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Lin H, Liu Y, Wei Y, Guan X, Yu S, Man Y, Deng D. Characteristics of imaging in hepatic inflammatory pseudotumors: a comparison between IgG4-related and IgG4-unrelated cases. Insights Imaging 2024; 15:203. [PMID: 39120829 PMCID: PMC11315856 DOI: 10.1186/s13244-024-01782-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES The objective of this study was to examine the imaging features of hepatic inflammatory pseudotumors (IPTs) associated with IgG4-related and IgG4-unrelated conditions and to enhance the approach toward distinguishing between these two types of IPTs. METHODS A retrospective study was conducted, involving 20 patients diagnosed with hepatic IPTs. Imaging procedures were conducted within a timeframe of 4 weeks prior to hepatectomy or biopsy. The imaging features were then analyzed and compared using chi-squared analysis. RESULTS Seventeen (81.0%) IPTs were located in the hepatic subcapsular area; six (66.7%) IgG4-related IPTs were distributed around the hepatic hilum; and eleven (91.7%) IgG4-unrelated and three (33.3%) IgG4-related IPTs had unclear boundaries. All lesions exhibited similar characteristics in CT scans, T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), with the apparent diffusion coefficient (ADC) values slightly higher than the surrounding liver tissue. Delayed hypoenhancement, observed in five cases (55.6%), was exclusively present in IgG4-related IPTs. The remaining IPT lesions displayed progressive enhancement, septal and marginal enhancement, and persistent enhancement. Central enhancement was absent in three IgG4-related IPTs (33.3%) and ten IgG4-unrelated IPTs (83.3%). The duct-penetrating sign was identified in two IgG4-unrelated IPTs (16.7%) and seven IgG4-related IPTs (77.8%). Furthermore, seven patients with IgG4-related IPTs had additional lesions outside the liver. CONCLUSIONS IgG4-related lesions are frequently found in the vicinity of the hepatic hilum; they display the duct-penetrating sign and affect other organs as well. Both groups exhibited progressive or persistent contrast enhancement in typical IPT lesions, but delayed hypoenhancement was only observed in the IgG4-related IPT group. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement. CRITICAL RELEVANCE STATEMENT Differences in imaging features differentiate IgG4-related and -unrelated inflammatory pseudotumors (IPT). IgG4-related lesions are frequently near the hepatic hilum, display duct-penetrating sign, and affect other organs. Only the IgG4-related group demonstrated delayed hypoenhancement. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement. KEY POINTS Compared with IgG 4-unrelated IPTs, IgG4-related IPTs show delayed hypoenhancement and affect other organs. IgG4-unrelated IPTs have unclear boundaries and lack central enhancement. Improved IPT diagnostic capabilities can help minimize additional, potentially unnecessary, interventions.
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Affiliation(s)
- Hua Lin
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Ying Liu
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Youyong Wei
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Xiaohui Guan
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Shuilian Yu
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Yuping Man
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China.
| | - Demao Deng
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China.
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Pan B, Wang Y, Zhu Z, Zhu X. Diagnostic Performance of 18F-FDG Positron Emission Tomography/Computed Tomography and Blood Test Parameters for Pulmonary Inflammatory Pseudotumor. J Thorac Imaging 2024:00005382-990000000-00129. [PMID: 38639385 DOI: 10.1097/rti.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE Pulmonary inflammatory pseudotumor (PIP) is an inflammatory proliferative tumor-like lesion that frequently exhibits hypermetabolism on 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography imaging (PET/CT) and is readily misdiagnosed as a malignant tumor. The purpose of this study was to identify PIP by combining PET/computed tomography metabolic and blood test characteristics with machine learning. PATIENTS AND METHODS We recruited 27 patients with PIP and 28 patients with lung cancer (LC). The PET metabolic and blood test parameters were collected, and the differences between the groups were evaluated. In addition, we combined the support vector machine (SVM) classifier with the indicators that differed between the groups to classify PIP and LC. RESULTS For PET metabolic parameters, our findings showed that, as compared with the LC group, maximal standardized uptake value (P< 0.001, t = -4.780), Mean standardized uptake value SUVmean, P< 0.001, t = -4.946), and SD40% (P< 0.001, t = -4.893) were considerably reduced in the PIP group, whereas CV40% (P= 0.004, t = 3.012) was significantly greater. For blood test parameters, the total white blood cell count (P< 0.001, t= 6.457) and absolute neutrophil count (P< 0.001, t= 6.992) were substantially higher in the PIP group than in the LC group. Furthermore, the performance of SVM trained solely on PET metabolic parameters (mean area under the curve [AUC] = 0.84) was comparable to that of SVM trained solely on blood test parameters (mean AUC = 0.86). Surprisingly, utilizing the combined parameters increased SVM performance significantly (mean AUC = 0.98). CONCLUSION PET metabolic and blood test parameters differed significantly between the PIP and LC groups, and the SVM paradigm using these significantly different features has the potential to be used to classify PIP and LC, which has important clinical implications.
