262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 11/03/2023] Open
Abstract
Introduction A mesenteric inflammatory myofibroblastic tumor (IMT) is a rare solid tumor of intermediate malignant potential that affects children, adolescents, and young adults predominantly. IMT is mostly encountered in the lung. We report a case of malignant jejunal mesenteric IMT in a 61-year-old male patient who presented with vague abdominal pain and generalized weakness. CT scan revealed a mesenteric mass displacing the attached jejunum. Surgical resection was curative. Discussion An extensive literature review was performed to update and further analyze the already available data. A total of 35 cases with mesenteric IMT were reported previously. Only five cases of jejunal mesenteric IMT were reported. Mesenteric IMT demands vast effort to reveal the diagnosis due to its vagueness in the clinical presentation. Mesenteric IMT resembles each other in plenty of pathological and immunohistochemical characteristics. Conclusion To the best of our knowledge, this is the first case of malignant jejunal mesenteric IMT in the elderly. Surgical resection was curative.
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Affiliation(s)
- Hamdi Al Shenawi
- Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Suhair K. Al Saad
- Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Fedaa Al-Sindi
- Department of Pathology, King Hamad University Hospital, Busaiteen, Bahrain
| | - Khalid Al-Sindi
- Department of Pathology, King Hamad University Hospital, Busaiteen, Bahrain
| | - Noor Al Shenawi
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Yahya Naguib
- Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Clinical Physiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Rami Yaghan
- Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
A 45-year-old man with suspected colonic malignancy was referred to F-FDG PET/CT for staging. PET/CT images showed segmental increased FDG uptake along the intestine with thickening of colonic wall, where no mass was obviously seen. Subsequently, left hemicolectomy and resection of partial small intestine were done. Histopathology of the resected specimen confirmed the diagnosis of inflammatory pseudotumor involving colon and small intestine. No recurrence was detected on follow-up CT images after 6 months. Although most of the previously reported intestinal inflammatory pseudotumor manifested as a mass, it should be considered as a differential diagnosis of FDG-avid segmental intestinal wall thickening.
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Karaisli S, Kamer E, Ekinci N, Cengiz F, Er A, Peskersoy M. Inflammatory myofibroblastic tumour of the colon: 2 case reports and a comprehensive review of the literature. Int J Colorectal Dis 2020; 35:947-958. [PMID: 32100112 DOI: 10.1007/s00384-020-03522-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Inflammatory myofibroblastic tumour (IMT), which is also named as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a rare tumour which rarely develops in the colorectal region. We aimed to review all reported cases to draw attention about this rare tumour. METHODS We present two new cases of colonic IMT with no recurrence during the follow-up period. We also reviewed previously reported colorectal IMT/IPT/PCG patients to investigate demographics, diagnosis and treatment modalities. RESULTS A total of 60 patients which including our 2 patients and 58 patients from 42 published articles were analysed. Male/female ratio was 34/26. Mean age was found to be 31.84 ± 22.26 years (9 months-82 years). Abdominal pain (56.7%) and fever (23.3%) were the most common complaints in the first admission. Fifty-nine (98.3%) out of 60 patients underwent surgery. During follow-up, 7 (14.3%) patients developed a local recurrence. CONCLUSION IMT may occur at any age. IMT is considered to be a borderline tumour with the potential for recurrence or distant metastasis. Complete resection of the tumour is recommended for treatment. Long-time follow-up is necessary due to recurrence potential of the tumour even many years after complete surgical resection. TRIAL REGISTRATION The study follows the regulation of the Institutional Review Board for human research at Izmir Katip Celebi University Ataturk Training and Research Hospital. Written informed consents were obtained from the patients who participated in this study.
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Affiliation(s)
- Serkan Karaisli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Erdinc Kamer
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nese Ekinci
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fevzi Cengiz
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ahmet Er
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Mustafa Peskersoy
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Abstract
Inflammatory fibroid polyps (IFPs) are rare non-neoplastic and proliferating submucosal lesions of the gastrointestinal tract. The classic IFP, which was first described by Vanek, consists of prominent blood vessels and is characterized by a heavy inflammatory infiltrate, which is rich in eosinophilic granulocytes. The clinical presentation depends on the size and location. Inflammatory fibroid polyps cannot be differentiated from malignancy without histological examination. We report a case of IFP in the stomach that mimicked a primary gastric malignancy showing an increased F-FDG uptake.
