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Akasaka S, Tokunaga N, Sugawara Y, Mikuriya Y, Ohta K, Teramoto N. A case of EBV-associated inflammatory pseudotumor of the spleen. Radiol Case Rep 2024; 19:3907-3911. [PMID: 39040827 PMCID: PMC11261270 DOI: 10.1016/j.radcr.2024.06.010] [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: 03/21/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/24/2024] Open
Abstract
Inflammatory pseudotumors (IPTs) of the spleen are rare and have often been reported to be associated with Epstein-Barr virus (EBV). Radiographically differentiating IPTs of the spleen from other malignant tumors is challenging, and splenectomy is often performed as a definitive treatment. We report a case of an EBV-associated splenic IPT in a male patient in his 70s. Contrast-enhanced computed tomography (CT) revealed a splenic mass that increased from 2.4 cm to 3.9 cm in diameter over one year. Magnetic resonance imaging (MRI) revealed that the mass showed a slightly high intensity on T1-weighted images and heterogeneous low intensity on T2-weighted images. On dynamic contrast-enhanced MRI, the mass showed weak and gradual inhomogeneous enhancement. A 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT demonstrated increased FDG uptake in the mass. Splenectomy was performed and the pathological diagnosis was EBV-associated IPT. EBV-associated splenic IPT can mimic malignant tumors on imaging, making it challenging to differentiate them from other splenic diseases.
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Affiliation(s)
- Sho Akasaka
- Department of Diagnostic Radiology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Nobuko Tokunaga
- Department of Diagnostic Radiology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Yoshifumi Sugawara
- Department of Diagnostic Radiology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Yoshihiro Mikuriya
- Department of Gastroenterological Surgery, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Koji Ohta
- Department of Gastroenterological Surgery, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Norihiro Teramoto
- Department of Pathology, NHO Shikoku Cancer Center, Matsuyama, Japan
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Zhong J, Su Z, Li H, Ma J, Li D. Case report: An inflammatory pseudotumor of the caudate lobe of the liver caused by a foreign body. Heliyon 2024; 10:e35355. [PMID: 39170311 PMCID: PMC11337713 DOI: 10.1016/j.heliyon.2024.e35355] [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: 02/01/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
This case report explores a rare foreign body-induced inflammatory pseudotumor in the caudate lobe of a 47-year-old male. The patient was admitted to the hospital due to epigastric pain and fever. Radiological examinations led to the diagnosis of a malignant tumor, and a resection of the caudate lobe lesion was performed. The excised tumor specimen revealed a fishbone-like foreign body. Immunohistochemistry suggested that this was an inflammatory pseudotumor rather than a malignant tumor. This prompted us to contemplate the origin of the foreign body and the mechanisms by which it led to the formation of the inflammatory pseudotumor.
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Affiliation(s)
- Jianfa Zhong
- Organ Transplantation Institute of Xiamen University, Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Zhaojie Su
- Organ Transplantation Institute of Xiamen University, Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Hao Li
- Organ Transplantation Institute of Xiamen University, Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Jingmiao Ma
- Organ Transplantation Institute of Xiamen University, Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China
| | - Dongbin Li
- Community Health Service Center of Heshan Street, Huli District, Xiamen, Fujian, China
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Zhang Q, Gao J. EBER-negative inflammatory pseudotumor-like follicular dendritic cell sarcoma of liver: A case report. Medicine (Baltimore) 2024; 103:e37651. [PMID: 38579046 PMCID: PMC10994431 DOI: 10.1097/md.0000000000037651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/28/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of the liver is rare. It was previously believed that Epstein-Barr virus (EBV) positivity was a necessary criterion for pathological diagnosis. However, we found that there were also cases of EBV negativity. Therefore, clinicians and pathologists are reminded that EBV positivity is not a necessary condition for diagnosis. PATIENT CONCERNS A 70-year-old female underwent computed tomography (CT) examination for upper abdominal discomfort, which revealed the presence of a liver tumor. Follow-up revealed that the tumor had progressively increased in size. DIAGNOSIS The final diagnosis was an IPT-like follicular cell sarcoma, based on CT, MRI, HE staining, and immunohistochemical staining. INTERVENTIONS The patient underwent a laparoscopic left hemihepatectomy. OUTCOMES The patient has not undergone any special treatment, such as radiotherapy and chemotherapy, and has been followed up for over 3 years without experiencing any recurrence. LESSONS IPT-like FDCS is a rare tumor that lacks definitive criteria, and its diagnosis mainly relies on pathological findings. Previously, it was believed that being EBV-positive was an important condition for diagnosis. Primary IPT-like FDCS in the liver is even rarer, and the patient in this case tested negative for EBV. It may be necessary for pathologists to consider the role of EBV in the diagnosis of IPT-like FDCS.
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Affiliation(s)
- Qiang Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Jialin Gao
- Department of Pathology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
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Ouzzaouit H, Kaitouni BI, Zouaidia F, Hamza S, Hrora A, Raiss M. Pseudotumor inflammatory of the spleen: A rare entity with diagnostic and therapeutic challenges: A case report. Int J Surg Case Rep 2024; 115:109215. [PMID: 38280342 PMCID: PMC10839638 DOI: 10.1016/j.ijscr.2023.109215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Inflammatory pseudotumor (IPT) of the spleen is a rare entity that can be difficult distinguishing it from malignancies, both in clinical presentation and radiological imaging. CASE PRESENTATION We present the case of a 43-year-old female presented with 15-cm left hypochondrial mass, Initial imaging studies raised concerns of malignancy, leading to a splenectomy. However, the final pathological examination determined that the patient had IPT of the spleen with focal expression of Smooth Muscle Antibody (SMA). CLINICAL DISCUSSION This case highlights the importance of considering IPT as a potential diagnosis of splenic masses that was difficult to diagnose before surgery. CONCLUSION The uniqueness of the case under consideration lies in the rarity and the atypical localization of IPT of the spleen.
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Affiliation(s)
- Hamza Ouzzaouit
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.
| | - Boubker Idrissi Kaitouni
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Fouad Zouaidia
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco; Anatomopathology department, Ibn Sina University Hospital, Rabat, Morocco
| | - Sekkat Hamza
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
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Almajali F, Almajali M, Schwetye K, Alexopoulos G, Khan M, Coppens J, Mercier P. IgG4-negative pituitary inflammatory pseudotumor with sphenoidal involvement resembling a macroadenoma. Br J Neurosurg 2023; 37:1886-1892. [PMID: 33063545 DOI: 10.1080/02688697.2020.1834509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inflammatory pseudotumors (IPTs) are rare benign conditions of unknown etiology that can affect any part of the body. IPTs are most commonly associated with Immunoglobulin G4 (IgG4)-related disease. Central nervous system IPTs, especially with pituitary involvement, are even rarer entities. The presence of an IgG4-negative pituitary IPT with simultaneous extracranial involvement has not been reported. CASE REPORT We present the case of a 41-year-old female with past medical history of rheumatoid arthritis and a diagnosis of pituitary IPT with coexisting sphenoidal (extracranial) involvement mimicking a pituitary macroadenoma at presentation. The patient underwent multiple consecutive biopsies, and an extensive workup prior to establishing the diagnosis. Laboratory work-up showed normal serum IgG4 and unremarkable liver function tests. CONCLUSION Pituitary lesions with simultaneous sphenoidal involvement in patients with IgG4-negative systemic inflammatory disease should raise the clinical suspicion for intracranial IPTs, as these tumors can mimic aggressive counterparts causing adjacent bony erosion, and local invasion.
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Affiliation(s)
- Fawwaz Almajali
- Department of Neurology, Saint Louis University, St. Louis, MO, USA
| | | | - Kate Schwetye
- Department of Pathology, Saint Louis University, St. Louis, MO, USA
| | | | - Maheen Khan
- Department of Neurosurgery, Saint Louis University, St. Louis, MO, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University, St. Louis, MO, USA
| | - Philippe Mercier
- Department of Neurosurgery, Saint Louis University, St. Louis, MO, USA
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Hideshima K, Suzuki T, Oe S, Shinohara N, Matuhashi N, Ichii O, Tai M, Ejiri Y, Miyagawa K, Harada M. IgG4-related hepatic inflammatory pseudotumor in a patient with serum IgG4-negative type 1 autoimmune pancreatitis. Clin J Gastroenterol 2023; 16:895-900. [PMID: 37794288 DOI: 10.1007/s12328-023-01861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023]
Abstract
IgG4-related disease (IgG4-RD) can cause heterogeneous lesion in various organs. Serum IgG4 levels are useful in monitoring patients with IgG4-RD; however, when it is negative, more careful observation is required. A 58-year-old woman who had been diagnosed with serum IgG4-negative type 1 autoimmune pancreatitis (AIP) 3 years prior visited our hospital for the evaluation of a liver tumor. She had visited a nearby hospital 1 month prior with complaints of a swelling in her right neck, and histological examinations were suggestive of IgG4-related sialadenitis. A positron emission tomography scan showed fluoro-deoxy-glucose accumulation in her right liver lobe; therefore, she was referred to our hospital. Liver tumor biopsy showed inflammatory cell infiltration and storiform fibrosis, without histological findings indicative of a malignancy. Many IgG4-positive cells were detected in immunostaining; thus, an IgG4-related hepatic inflammatory pseudo-tumor was diagnosed. After increasing in steroid dosage, the patient remained recurrence-free with 2 years. To our knowledge, this is the first report of mass-forming IPT for serum IgG4-negative type 1 AIP. Occasionally, IgG4-related IPT may appear in the periphery of the liver, and serum IgG4-negative cases should be more carefully observed because serum IgG4 is not an indicator.