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Affiliation(s)
- Bo Pan
- Department of Nuclear Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC
| | - Yanming Wang
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, China
| | - Zehua Zhu
- Department of Nuclear Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC
| | - Xingxing Zhu
- Department of Nuclear Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC
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Allama AM, Almuhammadi GA, Alzughaibi RA, Ishqi RZ, Al-Refai MA. A Case Report of Inflammatory Myofibroblastic Tumor: A Rare Benign Lung Tumor. Cureus 2024; 16:e59237. [PMID: 38813309 PMCID: PMC11133774 DOI: 10.7759/cureus.59237] [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] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) of the lung are a rare type of mesenchymal tumors that tend to occur more in the lungs of children. They are extremely rare in adults. IMTs require extensive pulmonary resection because they are commonly locally invasive. The key to preventing recurrence is complete resection, and the prognosis is excellent after surgery. We report a case of a patient with an inflammatory pseudotumor of the lung. The patient is a 27-year-old female who presented with a dry cough. A chest radiograph and computed tomography showed a lesion in the left main bronchus and near-total left lung collapse. As surgery was necessary to establish the diagnosis, left pneumonectomy was performed followed by a histological examination of the surgical specimen which confirmed inflammatory pseudotumor.
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Affiliation(s)
- Amr M Allama
- Thoracic Surgery, King Fahad General Hospital, Madinah, SAU
| | | | | | - Raha Z Ishqi
- College of Medicine, Taibah University, Madinah, SAU
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Geng ZY, Li ZH, Li SH, Wu B, Sheng YL, Yuan P, Li F, Qi Y. Case report: Uniportal video-assisted thoracoscopic sleeve lobectomy in a 6-year-old patient with inflammatory myofibroblastic tumor (IMT). Front Pediatr 2023; 11:1285181. [PMID: 37915983 PMCID: PMC10616251 DOI: 10.3389/fped.2023.1285181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm that can occur in various organs, including the lung. Surgical resection is usually the preferred treatment for localized IMT.A 6-year-old female was admitted to our hospital with complaints of "coughing and vomiting for 6 days". A chest CT scan revealed occlusion of the left main bronchus, segmental atelectasis of the left lower lung, and cystic low-density shadows along the bronchial pathway. Subsequent fiberoptic bronchoscopy confirmed the diagnosis of IMT through pathological biopsy. After excluding surgical contraindications, the patient underwent uniportal video-assisted thoracoscopic sleeve lobectomy for treatment. The patient had an uneventful postoperative course and was discharged four days after surgery. After one month, the patient received a follow-up examination and reported no significant discomfort. A chest CT scan revealed no postoperative complications.Our experience suggests that uniportal video-assisted thoracoscopic surgery may be a safe and effective approach for the treatment of pediatric patients with IMT requiring complex surgical procedures such as sleeve lobectomy and tracheoplasty.