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Inflammatory Pseudotumor (IPT) and Inflammatory Myofibroblastic Tumor (IMT): A Representative Literature Review Occasioned by a Rare IMT of the Transverse Colon in a 9-year-old Child. TUMORI JOURNAL 2015; 101:249-56. [DOI: 10.5301/tj.5000353] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 12/18/2022]
Abstract
Aims and Background Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) represent different entities. However, it is only in recent years that this has been taken into increasing consideration. Some authors still use both terms synonymously or interchangeably. Inflammatory myofibroblastic tumor is a real neoplasm because of the proliferation of myofibroblastic cells. Inflammatory pseudotumor is a more inflammatory reactive or regenerative entity and shows an overlapping with immunoglobulin G4-related disease. Methods and Study Design To analyze the current situation, 443 publications from the last 5 years (2009 to February 2014) were included. Reports involved 938 patients and 956 organ sites. The age distribution is twin peaked with one maximum in childhood and the other between 50 and 60 years of age. This distribution is questionable due to the more frequent occurrence of IPT in the liver and of IMT in the lung. Inflammatory pseudotumors mainly occur in older patients; IMTs in children and young adults. Results and Conclusions The liver and biliary tract were the most commonly affected of all body regions, at 32%. This was followed by the lung, including the respiratory tract, at 27%, and by the gastrointestinal tract, at 10%. Lesions of the large bowel, as in the present case of a 9-year-old boy, are very rare. There were organ-related as well as nonspecific clinical symptoms, such as fever, weight loss, and fatigue. Laboratory test results revealed anemia and elevated inflammation-dependent parameters. The patterns in medical imaging are variable and nonspecific. Morphology often suggests a malignant process. For this reason, therapy in most cases is surgical, but this is required more often in IMTs. Many IPTs could be treated conservatively.
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Gong S, Auer I, Duggal R, Pittaluga S, Raffeld M, Jaffe ES. Epstein-Barr virus-associated inflammatory pseudotumor presenting as a colonic mass. Hum Pathol 2015; 46:1956-61. [PMID: 26477709 DOI: 10.1016/j.humpath.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/09/2015] [Accepted: 08/20/2015] [Indexed: 12/16/2022]
Abstract
Epstein-Barr virus (EBV)-positive inflammatory pseudotumor (IPT) commonly involves spleen and liver and has only rarely been reported in the gastrointestinal (GI) tract. The spindle cells may express myofibroblastic or follicular dendritic cell markers. We report a challenging case of EBV-positive IPT arising in the ascending colon. The lesion was composed of spindle cells positive for smooth muscle actin but negative for all follicular dendritic cell markers tested and was associated with an exuberant lymphoid proliferation containing reactive follicles, abundant plasma cells, and small lymphocytes. We further discuss pitfalls for possible misdiagnosis as ALK-positive inflammatory myofibroblastic tumor, IgG4-related disease, and peripheral T-cell lymphoma. Our case represents the first EBV-positive inflammatory pseudotumor of the GI tract in the Western literature. Awareness of this rare entity in GI tract is essential for correct diagnosis and appropriate patient management.
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Affiliation(s)
- Shunyou Gong
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Iwona Auer
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Calgary & Calgary Laboratory Services, Calgary, AB T2N 2T9, Canada
| | - Rajan Duggal
- Department of Pathology, Medanta The Medicity, Gurgaon 122001, Delhi NCR, India
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
| | - Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
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Sherman JL, Darbinyan A, Magid MS, Ong P, Weissman B, Benkov K, Lipskar AM. Pediatric colonic inflammatory myofibroblastic tumor presenting as colo-colonic intussusception: A case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Huang Y, Li LP, Wang J, Lun ZJ, Li W, Yang Z. Inflammatory pseudotumor of the colon causing intussusception: A case report and literature review. World J Gastroenterol 2015; 21:704-710. [PMID: 25593502 PMCID: PMC4292308 DOI: 10.3748/wjg.v21.i2.704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/18/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception from clinically suspected malignancy of the right colon where the patient underwent right hemicolectomy. Histopathology of the resected specimen confirmed IPT of the colon. This patient was observed to have abnormally elevated total leukocyte count and platelets before and after surgery. In an adult with intussusception associated with an abdominal mass, the possibility of IPT of the colon should be considered. Considering the abnormally high total leukocyte and platelet counts and colonic IPT, it is necessary to prevent postoperative adverse effects due to these changes. Although IPT of the colon is usually a benign process, controversy regarding its management still exists. We consider hemicolectomy as a safe treatment approach for colonic IPT and review the existing literature.
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Affiliation(s)
- Simona Gurzu
- Department of Surgery, University of Medicine and Pharmacy of Targu-Mures, Targu Mures, Romania.
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