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Affiliation(s)
- Kosuke Hideshima
- The Third Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
- Department of Gastroenterology, Fukushima Rosai Hospital, 3 Numaziri, Uchigo Tsuzuri-machi, Iwaki, Japan.
| | - Tomohiro Suzuki
- Department of Gastroenterology, Fukushima Rosai Hospital, 3 Numaziri, Uchigo Tsuzuri-machi, Iwaki, Japan
| | - Shinji Oe
- The Third Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Nobuhiko Shinohara
- The Third Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Nobuo Matuhashi
- Department of Gastroenterology, Fukushima Rosai Hospital, 3 Numaziri, Uchigo Tsuzuri-machi, Iwaki, Japan
| | - Osamu Ichii
- Department of Gastroenterology, Fukushima Rosai Hospital, 3 Numaziri, Uchigo Tsuzuri-machi, Iwaki, Japan
| | - Mayumi Tai
- Department of Gastroenterology, Fukushima Rosai Hospital, 3 Numaziri, Uchigo Tsuzuri-machi, Iwaki, Japan
| | - Yutaka Ejiri
- Department of Gastroenterology, Fukushima Rosai Hospital, 3 Numaziri, Uchigo Tsuzuri-machi, Iwaki, Japan
| | - Koichiro Miyagawa
- The Third Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masaru Harada
- The Third Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Zhang P, Wang C, Lv Z, Du M, Xu R. Crizotinib combined with bronchoscopic interventional treatment in ALK-positive inflammatory myofibroblastic tumor of left main stem bronchus: a case report. J Cardiothorac Surg 2023; 18:318. [PMID: 37950305 PMCID: PMC10638830 DOI: 10.1186/s13019-023-02427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT), also known as an inflammatory pseudotumor, is a unique type of intermediate soft tissue tumor that commonly occurred in the lung. Its unclear etiology and cellular activity brought about the confusion not only in naming of it, but also in diagnosis and treatment. CASE PRESENTATION We reported the case of an 18-year-old male student who suffered from shortness of breath, chest tightness and chest pain. Chest computed tomography scan showed a spherical neoplasm blocking left main stem bronchus. After fiberoptic bronchoscopy procedure, the results of histopathological and immunohistochemical analysis indicated an IMT. The targeted next generation sequencing based genomic profiling of the tumor using formalin-fixed and paraffin embedded tissue was performed and a EML4-ALK fusion was detected. The patient began to receive Crizotinib, a ALK tyrosine kinase inhibitor, at a dose of 250 mg twice daily orally. The patient has recovered well after the operation, and no recurrence or metastasis has been found after 12 months' follow-up. CONCLUSION By means of the diagnosis and treatment of this case, the characteristics and therapies of IMT are illustrated. In addition, it also provides a reference for the therapeutic strategy of IMT in the future.
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Affiliation(s)
- Peng Zhang
- Department of Cardiothoracic Surgery, The 961st Hospital of Joint Logistics Support Force of PLA, Qiqihar, 230200, China
| | - Chenchen Wang
- Department of Emergency and Critical Care Medicine, The 961st Hospital of Joint Logistics Support Force of PLA, Qiqihar, 230200, China
| | - Zechao Lv
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, 200040, China
| | - Mingxiang Du
- Department of Cardiothoracic Surgery, The 961st Hospital of Joint Logistics Support Force of PLA, Qiqihar, 230200, China
| | - Ruixin Xu
- Department of Cardiothoracic Surgery, The 960th Hospital of Joint Logistics Support Force of PLA, No. 25 Shifan Road, Tianqiao District, Jinan, 250031, People's Republic of China.
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Kim SR, Kim SK, Koma YI, Sasaki M, Asai A, Nishikawa H. Hepatic Inflammatory Pseudotumor-Focusing on Its Heterogeneity. Diagnostics (Basel) 2023; 13:2857. [PMID: 37685395 PMCID: PMC10486865 DOI: 10.3390/diagnostics13172857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Hepatic inflammatory pseudotumors (IPTs) are defined as benign, non-malignant, non-metastasizing tumors characterized by the presence of myofibroblastic spindle cells, hetorogenous populations of inflammatory cells, particularly plasma cells, lymphocytes and macrophages, as well as locations of fibrosis and necrosis without cellular anaplasia or atypical mitoses. Despite subsequent reports in the references, hepatic IPT remains difficult to diagnose; while posing major issues specifically for its differential diagnosis compared with that of other various benign diseases and malignant hepatic tumors. Histopathological findings are always a requisite for confirming the diagnosis, particularly given that the pathogenesis of IPT remains ambiguous to date. Hepatic IPT is a heterogeneous entity in terms of its clinical features, pathological findings, and pathogenesis. Once the diagnosis is confirmed, however, needless surgery such as wedge resection and lobectomy should be avoided. Here, we discuss the heterogeneity of hepatic IPT, its clinical features, pathological findings, and pathogenesis, and describe its differential diagnosis.
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Affiliation(s)
- Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Japan;
| | - Soo Ki Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Japan;
| | - Yu-ichiro Koma
- Department of Pathology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
| | - Akira Asai
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
| | - Hiroki Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan
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Abstract
Hepatic inflammatory pseudotumor (IPT) describes a mass lesion composed of fibroblasts or myofibroblasts with a dense inflammatory infiltrate comprising lymphocyte, plasma cells, and histiocytes. These lesions are presumed to be an exuberant response to an infectious organism, although in most cases the causative agent is unknown. In specific circumstances, pathologists should consider ancillary techniques to exclude specific infections, such as mycobacteria, Candida, or syphilis. IgG4-related disease may cause a plasma-cell rich IPT. Finally, true neoplasms can mimic IPTs and must be excluded with appropriate ancillary studies, including inflammatory myofibroblastic tumor, follicular dendritic cell tumor, inflammatory angiomyolipoma, Hodgkin lymphoma, and inflammatory hepatocellular carcinoma.
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Affiliation(s)
- Donghai Wang
- Department of Pathology, New York University Grossman School of Medicine, NYU Langone Health, 560 First Avenue TH-483, New York, NY 10016, USA
| | - Joseph Misdraji
- Department of Pathology, Yale School of Medicine, Yale New Haven Hospital, 20 York Street EP2-611, New Haven, CT 06510, USA.
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Auerbach A, Girton M, Aguilera N. Controversies in the Spleen: Histiocytic, Dendritic, and Stromal Cell Lesions. Surg Pathol Clin 2023; 16:385-400. [PMID: 37149364 DOI: 10.1016/j.path.2023.01.004] [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: 05/08/2023]
Abstract
Histiocytic, dendritic, and stromal cell lesions that occur in the spleen are challenging diagnostically, not well studied due to their rarity, and therefore somewhat controversial. New techniques for obtaining tissue samples also create challenges as splenectomy is no longer common and needle biopsy does not afford the same opportunity for examination of tissue. Characteristic primary splenic histiocytic, dendritic, and stromal cell lesions are presented in this paper with new molecular genetic findings in some entities that help differentiate these lesions from those occurring in non-splenic sites, such as soft tissue, and identify possible molecular markers for diagnosis.
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Affiliation(s)
| | - Mark Girton
- University of Virginia Health System, Charlottesville, VA, USA
| | - Nadine Aguilera
- University of Virginia Health System, Charlottesville, VA, USA.
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Ramos JG, Ochoa A, Cicutti S, Del Rio R, Lubienieki F. Inflammatory myofibroblastic tumor of the lung involving the central nervous system in pediatric patients. Childs Nerv Syst 2023; 39:1137-1145. [PMID: 37017800 DOI: 10.1007/s00381-023-05925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION The inflammatory myofibroblastic tumor (IMT) is a very rare lesion with an incidence of less than 0.1% of total neoplasms and with main affection in the lungs. Involvement in the central nervous system is extremely rare, but with a much more aggressive course than IMT diagnosed in the rest of the body. We report the 2 cases presented in our neurosurgery department to date; both were treated satisfactorily without intercurrences in 10 years of follow-up. HISTORICAL BACKGROUND The World Health Organization described the IMT as a distinctive lesion composed of myofibroblastic spindle cells accompanied by an inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils. CLINICAL PRESENTATION Clinical manifestations of patients with CNS IMT vary and may consist of headache, vomiting, seizures, and blindness. Seizures are the most common symptom in patients with focal lesions. DIAGNOSIS The true origin of this entity remains to be elucidated, but to date, etiologies ranging from chromosomal alterations to autoimmune or postinfectious mechanisms have been described. Due to its rarity and non-specificity in imaging, the final diagnosis of IMT in the brain parenchyma relies on pathological examination. MANAGEMENT Treatment options are controversial and include total or subtotal removal, high-dose steroids, and radiation therapy. In the last decade, the development of ALK Tyrosine Kinase Inhibitors allows the possibility of chemotherapy in those patients harboring ALK mutations. CONCLUSION IMT is a rare tumor that can exceptionally be found in the CNS. The cause is still unknown although the different studies focus on a neoplastic origin. The diagnosis is based in the use of different modalities of imaging and with histological confirmation. Optimal management is gross total resection whenever possible, is the only established curative treatment. Further research with longer follow-up is needed to clarify the natural history of this rare tumor.
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Affiliation(s)
- Javier Gonzalez Ramos
- Division of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, ZC: 1245, Buenos Aires, Argentina.
| | - Adalberto Ochoa
- Division of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, ZC: 1245, Buenos Aires, Argentina
| | - Santiago Cicutti
- Division of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, ZC: 1245, Buenos Aires, Argentina
| | - Ramiro Del Rio
- Division of Pediatric Neurosurgery, Hospital de Pediatría Juan P. Garrahan, Combate de los Pozos 1881, ZC: 1245, Buenos Aires, Argentina
| | - Fabiana Lubienieki
- Division of Pathology, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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Li Y, Yang X, Tao L, Zeng W, Zuo M, Li S, Wu L, Lin Y, Zhang Z, Yun J, Huang Y. Challenges in the Diagnosis of Epstein-Barr Virus-positive Inflammatory Follicular Dendritic Cell Sarcoma: Extremely Wide Morphologic Spectrum and Immunophenotype. Am J Surg Pathol 2023; 47:476-489. [PMID: 36574358 DOI: 10.1097/pas.0000000000002011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV)-positive inflammatory follicular dendritic cell (FDC) sarcoma (EBV + IFDCS) is a rare entity, and its histopathological characteristics have not been fully described. Here, we investigated the wide morphologic spectrum and immunophenotype of this tumor with the aim to help avoid misdiagnosis. Thirteen cases of EBV + IFDCS were retrospectively analyzed, combined with a review of 70 cases reported in the literature. The median age of patients was 49 (range, 29 to 67 y). Six patients were male and 7 were female. Most cases (92.3%, 12/13) occurred in the liver or spleen, and only 1 case affected an extra-hepatosplenic site (lung, 7.7%, 1/13). Tumors were assessed for a variety of histologic features and assigned to the following morphologic groups: classic type (53.8%, 7/13), lymphoma-like subtype (38.5%, 5/13), and hemangioma-like subtype (7.7%, 1/13). The classic type had distinct EBV-positive neoplastic cells with a fascicular or storiform growth pattern, variable lymphoplasmacytic infiltrates, and blood vessels. The lymphoma-like subtype had extremely prominent lymphoplasmacytic infiltrates (resembling marginal zone lymphoma with plasmacytoid differentiation) with singly dispersed distinct EBV-positive neoplastic cells, highlighted by in situ hybridization for EBV-encoded small RNA. The hemangioma-like subtype had extremely prominent blood vessels with hyaline and/or fibrinoid degeneration, singly dispersed distinct EBV-positive neoplastic cells, and limited lymphoplasmacytic infiltrates. Immunohistochemically, the neoplastic cells showed variable staining for FDC markers (CD21, CD35, CD23, and SSTR2) and the fibroblastic marker SMA, with the staining ranging from very focal to extensive. The number of EBV-positive neoplastic cells ranged from 80 to 400/HPF. All cases showed variable expression of PD-ligand 1 (PD-L1) (CPS: 5-90). IgG4-positive cells ranged from rare up to 100/HPF. Interestingly, 2 cases satisfied the criteria proposed in a previous study, mimicking IgG4-related disease. EBV + IFDCS is an entity with an extremely wide morphologic spectrum and immunophenotype. Awareness of the spectrum of morphologic presentations of this rare tumor, specifically the lymphoma-like subtype and hemangioma-like subtype, is important for accurate diagnosis.
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Affiliation(s)
- Yan Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Xia Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Lili Tao
- Department of Pathology, Peking University Shenzhen Hospital
| | - Weimei Zeng
- Guangdong No. 2 Provincial People's Hospital, Guangzhou, Guangdong
| | - Min Zuo
- Department of Pathology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Shuo Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Liyan Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Yanshong Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Ziying Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Jingping Yun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
| | - Yuhua Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-sen University Cancer Center
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Abe K, Kitago M, Matsuda S, Shinoda M, Yagi H, Abe Y, Oshima G, Hori S, Endo Y, Yokose T, Miura E, Kubota N, Ueno A, Masugi Y, Ojima H, Sakamoto M, Kitagawa Y. Epstein-Barr virus-associated inflammatory pseudotumor variant of follicular dendritic cell sarcoma of the liver: a case report and review of the literature. Surg Case Rep 2022; 8:220. [PMID: 36484868 PMCID: PMC9733763 DOI: 10.1186/s40792-022-01572-w] [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: 08/06/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Follicular dendritic cell sarcoma is a rare stromal tumor with no standard treatment. However, some reports have revealed that follicular dendritic cell sarcoma has an inflammatory pseudotumor variant associated with Epstein-Barr virus infection that has a relatively good prognosis. In this report, we present a case of a resected inflammatory pseudotumor variant of follicular dendritic cell sarcoma of the liver, and have reviewed the literature on the clinicopathological, molecular, and genomic features of this tumor. CASE PRESENTATION The inflammatory pseudotumor variant of follicular dendritic cell sarcoma originates only in the liver or spleen, causes no symptoms, and is more common in middle-aged Asian women. It has no characteristic imaging features, which partially explains why the inflammatory pseudotumor variant of follicular dendritic cell sarcoma is difficult to diagnose. Pathologically, the inflammatory pseudotumor variant of follicular dendritic cell sarcoma has spindle cells mixed with inflammatory cells and is variably positive for follicular dendritic cell markers (CD21, CD23, and CD35) and Epstein-Barr virus-encoded RNA. On genetic analysis, patients with this tumor high levels of latent membrane protein 1 gene expression and extremely low levels of host C-X-C Chemokine Receptor type 7 gene expression, indicating that the inflammatory pseudotumor variant of follicular dendritic cell sarcoma has a latent Epstein-Barr virus type 2 infection. CONCLUSIONS The inflammatory pseudotumor variant of follicular dendritic cell sarcoma is an Epstein-Barr virus-associated tumor and a favorable prognosis by surgical resection, similar to Epstein-Barr virus-associated gastric cancer.
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Affiliation(s)
- K. Abe
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - M. Kitago
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - S. Matsuda
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - M. Shinoda
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - H. Yagi
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - Y. Abe
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - G. Oshima
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - S. Hori
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - Y. Endo
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - T. Yokose
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - E. Miura
- grid.26091.3c0000 0004 1936 9959Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - N. Kubota
- grid.26091.3c0000 0004 1936 9959Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - A. Ueno
- grid.26091.3c0000 0004 1936 9959Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Y. Masugi
- grid.26091.3c0000 0004 1936 9959Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - H. Ojima
- grid.26091.3c0000 0004 1936 9959Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - M. Sakamoto
- grid.26091.3c0000 0004 1936 9959Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Y. Kitagawa
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582 Japan
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14
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Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, Brousset P, Cerroni L, de Leval L, Dirnhofer S, Dogan A, Feldman AL, Fend F, Friedberg JW, Gaulard P, Ghia P, Horwitz SM, King RL, Salles G, San-Miguel J, Seymour JF, Treon SP, Vose JM, Zucca E, Advani R, Ansell S, Au WY, Barrionuevo C, Bergsagel L, Chan WC, Cohen JI, d'Amore F, Davies A, Falini B, Ghobrial IM, Goodlad JR, Gribben JG, Hsi ED, Kahl BS, Kim WS, Kumar S, LaCasce AS, Laurent C, Lenz G, Leonard JP, Link MP, Lopez-Guillermo A, Mateos MV, Macintyre E, Melnick AM, Morschhauser F, Nakamura S, Narbaitz M, Pavlovsky A, Pileri SA, Piris M, Pro B, Rajkumar V, Rosen ST, Sander B, Sehn L, Shipp MA, Smith SM, Staudt LM, Thieblemont C, Tousseyn T, Wilson WH, Yoshino T, Zinzani PL, Dreyling M, Scott DW, Winter JN, Zelenetz AD. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022; 140:1229-1253. [PMID: 35653592 PMCID: PMC9479027 DOI: 10.1182/blood.2022015851] [Citation(s) in RCA: 549] [Impact Index Per Article: 274.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Since the publication of the Revised European-American Classification of Lymphoid Neoplasms in 1994, subsequent updates of the classification of lymphoid neoplasms have been generated through iterative international efforts to achieve broad consensus among hematopathologists, geneticists, molecular scientists, and clinicians. Significant progress has recently been made in the characterization of malignancies of the immune system, with many new insights provided by genomic studies. They have led to this proposal. We have followed the same process that was successfully used for the third and fourth editions of the World Health Organization Classification of Hematologic Neoplasms. The definition, recommended studies, and criteria for the diagnosis of many entities have been extensively refined. Some categories considered provisional have now been upgraded to definite entities. Terminology for some diseases has been revised to adapt nomenclature to the current knowledge of their biology, but these modifications have been restricted to well-justified situations. Major findings from recent genomic studies have impacted the conceptual framework and diagnostic criteria for many disease entities. These changes will have an impact on optimal clinical management. The conclusions of this work are summarized in this report as the proposed International Consensus Classification of mature lymphoid, histiocytic, and dendritic cell tumors.
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Affiliation(s)
- Elias Campo
- Haematopathology Section, Hospital Clínic of Barcelona, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Barcelona, Spain
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Pierre Brousset
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ahmet Dogan
- Laboratory of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, CIBERONC, Pamplona, Spain
| | - John F Seymour
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Julie M Vose
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, NE
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, and Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ranjana Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford University, Stanford, CA
| | - Stephen Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wing-Yan Au
- Blood-Med Clinic, Hong Kong, People's Republic of China
| | - Carlos Barrionuevo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Francesco d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew Davies
- Cancer Research UK Centre, Centre for Cancer Immunology, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research, Hospital of Perugia, University of Perugia , Perugia, Italy
| | - Irene M Ghobrial
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
| | - John R Goodlad
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John G Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Brad S Kahl
- Oncology Division, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Won-Seog Kim
- Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - John P Leonard
- Weill Department of Medicine, Weill Medical College, Cornell University, New York, NY
| | - Michael P Link
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Armando Lopez-Guillermo
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Victoria Mateos
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cancer, Universidad de Salamanca, Salamanca, Spain
| | - Elizabeth Macintyre
- Laboratoire d'Onco-Hématologie, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris Cité and Institut Necker-Enfants Malades, Paris, France
| | - Ari M Melnick
- Division of Hematology and Oncology, Weill Medical College, Cornell University, New York, NY
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Marina Narbaitz
- Department of Pathology, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina and Fundacion para combatir la leucemia (FUNDALEU), Buenos Aires, Argentina
| | - Astrid Pavlovsky
- Fundación para Combatir la Leucemia (FUNDALEU), Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | - Stefano A Pileri
- Haematopathology Division, IRCCS, Istituto Europeo di Oncologia, Milan, Italy
| | - Miguel Piris
- Jiménez Díaz Foundation University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Vincent Rajkumar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven T Rosen
- Beckman Research Institute, and Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Birgitta Sander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laurie Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Thieblemont
- Service Hémato-Oncologie, AP-HP, Hôpital Saint-Louis, Paris, France
- DMU-DHI, Université de Paris-Paris Diderot, Paris, France
| | - Thomas Tousseyn
- Department of Pathology, Universitair Ziekenhuis Leuven Hospitals, Leuven, Belgium
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Pier-Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Martin Dreyling
- Department of Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College, Cornell University, New York, NY
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15
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Chen F, Li J, Xie P. Imaging and pathological comparison of inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen: A case report and literature review. Front Surg 2022; 9:973106. [PMID: 36132202 PMCID: PMC9483013 DOI: 10.3389/fsurg.2022.973106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundInflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is a rare subtype of follicular dendritic cell sarcoma (FDCS) that is mainly located in the liver and spleen (1). Splenic IPT-like FDCS is a rare low-grade malignancy with non-specific clinical manifestations and laboratory findings. Herein, we reported the pathological and imaging features of a case with splenic IPT-like FDCS.Case presentationA 57-year-old woman was found to have a mass in the spleen during a physical examination and was hospitalized for further treatment. Her laboratory results were within the normal range. Unenhanced and contrast-enhanced computed tomography scans of the whole abdomen showed a round mass in the spleen, with a diameter of about 5 cm. After further examination with enhanced MRI, a provisional diagnosis of splenic hemangioma or splenic hamartoma was made. The patient underwent splenectomy, and the pathological diagnosis was splenic IPT-like FDCS. No tumor recurrence or metastasis was found during the 1-year follow-up after the operation.ConclusionsHerein, we reported a case of splenic IPT-like FDCS. Although the clinical examination and laboratory examination lack specificity, the imaging of this case showed that the lesion was a solid mass with progressive enhancement, and the central scar showed the characteristics of delayed enhancement, which facilitated the diagnosis.
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Affiliation(s)
- Fuxing Chen
- Department of Radiology, Beilun District People’s Hospital, Ningbo, China
| | - Junqiang Li
- Department of Pathology, Beilun District People’s Hospital, Ningbo, China
| | - Pingkun Xie
- Department of Radiology, Beilun District People’s Hospital, Ningbo, China
- Correspondence: Pingkun Xie
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16
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Huang SH, Chuang CC, Huang CC, Jung SM, Lee CC. Diagnosis and Treatment of Inflammatory Pseudotumor with Lower Cranial Nerve Neuropathy by Endoscopic Endonasal Approach: A Systematic Review. Diagnostics (Basel) 2022; 12:2145. [PMID: 36140546 PMCID: PMC9497500 DOI: 10.3390/diagnostics12092145] [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: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory pseudotumor (IPT) is a non-neoplastic condition of unknown etiology. IPT with lower cranial nerve (CN IX, X, XI, XII) neuropathies is extremely rare. In this study, we systematically reviewed all previously reported cases regarding the management of IPT with lower cranial nerve neuropathies. We searched the PubMed/MEDLINE database for reports related to IPT with lower cranial nerve neuropathies. A total of six papers with 10 cases met the inclusion criteria (mean age 51.6 years, 70% male). The mean follow-up period was 15.4 months (range: 1-60 months). The most frequent treatment was corticosteroids alone (60%), followed by surgery alone (20%), and multimodal treatment (20%). Corticosteroid therapy was associated with an excellent (100%) response rate at 6 months of follow-up, and half of the patients were in complete remission after 9 months. Both cases who received surgery had persistent neurological deficits. Immediate complete remission of neurological symptoms and resolution on imaging after decompression surgery via an endoscopic endonasal approach (EEA) with corticosteroids was demonstrated in our representative case. This review suggests that EEA is a preferred method for diagnosis and treatment, a promising approach associated with favorable outcomes, and a viable first-line treatment for selected cases, followed by multimodal therapy.
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Affiliation(s)
- Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33301, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33301, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan
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17
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Huang Y, Shu SN, Zhou H, Liu LL, Fang F. Infant biliary cirrhosis secondary to a biliary inflammatory myofibroblastic tumor: A case report and review of literature. World J Clin Cases 2022; 10:8375-8383. [PMID: 36159551 PMCID: PMC9403675 DOI: 10.12998/wjcc.v10.i23.8375] [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: 03/30/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A biliary inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymoma that, although it has a broad age spectrum, usually occurs in adults. Diagnosis is difficult because biliary IMTs often exhibit nonspecific clinical symptoms and imaging features, resulting in delayed or inappropriate treatment. Although most IMTs are benign, some show malignant properties such as infiltration, recurrence, and metastasis.
CASE SUMMARY Here, we retrospectively describe a 10-month-old infant who was admitted to our hospital due to stubborn jaundice. The patient responded poorly to routine medical treatment and his clinical manifestations and laboratory tests lacked specificity, so we turned to repeated ultrasound scans and other imaging examinations. As both hepatosplenic ultrasonography and diffusion-weighted magnetic resonance imaging demonstrated a space-occupying lesion, an exploratory laparotomy was performed. The final diagnosis made over two mo after the disease onset was infant biliary cirrhosis caused by a biliary IMT, which partially infiltrated into the liver. This infant is the youngest case of biliary IMTs that has been reported till now. The patient underwent an incomplete resection of the mass and Kasai Portoenterostomy. However, because of cirrhosis, he also received a paternal liver transplant. Since some IMTs show malignant properties, we proceeded with a three-year of follow-up; however, no recurrence or metastasis has been noted.
CONCLUSION Neoplastic disease such as IMTs should be considered when routine medical treatment of obstructive jaundice is not successful. Observation of dynamic imaging changes is helpful for diagnosis. Periodic follow-up is necessary for IMTs.
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Affiliation(s)
- Yuan Huang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hua Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ling-Ling Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Feng Fang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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18
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Jang SY, Han YS, Lee SY, Han JR, Kweon YO, Tak WY, Park SY, Lee YR, Ryeom HK, Cha JG, Hong J, Kang YN. A Case of Hepatic Immunoglobulin G4-Related Disease Presenting as an Inflammatory Pseudotumor and Sclerosing Cholangitis. Diagnostics (Basel) 2022; 12:diagnostics12061497. [PMID: 35741307 PMCID: PMC9222153 DOI: 10.3390/diagnostics12061497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
An inflammatory pseudotumor is a benign disease characterized by tumor-like lesions consisting of inflammatory cells including plasma cells and fibrous tissue. Recently, some inflammatory pseudotumor cases proved to be a form of Immunoglobulin G4-related disease (IgG4-RD). This novel clinical entity, recognized as a fibroinflammatory condition, is characterized by lymphoplasmacytic infiltration with a predominance of IgG4-positive plasma cells, storiform fibrosis, and often elevated serum IgG4 concentrations. We report a case of IgG4-RD in the form of an inflammatory pseudotumor in the liver with combined sclerosing cholangitis. We recommend that for diagnosing IgG4-RD accurately, it is important to obtain adequate tissue samples and follow-up the lesion in clinical practice.