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Affiliation(s)
| | | | | | | | | | | | | | - Yu Qi
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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5
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Carrasco Rodríguez R, García Fontán EM, Blanco Ramos M, Magdalena Benavides LJ, Otero Lozano D, Moldes Rodriguez M, Cañizares Carretero MA. Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. Cir Esp 2022; 100:329-335. [PMID: 35577280 DOI: 10.1016/j.cireng.2022.05.012] [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: 02/04/2020] [Accepted: 03/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.
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Affiliation(s)
| | | | | | | | - Daniel Otero Lozano
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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Boriçi S, Tanka M, Serbo L. Inflammatory myofibroblastic tumour of the lung: Case report and review of the literature. Respirol Case Rep 2022; 10:e0885. [PMID: 34934506 PMCID: PMC8652042 DOI: 10.1002/rcr2.885] [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: 10/05/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) of the lung is a rare tumour encountered in children. Although it is seen mostly in paediatric ages, a small number of cases exists in the literature. It may appear as an inflammatory mass or may have the characteristics of a tumour with the ability for recidivism and metastasis. Careful follow-up of the cases is required to differentiate between the two. We present the case of a 4-year-old girl who presented with cough, and the chest x-ray and computed tomography scan revealed a tumour mass in the right lung. After lobectomy, histological examination combined with immunohistochemical study discovered an IMT of the lung.
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Affiliation(s)
- Sonila Boriçi
- Service of Pulmonology and AllergyUniversity Hospital Center “Mother Tereza”TiranaAlbania
| | - Marjeta Tanka
- Service of Pulmonology and AllergyUniversity Hospital Center “Mother Tereza”TiranaAlbania
| | - Luljeta Serbo
- Service of Pulmonology and AllergyUniversity Hospital Center “Mother Tereza”TiranaAlbania
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Demir Ö, Onal O. Surgical treatment outcomes of pulmonary inflammatory myofibroblastic tumors. Ann Thorac Med 2022; 17:44-50. [PMID: 35198048 PMCID: PMC8809124 DOI: 10.4103/atm.atm_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022] Open
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Operated pulmonary inflammatory myofibroblastic tumors: Our experience with 17 cases. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:101-108. [PMID: 35444850 PMCID: PMC8990154 DOI: 10.5606/tgkdc.dergisi.2022.21263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background
In this study, we aimed to evaluate the clinicopathological features of pulmonary inflammatory myofibroblastic tumor cases operated in our clinic.
Methods
A total of 17 inflammatory myofibroblastic tumor patients (5 males, 12 females; median age: 46 years) who were operated in our clinic between February 2000 and July 2019 were included. Data including sex, age, symptoms, accompanying diseases, tumor localization, tumor diameter, endobronchial extension, maximum standard uptake value of the tumors, surgery type, recurrence, and survival data were analyzed.
Results
Two patients were diagnosed preoperatively and two patients were diagnosed during surgery using frozen-section method before resection. Three (17.7%) patients underwent pneumonectomy, five (29.4%) patients lobectomy, three (17.7%) patients segmentectomy, five (29.4%) patients wedge resection, and one (5.8%) patient bronchial sleeve resection. All patients had complete resection with negative margins. None of them had lymph node metastasis. Median follow-up was 122 (range, 8 to 245 months) months. None of the patients received adjuvant therapy, there was no tumor recurrence or tumor-related death.
Conclusion
It is difficult to make a preoperative diagnosis of inflammatory myofibroblastic tumor patients. Systematic lymph node dissection is not required in diagnosed patients. Complete resection is the most important prognostic factor, and it is critical to achieve this with the smallest resection possible.
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Chen HC, Fu Q, Song Y, Wang DL. Clinical and pathological characteristics of patients with pulmonary inflammatory pseudotumors: An 18-year retrospective study of 31 cases. Medicine (Baltimore) 2021; 100:e27040. [PMID: 34477134 PMCID: PMC8415998 DOI: 10.1097/md.0000000000027040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/02/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the clinical and pathological characteristics in patients with pulmonary inflammatory pseudotumors (PIP).This retrospective study included 31 patients with PIP from 2001 to 2019. Preoperative computed tomography scan was performed in all patients. Clinical and pathological characteristics were collected and analyzed.Thirty-one patients (16 female and 15 male) were recruited, with a median age of 57 years (range, 11-72 years). Eight (25.8%) patients were asymptomatic, and the others had symptoms characterized by cough with sputum, chest and back pain, dry cough, fever and blood in sputum, or hemoptysis. All cases were single lesions, including 23 cases in the right lung, and 8 cases in the left lung. Computed tomography scan demonstrated irregular lobulated nodules or masses in 14 patients, and regular round or oval nodules or masses in 11 cases. The blurred edge of tumors and spiculation was found in 12 cases. Microscopic results were characterized by the collection of inflammatory mesenchymal cells. Immunohistochemical examination showed vimentin, smooth muscle actin, and anaplastic lymphoma kinase positive. Complete tumor resection was obtained in all cases. No recurrence or metastasis was observed during the follow-up period.PIP has a variety of manifestations. Preoperative diagnosis is difficult to reach. The final diagnosis still depends on the pathological and immunohistochemical examination. Complete surgical resection is the main treatment at present, and the overall prognosis is good.
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Affiliation(s)
- Heng-Chi Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiang Fu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Da-Li Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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10
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Kim HE, Yang YH, Lee CY. Video-Assisted Thoracic Surgery Segmentectomy. J Chest Surg 2021; 54:246-252. [PMID: 34353963 PMCID: PMC8350470 DOI: 10.5090/jcs.21.058] [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: 06/07/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Although lobectomy remains the gold-standard surgical treatment for non-small-cell lung cancer, the frequency of thoracoscopic segmentectomy is increasing. Multiple factors must be considered in the choice of the procedure, ranging from adequate surgical planning or simulation, tumor localization, and identification of the intersegmental plane to severing the intersegmental plane to achieve an oncologically safe surgical margin with no or minimal manual palpation and different landmarks. In this article, we present an overview of methods for each procedural step of thoracoscopic segmentectomy, from preoperative planning to division of the intersegmental plane.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Yang F, Zhang W, Han C, Jiang H. A case of pulmonary inflammatory myofibroblastic tumor treated with bronchoscopic therapy plus lobectomy. J Cardiothorac Surg 2021; 16:144. [PMID: 34039398 PMCID: PMC8157757 DOI: 10.1186/s13019-021-01528-5] [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: 02/03/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Inflammatory myofibroblastic tumor (IMT) is a rare tumor with malignant potential. We presented a case of a young adult who was diagnosed with IMT and treated with loop electrocautery therapy to relieve airway obstruction, followed by lobectomy to complete resection. Recent studies have supported the use of such interventional resection methods. Case presentation A non-smoking 30-year-old woman presented with a 1-month history of progressive dyspnea and productive cough. The Chest X-ray showed a homogenous opacity invading the entire left hemithorax, and the mediastinum content was attracted to the left side. In an effort to avoid pneumonectomy and afford rapid palliation of dyspnea, loop electrocautery was selected as the most appropriate therapy. The left upper lobectomy by thoracoscopy was performed instead of left upper lobe sleeve resection in order to better prevent the recurrence of lung atelectasis. After 6 years of follow-up, no evidence of recurrence has been found till now. Conclusion Interventional bronchoscopy coupled with surgical resection serves not only as a palliative management to bronchial obstruction but also a way to avoid pneumonectomy.
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Affiliation(s)
- Fan Yang
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China
| | - Wenxia Zhang
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China
| | - Cheng Han
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China
| | - Hanliang Jiang
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China.
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Carrasco Rodríguez R, García Fontán EM, Blanco Ramos M, Juaneda Magdalena Benavides L, Otero Lozano D, Moldes Rodriguez M, Cañizares Carretero MA. Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. Cir Esp 2021; 100:S0009-739X(21)00112-3. [PMID: 33896608 DOI: 10.1016/j.ciresp.2021.03.009] [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: 02/04/2020] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didńt find any loco-regional or distant recurrence in the patients studied. CONCLUSION IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.
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Affiliation(s)
| | | | | | | | - Daniel Otero Lozano
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
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Koç ZP, Özcan PP, Ayan E, Bozdoğan Arpacı R. Metabolic Characterization of Anterior Mediastinal Masses by 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2020; 29:105-111. [PMID: 33094573 PMCID: PMC7583747 DOI: 10.4274/mirt.galenos.2020.05657] [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: 12/01/2022] Open
Abstract
Objectives To evaluate the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the diagnosis of anterior mediastinal masses. Methods The oncological 18F-FDG PET/CT images of 41 patients (17 women, 24 men; age: 16-83 years, mean age: 50.5±19.5 years) who attended the nuclear medicine department between November 2016 and September 2017 were retrospectively evaluated for the metabolic characterization of their anterior mediastinal masses. Results Based on our results, the lesions of 4 patients were benign [maximum standard uptake value (SUVmax) <3] and that of 2 patients were non-tumoral (i.e., tuberculosis and sarcoidosis). The mean dimensions and the SUVmax levels of the malignant lesions were 6.4±3.7 cm and 11.9±9.6, respectively. The pathological results for the malign tumors were thymus tumors (n=8), lymphoma (n=8), lung cancer (n=11), carcinoid metastasis (n=2), thyroid carcinoma (n=2), germ cell carcinoma (n=1), schwannoma (n=1), and sarcoma (n=1). The degree of 18F-FDG accumulation could precisely identify the malign and benign tumors. Conclusion Thus, contrary to the known causes, it is possible that anterior mediastinal masses originate from structures other than the anterior mediastinal structures. In this study, the lymphoma and lung carcinoma pathology were more frequent than thymic lesions.
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Affiliation(s)
- Zehra Pınar Koç
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Pınar Pelin Özcan
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Erhan Ayan
- Mersin University Faculty of Medicine, Department of Thoracic Surgery, Mersin, Turkey
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Miyagi H, Ishii D, Hirasawa M, Yasuda S, Toriumi N, Sarashina T, Tanino M, Tanaka M, Tanaka Y, Miyamoto K. Spontaneous pneumothorax caused by an inflammatory myofibroblastic tumor-like lesion in a 14-year-old girl: a case report. Surg Case Rep 2020; 6:109. [PMID: 32448976 PMCID: PMC7246262 DOI: 10.1186/s40792-020-00873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background Spontaneous pneumothorax occurs more often in younger, slim, and shallow-chested men. Although less common, differential diagnoses for secondary pneumothorax in children are asthma, emphysematous blebs, catamenial pneumothorax, and others. We report a patient who presented with pneumothorax and was found to have an inflammatory myofibroblastic tumor (IMT)-like lesion, and present a review of the related literature. Case presentation A 14-year-old girl visited her physician for chest pain that developed while exercising. Although chest drainage was performed, the symptoms associated with a collapsed lung did not improve, and she was referred to our hospital. Computed tomography revealed the presence of a 19 × 17-mm cyst with a thick wall in the apex of the right lung. She was tested for infectious diseases, namely tuberculosis, but the results were not definitive. Catamenial pneumothorax was also suspected because she was menstruating when she presented to our hospital. As a therapeutic diagnosis, we performed a thoracoscopic partial resection of the right upper lobe of the lung. Three small openings were identified inside the cyst, suggesting connection with the bronchiole. The lesion was pathologically diagnosed as an IMT-like lesion. Considering the progress so far, we considered that the final diagnosis to be an IMT. The patient was discharged on postoperative day 3, and we have followed her for the past 6 months with no local recurrence or metastasis. Conclusions IMT is not uncommon in children. Therefore, this lesion should be considered as a possible diagnosis if children and young adults develop spontaneous pneumothorax.
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Affiliation(s)
- Hisayuki Miyagi
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Daisuke Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Masatoshi Hirasawa
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shunsuke Yasuda
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Naohisa Toriumi
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Takeo Sarashina
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mishie Tanino
- Department of Pathology, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mio Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, 232-8555, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, 232-8555, Japan
| | - Kazutoshi Miyamoto
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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15
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Thanage R, Jain S, Sonthalia N, Udgirkar S, Chandnani S, Contractor Q, Rathi P. An Enigmatic Liver Mass in a Child. Euroasian J Hepatogastroenterol 2020; 9:104-107. [PMID: 32117700 PMCID: PMC7047306 DOI: 10.5005/jp-journals-10018-1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hepatic space occupying lesions in childhood are a diagnostic challenge, as they are caused by a variety of malignant and nonmalignant disorders with a different prognosis and, of course, treatment. They are often misdiagnosed or diagnosed only after surgical resection. A 14-year-old boy presented with abdominal pain, evening-rise fever with loss of appetite and weight. The patient also developed jaundice after 2 months of above symptoms. Ultrasound of the abdomen showed an irregular infiltrative mass in segment IV of the liver. Gadobenate disodium magnetic resonance imaging done showed T1 hypointense and T2 hyperintense lesions in segment VIII of the liver with extension into porta with delayed enhancement suggestive of fibrous tumor. Liver biopsy showed extensive liver parenchymal fibrosis with a mixed inflammatory infiltrate with eosinophils. Bacterial, tubercular, and fungal culture of liver biopsy were negative. Although serum IgG4 levels were 7.88 g/L (N =1.9 g/L), IgG4 staining of liver biopsy was negative. The patient was started on prednisolone 1 mg/kg considering the diagnosis of inflammatory pseudotumor (IPT). Twenty days after starting the steroid, mass lesions were converted into multicystic abscess requiring antibiotics and pigtail drainage. On follow-up, patient had improved symptoms with mass lesions turned into small-sized abscess cavity. Hepatic IPTs are difficult to differentiate from malignant tumors, as they are rare and can have variable imaging findings. To avoid inadvertent surgery, histological confirmation of the hepatic mass is essential. Steroids should be used with caution with close follow-up to prevent iatrogenic complications, such as a chronic liver abscess.
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Affiliation(s)
- Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Nikhil Sonthalia
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
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16
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Hou TC, Wu PS, Huang WY, Yang YT, Tan KT, Liu SH, Chen YJ, Chen SJ, Su YW. Over expression of CDK4 and MDM2 in a patient with recurrent ALK-negative mediastinal inflammatory myofibroblastic tumor: A case report. Medicine (Baltimore) 2020; 99:e19577. [PMID: 32195970 PMCID: PMC7220190 DOI: 10.1097/md.0000000000019577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The diagnosis of anaplastic lymphoma kinase (ALK)-negative inflammatory myofibroblastic tumors (IMT) remains challenging because of their morphological resemblance with spindle cell sarcoma with myofibroblastic characteristics. PATIENT CONCERNS A 69-year-old female patient presented with loco-regional recurrent IMT several times within 8 years after primary treatment and neck lymph node metastasis 3.5 years after last recurrence. DIAGNOSIS The primary, recurrence, and lymph node metastasis lesions were diagnosed as ALK-negative IMTs based on the histopathological features. INTERVENTIONS Biopsy samples were obtained during repeated surgeries and evaluated for genomic alterations during first and recurrent presentations. The evaluation was done using pathway-driven massive parallel sequencing, and genomic alterations between primary and recurrent tumors were compared. OUTCOMES Copy number gains and overexpression of mouse double minute 2 homolog (MDM2) and cyclin dependent kinase 4 (CDK4) were observed in the primary lesion, and additional gene amplification of Discoidin Domain Receptor Tyrosine Kinase 2 (DDR2), Succinate Dehydrogenase Complex II subunit C (SDHC), and thyroid stimulating hormone receptor (TSHR) Q720H were found in the recurrent tumors. Metastases to the neck lymph node were observed 3.5 years after recurrence. LESSONS Our results indicated genetic evolution in a microscopically benign condition and highlighted the importance of molecular characterization of fibro-inflammatory lesions of uncertain malignant potential.
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Affiliation(s)
| | | | - Wen-Yu Huang
- Laboratory of Good Clinical Research Center, Mackay Memorial Hospital, Tamsui Branch, New Taipei City
| | | | | | | | | | | | - Ying-Wen Su
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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17
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Hameed T, