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Inflammatory Myofibroblastic Tumor of the Upper Airways Harboring a New TRAF3-ALK Fusion Transcript. CHILDREN-BASEL 2021; 8:children8060505. [PMID: 34203606 PMCID: PMC8232338 DOI: 10.3390/children8060505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare disease that mainly involves the lung and the abdomen with an intermediate clinical course but a recurrence rate between 15–30%. Radical surgery represents the gold standard of treatment, while chemotherapy and radiotherapy are considered for unresectable lesions. The identification of ALK translocations in IMT opened the option for the use of target therapies. Indeed, the ALK inhibitors have changed the treatment approach for aggressive lesions, improving the prognosis. Intraluminal upper-way IMT is extremely rare and represents a medical challenge. We reported an endotracheal IMT case presenting a previously unknown TRAF3-ALK fusion transcript.
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Inflammatory myophibroblastic tumor of the proximal ileon in a patient with complicated umbilical hernia: A case report and literature review. Int J Surg Case Rep 2021; 84:106091. [PMID: 34153698 PMCID: PMC8220590 DOI: 10.1016/j.ijscr.2021.106091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Inflammatory myofibroblastic tumors are neoplasms that occur infrequently, mainly affects children and young adults. It is an intermediate grade fibrotic multinodular neoplasm. Description of the case We present the case of a 47-year-old female patient, who underwent emergency umbilical hernioplasty, later developed intestinal obstruction secondary to an inflammatory myofibroblastic tumor. Discussion In 1939 Brunn described it for the first time, later in 1954 Umiker named it “Inflammatory Myofibroblastic Tumor”. The symptoms are nonspecific. In 15 to 40% of patients they are asymptomatic. Cells positive for actin, smooth muscle, vimentin and desmin, in 3367% of cases the cells are positive for ALK, which is present in some malignant lesions. The recommended treatment is radical resection. Conclusion The diagnosis is established by histopathological study, surgery is the cornerstone of treatment. Rare case of intestinal myofibroblastic tumor Inflammatory myofibroblastic tumors are infrequent tumors with benign behavior most of the time. Myofibroblastic tumor of unusual presentation Complete resection as the treatment of choice in myofibroblastic tumors
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Lopez-Nunez O, John I, Panasiti RN, Ranganathan S, Santoro L, Grélaud D, Wu T, Buccoliero AM, Casanova M, Alaggio R, Surrey LF. Infantile inflammatory myofibroblastic tumors: clinicopathological and molecular characterization of 12 cases. Mod Pathol 2020; 33:576-590. [PMID: 31690781 DOI: 10.1038/s41379-019-0406-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
Inflammatory myofibroblastic tumors arising in infants are rare, poorly investigated and mostly reported as isolated cases or as a part of larger series thus, their clinicopathological and molecular features are essentially unknown. Archival files from two large pediatric institutions and a tumor registry were queried for pediatric inflammatory myofibroblastic tumors. Available material from patients ≤12 months of age was reviewed. Additional immunostains (ALK-1, D240, WT1) and ALK-FISH studies were performed as needed. Targeted anchored multiplex PCR with next-generation sequencing was done in all cases. A total of 12 of 131 infantile cases (mean 5.5 months) were identified (M:F of 2:1). Anatomic locations included intestinal/mesenteric (n = 6), head/neck (n = 3), and viscera (n = 3). Half of tumors showed a hypocellular myxoid pattern, perivascular condensation, and prominent vasculature with vague glomeruloid structures present in four of them. The remaining cases exhibited a more cellular pattern with minimal myxoid component. ALK-1 immunohistochemistry was positive in most cases (11/12) with cytoplasmic-diffuse (n = 6), cytoplasmic-granular (n = 2), and dot-like (n = 3) staining patterns. ALK fusion partners identified in five cases included EML4, TPM4, RANBP2, and a novel KLC1. Three inflammatory myofibroblastic tumors showed fusions with other kinases including TFG-ROS1 and novel FN1-ROS1 and RBPMS-NTRK3 rearrangements. Favorable outcome was documented in most cases (10/11) with available follow-up (median 17 months) while three patients were successfully treated with crizotinib. In summary, infantile inflammatory myofibroblastic tumors are rare and can exhibit paucicellular, extensively myxoid/vascular morphology with peculiar immunophenotype mimicking other mesenchymal or vascular lesions. All tumors harbored kinase fusions involving ALK, ROS1, and NTRK3 including three novel fusion partners (KLC1, FN1, and RBPMS, respectively). A favorable response to crizotinib seen in three cases supports its potential use in infants as seen in older patients. Awareness of these unusual morphologic, immunophenotypic, and molecular features is critical for appropriate diagnosis and optimized targeted therapy.