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Affiliation(s)
- Se Young Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Young Seok Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (Y.S.H.); (J.R.H.)
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Ja Ryung Han
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (Y.S.H.); (J.R.H.)
| | - Young Oh Kweon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.J.); (Y.O.K.); (W.Y.T.); (S.Y.P.); (Y.R.L.)
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (S.Y.L.); (H.K.R.); (J.G.C.); (J.H.)
| | - Yoo Na Kang
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-420-4887; Fax: +82-53-422-9195
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Corrivetti F, Fraschetti F, Cacciotti G, Bernardi C, Sufianov A, Mastronardi L. Inflammatory pseudotumor simulating a jugular foramen meningioma: case report, technical video and literature review. World Neurosurg 2022; 161:106-109. [PMID: 35092811 DOI: 10.1016/j.wneu.2022.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Inflammatory pseudotumor (IP) is a non-neoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an inflammatory infiltrate, most commonly involving the lungs and orbits. Primary intracranial inflammatory pseudotumor is an extremely rare entity often arising from the meningeal structures of the skull base. We reported an extremely rare case of a primary intracranial IP located in the cerebello-pontine angle, mimicking a jugular foramen meningioma. We further illustrated our microsurgical technique through a surgical video and performed a review of the pertinent scientific literature. The patient underwent gross total microsurgical resection of the tumor mass through a left retrosigmoid approach. Intraoperative neuro-monitoring of VII-VIII cranial nerve complex and lower cranial nerve was performed, and thulium laser fibers were used as a tool for tumor debulking. Post-operatively, patient neurological symptoms recovered. Histopathological studies showed dense infiltrate of T and B cells lymphocytes and epithelioid granulomas, compatible with the diagnosis of inflammatory pseudotumor. Post-operative, MRI scans showed complete tumor resection. Patient underwent a 3-month oral corticosteroid therapy showing no signs of recurrence at the radiological follow-up. Primary intracranial inflammatory pseudotumors are very rare pathological entities that can mimic extra-axial tumors, and should take into consideration as a potential differential diagnosis. Complete microsurgical resection in combination with other treatments (steroids therapy, radiotherapy) is the most common treatment of choice and in associated to good outcome and low rate of recurrence.
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Affiliation(s)
- Francesco Corrivetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy; Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Asl Salerno, Salerno, Italy
| | - Flavia Fraschetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy
| | - Guglielmo Cacciotti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy
| | - Cinzia Bernardi
- Division of Pathological Anatomy, San Filippo Neri Hospital/ASL Roma1, Roma, Italy
| | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russian Federation; Department of Neurosurgery, The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health, Russian Federation
| | - Luciano Mastronardi
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy; Department of Neurosurgery, The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health, Russian Federation.
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20
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Cho YJ, Han SI, Lim SC. Intra-muscular follicular dendritic cell sarcoma in the thigh: A case report. Medicine (Baltimore) 2021; 100:e27209. [PMID: 34516525 PMCID: PMC8428715 DOI: 10.1097/md.0000000000027209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Follicular dendritic cell sarcoma (FDCS) is an intermediate-grade malignancy originating from follicular dendritic cells. Nodal FDCS is the most common type, meaning that the extranodal type may not be recognized and could be easily misdiagnosed. Reported extranodal sites include the head and neck, retroperitoneum, spleen, liver, and gastrointestinal tract. FDCS in the soft tissue is extremely rare. PATIENT CONCERNS A 75-year-old male presented with complaints of a localized swelling and intra-muscular soft tissue mass in the left upper thigh. DIAGNOSIS The present tumor consisted of fascicular or vague storiform-arranged spindle cells with less pleomorphism and many lymphoid aggregates. Tumor cells were positive for CD21, CD35, CD68, vimentin, and EGFR. Intra-muscular FDCS was confirmed by immunohistochemical studies. INTERVENTIONS The patient received a wide marginal excision, followed by adjuvant radiotherapy. OUTCOMES Symptomatic improvements were achieved and no subsequent relapses were observed. LESSONS If the tumor arises in the extranodal sites, especially in the soft tissue, it is difficult to include FDCS in the differential diagnosis. When the immunoprofile is not consistent with that of common spindle cell tumors, immunostaining for follicular dendritic cell markers such as CD21, CD23, and CD35, as well as further immunohistochemistry for D2-40, CD68, EGFR, Epstein-Barr virus, and BRAF can be helpful for the diagnosis and subtyping of FDCS. To the best of our knowledge, the present case is the first case of intramuscular FDCS.
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Affiliation(s)
- Yong Jin Cho
- Department of Orthopedic Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Song Iy Han
- Division of Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Pathology, College of Medicine, Chosun University, Gwangju, Republic of Korea
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21
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Kihara Y, Takeda Y, Ohmura Y, Katsura Y, Shinke G, Ikeshima R, Katsuyama S, Kawai K, Hiraki M, Sugimura K, Masuzawa T, Takeno A, Hata T, Murata K. Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases. Surg Case Rep 2021; 7:183. [PMID: 34390417 PMCID: PMC8364615 DOI: 10.1186/s40792-021-01269-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Ligation clips are used for vessel or tissue ligation in surgery. Although previous reports have described the migration of metallic clips after hepato-biliary-pancreatic surgery, very few reports have described the migration of non-absorbable polymer clips (NAPCs: Hem-o-Lok). Case presentation We present 4 cases of NAPC migration that occurred after laparoscopic surgery. Case 1 was an 81-year-old woman that had undergone a laparoscopic right hemihepatectomy for an intrahepatic bile duct cyst adenocarcinoma at the age of 79 years. Two years after the operation, she underwent an upper gastrointestinal endoscopy to investigate epigastric pain. The endoscopy showed NAPCs lodged at the anterior side of the duodenal bulb. Case 2 was an 80-year-old man that had undergone a laparoscopic cholecystectomy for choledocholithiasis at the age of 77 years. Three years after the operation, follow-up computed tomography and magnetic resonance cholangiopancreatography (MRCP) imaging indicated a mass in the upper bile duct. After a laparoscopic bile duct resection and reconstruction, an NAPC was found inside the inflammatory pseudotumor. Case 3 was a 63-year-old man that had undergone laparoscopic liver S4b and S5 resections and lymph node dissection for gallbladder cancer. Three months after the operation, follow-up MRCP imaging suggested a bile duct stenosis. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, and an NAPC was found inside the bile duct. Case 4 was a 74-year-old man that had undergone a laparoscopic S5 segmentectomy, S7 partial liver resection, and cholecystectomy for liver metastasis of lung cancer and cholelithiasis. A trans-cystic drainage tube was inserted, and it was ligated and fixed with NAPCs. Three months after the operation, follow-up MRCP imaging showed common bile duct stones (CBDS). An ERCP was performed, and two NAPCs were found with the CBDS. Conclusions Few previous reports have described complications due to NAPC migration after hepato-biliary-pancreatic surgery. However, with the widespread use of NAPC, postoperative complications due to NAPC migration are expected to increase in the near future. The differential diagnosis of complications should include potential NAPC migration in patients that have undergone laparoscopic surgery.
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Affiliation(s)
- Yukari Kihara
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Yoshiaki Ohmura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Go Shinke
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Ryo Ikeshima
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Shinsuke Katsuyama
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kenji Kawai
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Masayuki Hiraki
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Keijiro Sugimura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Toru Masuzawa
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Taishi Hata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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22
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Liu Z, Li G, Gou A, Xiao Z, Xu Y, Song S, Guo K, Ma G. Inflammatory myofibroblastic tumor in the pancreatic neck: a rare case report and literature review. Gland Surg 2021; 10:1832-1839. [PMID: 34164329 DOI: 10.21037/gs-21-303] [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: 11/06/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare disease of unknown etiology. It usually occurs in abdominal soft tissues and lung, and is extremely rare in the pancreas. IMT can occur in any part of a person at any age, however, it mostly affects children and young people. Its clinical manifestations are atypical, imaging examinations are not specific, and the differential diagnosis of pancreatic malignancies is difficult, making it easily misdiagnosed. Surgical resection is the preferred method of treatment for IMT. In this case report, we report a rare case of IMT in the neck of the pancreas and reviewed the relevant literature. In our case, the patient was a 57-year-old woman with an IMT in the neck of the pancreas. Abdominal pain was the only clinical symptom, and imaging features were not specific. She underwent surgery to remove the pancreatic mass, and the final diagnosis of IMT was based on histopathology and immunohistochemistry. After 6 months of regular follow-up, the patient had no complications or further incidents. The purpose is to emphasize the difficulty of the preoperative diagnosis of pancreatic IMT and the difficulty of distinguishing it from pancreatic malignancies. It is hoped that clinicians can gain a deeper understanding of pancreatic IMT through this case report.
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Affiliation(s)
- Zhe Liu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Guichen Li
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Anjiang Gou
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Zhihuan Xiao
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Yuanhong Xu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Shaowei Song
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Kejian Guo
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Gang Ma
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
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23
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Sangiorgio VFI, Arber DA. Non-hematopoietic neoplastic and pseudoneoplastic lesions of the spleen. Semin Diagn Pathol 2021; 38:159-164. [DOI: 10.1053/j.semdp.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
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24
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A Rare Case of Plasma Cell Granuloma. Case Rep Dent 2020; 2020:8861918. [PMID: 33425399 PMCID: PMC7781719 DOI: 10.1155/2020/8861918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell granulomas (PCGs) or inflammatory pseudotumors are nonneoplastic lesions that consist of predominantly antibody-secreting plasma cells and innate immune cells such as neutrophils, macrophages, and eosinophils. Unlike in multiple myeloma, the plasma cells are polyclonal and present in a spindly fibroblast-rich stromal background. These lesions mainly occur in the lungs; however, they can arise in other organs. PCGs from the gingiva are extremely rare, and a proper diagnosis is crucial to treat these patients further. These tumors have an increased number of plasma cells that are immunoreactive with CD138 and are polyclonal for kappa and lambda light chains, confirming these proliferations' nonneoplastic nature. Surgical resection with clear margins, when possible, is the primary choice of treatment. Radiation and anti-inflammatory steroid therapy are other therapeutic approaches. Critical and careful examination by a pathologist is necessary to rule out plasma cell neoplasms. Here, we report a rare occurrence of gingival PCG in an elderly male.
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25
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Coelho VV, Surendran S, Roopavathana B, Chase S. Colonic inflammatory myofibroblastic tumour presenting as 'pyrexia of unknown origin': report of a rare disease and its unique presentation. BMJ Case Rep 2020; 13:13/12/e236056. [PMID: 33298475 DOI: 10.1136/bcr-2020-236056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An intra-abdominal inflammatory myofibroblastic tumour (IMT) belongs to a rare group of diseases initially described as an inflammatory pseudotumour. Even though it is seen more often in children, its incidence in adults is even rarer. Clinical presentations can vary depending on its site and inherent tumour properties. The colon is an uncommon site for IMT and pyrexia of unknown origin (PUO) as its dominant clinical presentation is even rarer. A 27-year-old woman presented with PUO. She was evaluated under the department of internal medicine before undergoing an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan. This showed an intensely enhancing descending colon mass. An image-guided biopsy of this lesion was reported as IMT. She underwent a left hemicolectomy and complete excision of the tumour, following which her symptoms resolved completely. The patient has been disease-free at a 6-month follow-up and is asymptomatic at 1 year.
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Affiliation(s)
- Victor Vijay Coelho
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suraj Surendran
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Beulah Roopavathana
- General Surgery Unit IV, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suchita Chase
- General Surgery Unit IV, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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26
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Buysse J, Gupta U, Porayette P. Echocardiographic Findings in Children with Native Mitral Valve Masses Complicated by Systemic Embolization. CASE (PHILADELPHIA, PA.) 2020; 4:415-419. [PMID: 33117941 PMCID: PMC7581644 DOI: 10.1016/j.case.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
• Case of mitral valve IMT with embolization. • Case of Streptococcus pneumoniae mitral valve endocarditis with embolization. • Use of 2D and 3D echocardiography for management of mitral valve masses.
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Affiliation(s)
- Janelle Buysse
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Umang Gupta
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Prashob Porayette
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
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27
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Smaily H, Cherfane P, Matar N. Pediatric laryngeal inflammatory myofibroblastic tumour: Case report and systematic review of the literature. Auris Nasus Larynx 2020; 48:1047-1053. [PMID: 32878712 DOI: 10.1016/j.anl.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/12/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumours (IMT) are rare benign neoplasms in the pediatric population, found most frequently in the lungs with rare reports of laryngeal involvement. The aim of this paper is to present a clinical case of laryngeal IMT followed by a systematic review on pediatric laryngeal IMT. CASE REPORT We present the case and the management of a 13-year-old boy with a laryngeal IMT MATERIAL AND METHODS: A comprehensive review of literature was conducted in September 2019 using Pubmed and Scopus. Included articles were reviewed for mean age at presentation, gender, main symptoms, treatment modality, histopathological features and follow-up RESULTS: Sixteen cases of pediatric laryngeal IMT were reported in the literature. The mean age of presentation was 7 years; endoscopic surgical resection was used in 87% of procedures, and the mean number of interventions needed to achieve remission was 1.6. CONCLUSIONS Pediatric laryngeal IMT are rare benign proliferations with only 16 reported case in the medical literature. The diagnosis of this entity remains a challenge and the standard of care is surgery with clear margins.
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Affiliation(s)
- Hussein Smaily
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
| | - Patrick Cherfane
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Nayla Matar
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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28
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Nakamura T, Yoshihara M, Tamauchi S, Kajiyama H, Kikkawa F. Follicular dendritic cell sarcoma of the uterine cervix: a case report. BMC WOMENS HEALTH 2020; 20:182. [PMID: 32807169 PMCID: PMC7433043 DOI: 10.1186/s12905-020-01045-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
Background Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor that mostly occurs in systemic lymph nodes. FDCS in the uterine cervix has not yet been reported. Case presentation A 49-year-old woman was referred to our department with a cervical tumor, which was histologically suspected to be undifferentiated carcinoma. She underwent hysterectomy, salpingo-oophorectomy, and pelvic lymphadenectomy after neoadjuvant chemotherapy with paclitaxel and carboplatin. The resected specimen contained high numbers of spindle cells and was immunohistochemically confirmed to be FDCS. The tumor was completely resected and recurrence was not detected at a 16-month follow-up. Conclusion FDCS is an extremely rare malignant tumor in the uterine cervix, and an accurate diagnosis and complete resection are essential for a good prognosis.
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Affiliation(s)
- Takuto Nakamura
- Department of Obstetrics and Gynecology, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65, Tsuruma-cho, Showa-ku, Nagoya, Aichi, Japan.
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65, Tsuruma-cho, Showa-ku, Nagoya, Aichi, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65, Tsuruma-cho, Showa-ku, Nagoya, Aichi, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65, Tsuruma-cho, Showa-ku, Nagoya, Aichi, Japan
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29
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Bruehl FK, Azzato E, Durkin L, Farkas DH, Hsi ED, Ondrejka SL. Inflammatory Pseudotumor-Like Follicular/Fibroblastic Dendritic Cell Sarcomas of the Spleen Are EBV-Associated and Lack Other Commonly Identifiable Molecular Alterations. Int J Surg Pathol 2020; 29:443-446. [PMID: 32787485 DOI: 10.1177/1066896920949675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammatory pseudotumor-like follicular/fibroblastic dendritic cell sarcoma (IPT-like FFDCS) is a rare, indolent neoplasm that occurs in the spleen or liver and harbors Epstein-Barr virus (EBV) integrated into the host genome. The molecular genetic characteristics of IPT-like FFDCS have not been well studied and there are no established and actionable molecular features to guide treatment decisions or diagnosis beyond the recognition of viral genome integration. We subjected two cases of IPT-like FFDCS to a comprehensive next-generation sequencing analysis. Several variants of uncertain clinical significance were detected in both tumors. No variants of potential or strong clinical significance were detected within the targeted regions of the evaluated genes. Additionally, no fusion events were detected involving the genes in either tumor. The performed molecular analysis identified no genetic aberrations in IPT-like FFDCS and its genomic landscape remains, with the exception of a monoclonal EBV gene, largely undefined.
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30
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Tabibzadeh A, Karbalaie Niya MH, Esghaei M, Bokharaei-Salim F, Ataei-Pirkooh A, Kiani SJ, Monavari SHR. Molecular Epidemiology of Epstein-Barr virus (EBV) in Patients with Hematologic Malignancies. Asian Pac J Cancer Prev 2020; 21:693-698. [PMID: 32212795 PMCID: PMC7437315 DOI: 10.31557/apjcp.2020.21.3.693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Epstein-Barr virus (EBV) is associated with different malignant diseases, such as Hodgkin lymphoma (HL) and lymphoproliferative disorders. Patients with hematologic malignancies by variable severity could be suspected for the infection with different types of this virus. This preliminary study reported the genotyping and related viral load of Epstein-Barr virus in Iranian patients with hematologic malignancies for estimation of possible factors affecting malignancy. Methods: Peripheral blood mononuclear cells (PBMC) of HL (n=20), NHL (n=29), acute lymphocytic leukemia (ALL) (n=18) and chronic lymphocytic leukemia (CLL) (n=12) were obtained. After DNA extraction, a nested-PCR and a conventional-PCR targeting EBNA-2 and EBNA-3C genes were performed. A real-time PCR assay for viral load quantitation carried out. Standard curve analysis used for evaluation of amplification specificity. Results: Of 79 included patients, 34 (43%) were EBV positive. There were 23.5% (8/34), 38.2% (13/34), 23.5% (8/34), 14.8% (5/34) in HL, NHL, ALL and CLL groups, respectively. Also, the main genotype was genotype I (91.2%) which it follows by 8.8% (3/34) genotype II. The real-time PCR assay showed the mean viral load ± std. deviation was 2.75×105 ± 1.202×106 copies/μg DNA and the higher viral load was seen in NHL patients. Conclusion: This preliminary investigation in Iran shows that the main EBV genotype into our region probably is genotype I (91.2%) which it is similar to others. We could not find any statistically significant association between the virus infection and viral load with any specific disease and patients’ demographic data.
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Affiliation(s)
- Alireza Tabibzadeh
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Esghaei
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Seyed Jalal Kiani
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran
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31
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Han MS, Moon KS, Lee KH, Jang WY, Kim SK, Jung S. Intracranial Inflammatory Pseudotumor Associated with Idiopathic Hypertrophic Pachymeningitis Mimicking Malignant Tumor or High-Grade Meningioma. World Neurosurg 2020; 134:372-376. [DOI: 10.1016/j.wneu.2019.10.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
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32
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Chong S, Teh CS, Singh S, Seong MK, Viswaraja S. Aggressive Inflammatory Pseudotumor of the Maxillary Sinus and Orbit. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556131409300308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sheldon Chong
- Department of Otorhinolaryngology, Modbury Hospital,
Adelaide, Australia
| | - Carren S.L. Teh
- Department of Otorhinolaryngology–Head and Neck
Surgery, Sungai Buloh Hospital, Selangor, Malaysia
| | - Shashinder Singh
- Department of Otorhinolaryngology, Gosford Private
Hospital, Gosford North, Australia
| | - Mun Kein Seong
- Department of Pathology, University Malaya Medical
Centre, Kuala Lumpur, Malaysia
| | - Subrayan Viswaraja
- Department of Ophthalmology, University Malaya Medical
Centre, Kuala Lumpur, Malaysia
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Pediatric Inflammatory Myofibroblastic Tumor of the Liver: A Rare Cause of Portal Hypertension. ACG Case Rep J 2019; 6:1-4. [PMID: 31620493 PMCID: PMC6658019 DOI: 10.14309/crj.0000000000000028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Hepatic inflammatory pseudotumors or myofibroblastic tumors are benign neoplasms rarely seen in children. We report a case of a previously healthy 10-year-old girl with prolonged fever and abdominal pain who was found to have hepatosplenomegaly and pancytopenia. Imaging revealed a periportal mass along with thrombosis of portal vein and splenomegaly. Liver biopsy showed normal hepatic architecture with no evidence of cirrhosis. She underwent endoscopic banding of esophageal varices. Biopsy of the mass was suggestive of inflammatory myofibroblastic tumor without malignant changes. She has been successfully managed with nonsteroidal anti-inflammatory drug and pulse steroids with resolution of symptoms and decrease in size of the tumor with more than 2 years of follow-up.
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34
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Hatama S, Murakami K, Yamamoto S, Kadota K. Detection of bovine papillomavirus type 2 DNA in calf conjunctival myofibroblastoma. J Vet Med Sci 2018; 80:1544-1548. [PMID: 30158370 PMCID: PMC6207528 DOI: 10.1292/jvms.18-0341] [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] [Indexed: 11/22/2022] Open
Abstract
An 8-month-old male Japanese Black calf was referred for the evaluation of a slow-growing
conjunctival mass in the right eye. A superficial keratectomy was performed followed by
recurrence on two occasions. No metastases were found in surrounding tissues.
Histological, immunohistochemical, and ultrastructural investigation revealed that both
the primary and the recurrent lesions were benign, conjunctival, myofibroblastomas.
Interestingly, bovine papillomavirus type 2 (BPV-2) DNA was detected in both
myofibroblastoma lesions. Archival bovine myofibroblastomas from the vulva and neck were
also analyzed for papillomaviral genomes. BPV-2 DNA was also amplified from these lesions.
To the best of our knowledge, this is the first report describing a potential causal
relationship between BPV-2 infection and conjunctival myofibroblastoma.
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Affiliation(s)
- Shinichi Hatama
- National Institute of Animal Health, National Agriculture and Research Organization, 3-1-5 Kannondai, Tsukuba, Ibaraki 305-0856, Japan
| | - Kenji Murakami
- Nakasorachi NOSAI, 1-5-14 Omachi, Takikawa, Hokkaido 073-0022, Japan
| | - Shinji Yamamoto
- Souya Livestock Hygiene Service Center, 8-3 Midorigaoka, Hamatonbetsu, Esashi, Hokkaido 098-5738, Japan
| | - Koichi Kadota
- Hokkaido Research Station, National Institute of Animal Health, National Agriculture and Research Organization, 4 Hitsujigaoka, Toyohira, Sapporo, Hokkaido 062-0045, Japan
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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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36
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Nianyu XMD, Youfeng XMD, Li SMD, Shengmin ZMD, Yunzhong WMD. Imaging Features of Multiple Inflammatory Pseudotumor- Like Follicular Dendritic Cell Sarcoma in Spleen: A Case Report and Literature Review. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2018. [DOI: 10.37015/audt.2018.180001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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37
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Tregnago AC, Morbeck DL, D’Almeida Costa F, Campos AHJFM, Soares FA, Vassallo J. Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41241-017-0051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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38
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Wang X, Wang Z, Chen Y, Qian M. Inflammatory myofibroblastic tumor of the right frontal lobe. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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39
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Wang S, Chen L, Cao Z, Mao X, Zhang L, Wang B. Inflammatory myofibroblastic tumor of the lumbar spinal canal: A Case Report With Literature Review. Medicine (Baltimore) 2017; 96:e6488. [PMID: 28658093 PMCID: PMC5500015 DOI: 10.1097/md.0000000000006488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
RATIONALE Inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymal tumor. IMT can arise in multiple anatomic locations. IMT of the lumbar spinal canal is exceptionally rare. PATIENT CONCERNS Here, we report the case of a 56-year-old male patient with an IMT who was in good health until 1 year prior to admission, when he began experiencing pain in both lower extremities and the lower back. INTERVENTIONS A space-occupying lesion in the lumbar canal was identified by magnetic resonance imaging and then surgically resected. DIAGNOSES Histopathological analysis of the lesion revealed a composition of mucous edema, inflammatory cells, collagenous fibers, and spindle cells that were diffuse and positive for smooth muscle actin and CD68; focal positive for vimentin and desmin; and negative for CD34 (marker of vascular endothelial cells), CD21, CD23, CD35, S-100, Epstein-Barr virus infection, Ki-67, and anaplastic lymphoma kinase. Thus, the diagnosis was an IMT of the lumbar canal. OUTCOMES In the spinal canal, IMT should be considered in the evaluation of tumors although it is a very rare diagnosis. It is a benign lesion, but it has potential for invasion and recurrence. LESSONS There are no characteristic imaging features of these tumors, but they can be addressed by complete surgical excision. Patients with these lesions should undergo frequent long-term follow-up to detect and address recurrence.
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Affiliation(s)
- Shanshan Wang
- Shandong Medical Imaging Research Institute, Shandong University
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
- Medical Imaging Research Institute, Binzhou Medical University
| | - Liang Chen
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
| | - Zhang Cao
- Department of Pathology, Affiliated Hospital of Binzhou Medical University, China
| | - Xijin Mao
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
- Medical Imaging Research Institute, Binzhou Medical University
| | - Lin Zhang
- Department of Radiology, Affiliated Hospital of Binzhou Medical University
| | - Bin Wang
- Medical Imaging Research Institute, Binzhou Medical University
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40
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Van Baeten C, Van Dorpe J. Splenic Epstein-Barr Virus–Associated Inflammatory Pseudotumor. Arch Pathol Lab Med 2017; 141:722-727. [DOI: 10.5858/arpa.2016-0283-rs] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Splenic inflammatory pseudotumor (IPT) is an uncommon lesion with an inflammatory morphologic aspect that often poses a diagnostic challenge. The etiology of IPT can be infectious, autoimmune, reactive, or neoplastic. Splenic Epstein-Barr virus (EBV)–associated IPTs form a subset of splenic IPTs in which there is a spindle cell component infected by EBV. The best characterized and most frequent subgroup of splenic EBV-associated IPT is IPT-like follicular dendritic cell tumor. This review also focusses on EBV-associated splenic IPTs without follicular dendritic cell marker expression. These lesions are less well characterized, making the differential diagnosis with other splenic lesions even more difficult. Recently, increased numbers of immunoglobulin G4–positive plasma cells and the presence of numerous granulomas have been reported in EBV-associated IPTs, and this can add to the difficulties in recognizing the neoplastic nature of these lesions. Herein, we also review the epidemiology, clinical features, histologic morphology, immunohistochemistry, electron microscopy, and pathogenesis of EBV-associated IPTs.
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Affiliation(s)
| | - Jo Van Dorpe
- From the Department of Pathology, Ghent University Hospital, Ghent, Belgium
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41
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Campbell BM, McBride CA, Fawcett JW. Unlucky versus coincidence: Dual hepato-pancreatico biliary diagnoses in a six-year-old. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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42
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Hang JF, Wang LC, Lai CR. Cytological features of inflammatory pseudotumor-like follicular dendritic cell sarcoma of spleen: A case report. Diagn Cytopathol 2016; 45:230-234. [PMID: 27775241 DOI: 10.1002/dc.23626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/13/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
Here, we present the first cytological report of a primary splenic inflammatory pseudotumor-like follicular dendritic cell sarcoma. The 57 year-old male was incidentally found with a 2.2 cm well-demarcated splenic nodule. A sonography guided fine needle aspiration of the lesion was performed. The cytologic smears revealed loosely cohesive fragments of oval to spindle cells in a background of prominent lymphoplasmacytic infiltration. The cells showed sparse chromatin, distinct nucleoli, syncytial cell borders, and occasional cytoplasmic processes. On the liquid-based preparation, several histiocyte-like cells with emperipolesis phenomenon were noted. Scant large atypical cells with prominent, cherry-red nucleoli were found on the cell block sections. The initial cytologic interpretation was "atypical cells cannot exclude classical Hodgkin lymphoma." The subsequent partial splenectomy showed an inflammatory pseudotumor-like follicular dendritic cell sarcoma. The tumor cells were positive for CD21, CD35, smooth muscle actin, and EBER in situ hybridization. The cytologic differential diagnoses are briefly discussed. The knowledge of this rare entity, awareness of its cytomorphology, and proper ancillary tests would be helpful for correct cytologic diagnosis. Diagn. Cytopathol. 2017;45:230-234. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Lei-Chi Wang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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43
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Zhang X, Tang S, Huang L, Yu H. Contrast-Enhanced Sonographic Characteristics of Hepatic Inflammatory Pseudotumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2039-2047. [PMID: 27503756 DOI: 10.7863/ultra.15.10057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/07/2015] [Indexed: 06/06/2023]
Abstract
A hepatic inflammatory pseudotumor, which can be misdiagnosed as a malignant tumor, is a relatively uncommon tumor with nonspecific imaging manifestations. As a new diagnostic technique, contrast-enhanced sonography has become increasingly important in the diagnosis of liver focal lesions. Here we present 3 cases of histologically confirmed hepatic inflammatory pseudotumors diagnosed with contrast-enhanced sonography. "Fast-in and centrifugal-out" may be a characteristic contrast-enhanced sonographic enhancement pattern in the diagnosis of hepatic inflammatory pseudotumors, which needs confirmation in further studies.
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Affiliation(s)
- Xiaoyue Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaoshan Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liping Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongwei Yu
- Department of Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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44
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Tay SY, Balakrishnan A. Laryngeal inflammatory myofibroblastic tumor (IMT): a case report and review of the literature. J Med Case Rep 2016; 10:180. [PMID: 27339455 PMCID: PMC4918124 DOI: 10.1186/s13256-016-0967-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This case report is interesting as cases of children with laryngeal inflammatory myofibroblastic tumor are not common and previously had been presented as isolated case reports. This is the first case report in Asia describing a laryngeal inflammatory myofibroblastic tumor and its removal using an endoscopic approach. CASE PRESENTATION Our patient is a 12-year-old Malay girl from Singapore who presented with hoarseness without respiratory distress. The initial impression was that of a granuloma or a papilloma. We did a biopsy, which confirmed the histology to be inflammatory myofibroblastic tumor, and a magnetic resonance imaging scan showed a contrast-enhanced lesion. The lesion was excised completely using an endoscopic approach. The child was discharged well on the first postoperative day and she has been on follow-up for a year in the clinic. CONCLUSIONS This report highlights the importance of understanding the differential diagnosis for a child with hoarseness. It is not uncommon for a pediatrician, a general practitioner, and a pediatric otolaryngologist to see a child presenting with hoarseness. In most cases, the diagnosis made would be screamer's nodules, which is commonly seen in children. In a small group, recurrent respiratory papillomatosis form the diagnosis. Over the past few years, the cases of recurrent respiratory papillomatosis have decreased significantly. Laryngeal tumors are not common in children. However, we must maintain a high index of suspicion when we have a child with hoarseness who does not improve with speech therapy and watchful waiting. In such situations, a stroboscope is usually necessary to diagnose the voice problems and to rule out pathological conditions such as laryngeal tumors. If left untreated, the lesion can grow with time and result in a life-threatening airway condition. We also demonstrate our endoscopic technique in this report, and it has proven to be safe with no increased recurrence and much lower morbidity.
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Affiliation(s)
- Sok Yan Tay
- Department of Otolaryngology Head and Neck Surgery, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Abhilash Balakrishnan
- Department of Otolaryngology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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45
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Lai LM, McCarville MB, Kirby P, Kao SCS, Moritani T, Clark E, Ishigami K, Bahrami A, Sato Y. Shedding light on inflammatory pseudotumor in children: spotlight on inflammatory myofibroblastic tumor. Pediatr Radiol 2015; 45:1738-52. [PMID: 25964134 DOI: 10.1007/s00247-015-3360-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/11/2015] [Accepted: 04/06/2015] [Indexed: 01/03/2023]
Abstract
Inflammatory pseudotumor is a generic term used to designate a heterogeneous group of inflammatory mass-forming lesions histologically characterized by myofibroblastic proliferation with chronic inflammatory infiltrate. Inflammatory pseudotumor is multifactorial in etiology and generally benign, but it is often mistaken for malignancy given its aggressive appearance. It can occur throughout the body and is seen in all age groups. Inflammatory pseudotumor has been described in the literature by many organ-specific names, resulting in confusion. Recently within this generic category of inflammatory pseudotumor, inflammatory myofibroblastic tumor has emerged as a distinct entity and is now recognized as a fibroblastic/myofibroblastic neoplasm with intermediate biological potential and occurring mostly in children. We present interesting pediatric cases of inflammatory myofibroblastic tumors given this entity's tendency to occur in children. Familiarity and knowledge of the imaging features of inflammatory pseudotumor can help in making an accurate diagnosis, thereby avoiding unnecessary radical surgery.
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Affiliation(s)
- Lillian M Lai
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 3970 JPP, Iowa City, IA, 52242, USA.
| | - M Beth McCarville
- Department of Radiology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Patricia Kirby
- Department of Pathology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Simon C S Kao
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 3970 JPP, Iowa City, IA, 52242, USA
| | - Toshio Moritani
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 3970 JPP, Iowa City, IA, 52242, USA
| | - Eve Clark
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 3970 JPP, Iowa City, IA, 52242, USA
| | - Kousei Ishigami
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 3970 JPP, Iowa City, IA, 52242, USA
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Sato
- Department of Radiology, Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 3970 JPP, Iowa City, IA, 52242, USA
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46
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Werner RL, Castle JT. Inflammatory Myofibroblastic Tumor of the Nasal Cavity. Head Neck Pathol 2015; 10:336-9. [PMID: 26483083 PMCID: PMC4972743 DOI: 10.1007/s12105-015-0662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel L. Werner
- Department of Head and Neck and Endocrine Pathology, The Joint Pathology Center, Silver Spring, MD 20910 USA
| | - James T. Castle
- Department of Oral and Maxillofacial Pathology, Naval Postgraduate Dental School, 8955 Wood Road, Bethesda, MD 20889-5628 USA
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47
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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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48
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Inflammatory Pseudotumor of the Liver with Escherichia coli in the Sputum. Case Rep Med 2015; 2015:249210. [PMID: 26347780 PMCID: PMC4549540 DOI: 10.1155/2015/249210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/19/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
Inflammatory pseudotumor is a nonmalignant lesion that mimics malignant lesions and has been reported to occur at various sites throughout the body. Though it has been reported as a reaction to infection, the true etiology of the lesion is unknown. In this report, we present the case of a patient with a liver lesion of unknown origin. Through a series of imaging studies, we were able to observe the locally aggressive nature of this lesion as it rapidly eroded into the lung. Sputum cultures showed growth of E. coli, indicating E. coli infection as a possible etiology of this lesion. Pathology was consistent with inflammatory pseudotumor.
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49
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Kheiwa A, Turner D, Schreiber T. Left main coronary artery embolization in an 11-year-old girl due to inflammatory myofibroblastic tumor of the mitral valve. Catheter Cardiovasc Interv 2015; 87:933-8. [DOI: 10.1002/ccd.26149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 06/13/2015] [Accepted: 07/21/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Ahmed Kheiwa
- Department of Cardiology; Children's Hospital of Michigan; Detroit, Michigan
| | - Daniel Turner
- Department of Cardiology; Children's Hospital of Michigan; Detroit, Michigan
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50
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Gu LI, Ouyang C, Lu F. Follicular dendritic cell sarcoma with extensive lymph node involvement: A case report. Oncol Lett 2015; 10:399-401. [PMID: 26171038 DOI: 10.3892/ol.2015.3234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 04/17/2015] [Indexed: 11/06/2022] Open
Abstract
Follicular dendritic cell sarcoma (FDCS) is an extremely rare neoplasm originating from the follicular dendritic cells in the lymphoid follicles. Current knowledge on its pathogenesis is limited and a well-defined treatment is required. The main channel through which clinicians obtain practical information on FDCS is via studying published case reports. To enrich the existing available literature and enhance the understanding of this rare disease, the present study describes a case of FDCS with extensive lymph node involvement in a 65-year-old male patient whose predominant symptom was a recurrent fever. The diagnosis of FDCS was eventually established based on the immunohistochemical staining of biopsy specimens of the cervical lymph nodes. The patient improved and symptoms disappeared after one cycle of systemic chemotherapy.
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Affiliation(s)
- L I Gu
- Division of Digestive Disease, Xiangya Second Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Chunhui Ouyang
- Division of Digestive Disease, Xiangya Second Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Fanggen Lu
- Division of Digestive Disease, Xiangya Second Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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