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Irani S, Rabbani Anari M, Yazdani Bioki F, Nasirmohtaram S, Kaedi Z, Alipour S. Inflammatory Myofibroblastic Tumor: Two Cases in Head and Neck Region. Indian J Otolaryngol Head Neck Surg 2022; 74:6394-6399. [PMID: 36742535 PMCID: PMC9895362 DOI: 10.1007/s12070-022-03119-9] [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: 12/31/2021] [Accepted: 07/06/2022] [Indexed: 02/07/2023] Open
Abstract
Previously described as inflammatory pseudotumor, inflammatory myofibroblastic tumors (IMT) are now considered as distinct tumors of specific histopathologic features. This rare mesenchymal tumor consists of spindle shaped fibroblasts associated with various amounts of inflammatory cells. Head and neck region, is an unusual site of involvement. In this article, we will introduce two separate cases with the diagnosis of IMT involving the nasopharynx and the temporal bone which are both rare locations of presentation. Inflammatory myofibroblastic tumor should be considered in the differential diagnosis list of every mass in head and neck region.
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Affiliation(s)
- Shirin Irani
- Otorhinolaryngology Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Rabbani Anari
- Otorhinolaryngology Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Yazdani Bioki
- Department of Pathology, School of Medicine, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sevil Nasirmohtaram
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Amir-Almomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zohre Kaedi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Alipour
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Mishra S, Suh CH, Bergmark RW, Jo VY, Miyawaki EK, Schoenfeld JD, Uppaluri R, Guenette JP. Imaging features, therapies, and outcomes of fibrosing inflammatory pseudotumor of the nasopharynx: A systematic review. J Neuroimaging 2021; 32:223-229. [PMID: 34879175 DOI: 10.1111/jon.12953] [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: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Fibrosing inflammatory pseudotumor (FIP) of the nasopharynx is a rare nonneoplastic inflammatory lesion that is frequently mistaken for malignancy or infection. It is often misdiagnosed by radiologists as nasopharyngeal carcinoma or lymphoma, resulting in multiple biopsies and delays in diagnosis. The purpose is to understand trends in clinical presentation, imaging findings, treatment modalities, and patient outcomes of nasopharyngeal FIP. METHODS MEDLINE and EMBASE databases were queried for articles related to FIP of the nasopharynx. Articles that described cases of FIP involving the nasopharynx were selected. Studies that described inflammatory pseudotumor of the nasopharynx associated with known distinct pathologic entities were excluded. RESULTS A total of 19 articles describing 37 patients were included. MRI findings were reported in 32 patients. All cases demonstrated avid gadolinium enhancement. T2-weighted imaging characteristics were described or displayed for 21 patients: 95% demonstrated hypointensity compared to surrounding mucosa. Fluorodeoxyglucose (FDG) PET/CT findings were reported for 6 patients, all demonstrating mild FDG avidity. CONCLUSIONS Nasopharyngeal FIP is a histological diagnosis of exclusion that presents with facial pain and, often, cranial neuropathies. Relatively low T2-weighted MRI signal should inform the interpreting neuroradiologist to include FIP as a differential consideration for both the ordering provider and pathologist. Corticosteroid therapy is the most frequently employed therapy and results in partial or complete response in most patients. Radiation therapy and anti-inflammatory medications have also been reported to have potential therapeutic roles.
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Affiliation(s)
- Shruti Mishra
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Regan W Bergmark
- Division of Otolaryngology-Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edison K Miyawaki
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Miyawaki EK, Hsu L, Bhattacharyya S, O'Hare MJ, Roy A, Kett L, Caplan RA, Dattilo LW, Jo VY, Guenette JP. Fibrosing Inflammatory Pseudotumor Presenting as Cranial Neuropathy. Case Rep Neurol 2020; 12:247-254. [PMID: 32774282 PMCID: PMC7383149 DOI: 10.1159/000507920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 12/27/2022] Open
Abstract
We report two cases of biopsy-corroborated “fibrosing inflammatory pseudotumor” to illustrate that the entity, rarely described in the neurological literature, should be included in the differential diagnosis of either a cranial mononeuropathy or, certainly, in the case of progressive cranial neuropathies. A broad differential diagnosis arises in certain contexts. Early steroid treatment can be effective, and perhaps later-generation immune-modulating agents may confer further options, although there is no known definitive treatment.
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Affiliation(s)
- Edison K Miyawaki
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liangge Hsu
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meabh J O'Hare
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexis Roy
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Kett
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel A Caplan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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A Rare Presentation of Inflammatory Myofibroblastic Tumor in the Nasolabial Fold. Case Rep Otolaryngol 2019; 2019:3257697. [PMID: 30809407 PMCID: PMC6364106 DOI: 10.1155/2019/3257697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/22/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a benign lesion that occurs most frequently in the soft tissues and viscera. In the head and neck region, the tumor has been reported to occur in the orbit, tongue, nasopharynx, larynx, and paranasal sinuses and the central nervous system. Despite being a benign lesion, it exhibits infiltrative and destructive behaviours, making histopathological examination necessary to confirm the diagnosis. We report the case of a 38-year-old female presented with a right nasolabial fold mass, which was confirmed histologically to be an IMT. Surgical excision of the mass was achieved through a sublabial approach with an uneventful postoperative period. To the best of our knowledge, this is the first reported case of an IMT in the nasolabial fold.
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Bennour A, Dughman A, Elkhashmee A. Retropharyngeal soft-tissue mass with multiple cranial neuropathies. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2019. [DOI: 10.4103/ijmbs.ijmbs_45_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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High-Resolution Isotropic Three-Dimensional MR Imaging of the Extraforaminal Segments of the Cranial Nerves. Magn Reson Imaging Clin N Am 2018; 26:101-119. [DOI: 10.1016/j.mric.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lahlou G, Classe M, Wassef M, Just PA, Le Clerc N, Herman P, Verillaud B. Sinonasal Inflammatory Myofibroblastic Tumor with Anaplastic Lymphoma Kinase 1 Rearrangement: Case Study and Literature Review. Head Neck Pathol 2017; 11:131-138. [PMID: 27443585 PMCID: PMC5429268 DOI: 10.1007/s12105-016-0744-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/09/2016] [Indexed: 12/27/2022]
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal tumors initially described in the lung. About half of them exhibit expression of the ALK1 protein, generally resulting from a gene rearrangement. Paranasal sinus IMTs are extremely uncommon, and gene rearrangement of ALK1 is very rare in this localization. A 47-year-old woman presented with rapidly progressive vision loss in her left eye. Clinical and imaging work-up revealed a tumor invading the left ethmoidal and sphenoidal sinuses and extending into the nasal cavity, the orbit and the skull base. Complete tumor resection was performed using an endonasal approach. Pathological examination revealed a paranasal localization of IMT, positive for ALK1 immunostaining. FISH analysis showed an ALK1 gene rearrangement. This case illustrates the local aggressive potential for IMTs. Treatment is primarily surgical, but targeted therapies (crizotinib) might be a solution for ALK1 rearranged cases with a poor prognosis.
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Affiliation(s)
- Ghizlene Lahlou
- ENT Department, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, France.
| | - Marion Classe
- Pathology Department, Lariboisiere Hospital, APHP, Paris 7 University, Paris, France
| | - Michel Wassef
- Pathology Department, Lariboisiere Hospital, APHP, Paris 7 University, Paris, France
| | | | - Nicolas Le Clerc
- ENT Department, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Philippe Herman
- ENT Department, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, France
- EA 7334 REMES, Paris 7 University, Paris, France
| | - Benjamin Verillaud
- ENT Department, Lariboisiere Hospital, 2 Rue Ambroise Paré, 75010, Paris, France
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Jung HN, Kim HJ, Kim YK, Song M, Kim HY, Park KM, Cha J, Kim ST. Discrepant lesion size estimated on T1- and fat-suppressed T2-weighted MRI: diagnostic value for differentiation between inflammatory pseudotumor and carcinoma of the nasopharynx. Diagn Interv Radiol 2017; 23:199-205. [PMID: 28420597 DOI: 10.5152/dir.2017.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Nasopharyngeal inflammatory pseudotumor (NIPT) is hard to differentiate from infiltrating nasopharyngeal carcinoma (NPC) on conventional magnetic resonance imaging (MRI). The purpose of this study is to determine whether discrepant lesion sizes estimated on T1- and fat-suppressed T2-weighted images can help distinguish between NIPT and NPC. METHODS We retrospectively reviewed MRI data of histologically proven 14 NIPTs and 18 infiltrating NPCs. We measured the area of the lesion on contrast-enhanced T1-weighted, unenhanced T1-weighted, and fat-suppressed T2-weighted images by placing the largest possible polygonal region-of-interest within the lesion at the same level. Using lesion size measured on contrast-enhanced T1-weighted image as the reference, we calculated and compared area ratio of T1 (ART1) and area ratio of T2 (ART2) between NIPTs and NPCs. For validation, we also undertook a double-blinded study by two reviewers and assessed the diagnostic performance and interobserver agreement. RESULTS For NIPTs, ART2 (median, 0.48; range, 0.18-0.97) was statistically significantly less than ART1 (median, 1.01; range, 0.80-1.99), while these values were not significantly different for NPCs. The interobserver agreement in differentiating between NIPT and NPC was good, with a sensitivity of 93% and a specificity of 83%-94%. CONCLUSION In contrast to NPCs, NIPTs appear smaller on fat-suppressed T2-weighted images than on T1-weighted images. This discrepancy in the lesion size estimated on T1-weighted and fat-suppressed T2-weighted images may provide a simple and consistent way to differentiate between NIPTs and NPCs on conventional MRI.
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Affiliation(s)
- Hye Na Jung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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