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Affiliation(s)
| | - Ivy John
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Presbyterian Shadyside Hospital, Pittsburgh, PA, USA
| | - Ryane N Panasiti
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarangarajan Ranganathan
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Diane Grélaud
- Department of Pathology, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | - Tao Wu
- Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China
| | | | | | - Rita Alaggio
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. .,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Lea F Surrey
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Morales Prillwitz O, Pérez Hurtado B, Olaya Álvarez S, Arevalo Sánchez NM, Astudillo Palomino RE. Gastric inflammatory myofibroblastic tumor in a 10-month-old girl: A case report. Int J Surg Case Rep 2020; 68:185-189. [PMID: 32172194 PMCID: PMC7068046 DOI: 10.1016/j.ijscr.2020.02.062] [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: 09/26/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Inflammatory Myofibroblastic Tumors (IMTs) are rare mesenchymal tumors of unclear etiology and uncertain malignant potential that affect all age groups. IMTs are most often found in the lungs; although they do occur in a variety of other organs. IMTs have been reported in the mesentery, head and neck, omentum, retroperitoneum, limbs, genitourinary tract, and, extremely rarely, in the stomach. There is scant epidemiological data on IMTs, in part, due to the absence of national and international registries. PRESENTATION OF CASE This is a case report of a 10-month-old girl who presented with clinical signs of fever and weight loss over a period of four months. The patient was initially diagnosed with a febrile syndrome of unknown origin. However, upon further investigation, a Gastric IMT was found, and the patient required a left hepatectomy and subtotal gastrectomy with Roux-en-Y reconstruction. CONCLUSION In the pediatric population clinical findings are often nonspecific. Based on this case study, we conclude that, in children with palpable masses, IMT should always be considered as a diagnostic option.
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Affiliation(s)
- Otto Morales Prillwitz
- Fundación Valle del Lili, Departamento de Cirugía Pediátrica, Cra 98 No. 18-49, Cali, 760032, Colombia.
| | - Bladimir Pérez Hurtado
- Fundación Valle del Lili, Departamento de Patología, Cra 98 No. 18-49, Cali, 760032, Colombia
| | - Stephany Olaya Álvarez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali, 760032, Colombia
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Delgado Torralbo JA, Pavón Masa M, Luque Crespo E. Bilateral Pulmonary Involvement. Non-Surgical Options for Inflammatory Pseudotumor - A Case Report. Arch Bronconeumol 2019; 56:49-51. [PMID: 31331707 DOI: 10.1016/j.arbres.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - María Pavón Masa
- Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, España
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Camela F, Gallucci M, di Palmo E, Cazzato S, Lima M, Ricci G, Pession A. Pulmonary Inflammatory Myofibroblastic Tumor in Children: A Case Report and Brief Review of Literature. Front Pediatr 2018; 6:35. [PMID: 29535991 PMCID: PMC5835069 DOI: 10.3389/fped.2018.00035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear etiology and variable clinical course, consisting of a proliferation of fibroblasts and myofibroblasts, mixed with inflammatory cells. Synonyms of IMT are inflammatory pseudotumor and plasma cell granuloma reflecting the alleged inflammatory nature attributed to this lesion, even though this heterogeneity in the disease denomination is probably involved in a dispersion of the literature data. Among primary pulmonary neoplasms, it represents the most frequent endobronchial tumor of childhood and beyond the lung it has been described mainly in the bladder, mediastinum and mesentery. Despite having a tendency for local recurrence, the risk of distant metastasis is low. Clinical presentation depends on localization therefore lung peripheral lesions are often asymptomatic resulting in a delayed diagnosis. Radiological findings can suggest the diagnosis that must be confirmed by histopathology assessment. The tumor has been characterized by the application of immunohistochemical techniques, molecular biology and cytogenetics, which are very precious for the diagnosis. The therapeutic approach consists in the complete surgical excision of the lesion that normally ensures excellent survival. Due to the potential risk of recurrence, close clinical trial is indicated. To date only 24 cases of pulmonary IMT have been described, although the prevalence is probably higher. We present a case report of a 3-year-old girl with pulmonary IMT and a brief review of known literature cases in order to highlight the most common clinical presentations, the most useful diagnostic tools and therapeutic approach.
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Affiliation(s)
- Federica Camela
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Mario Lima
- Department of Pediatric Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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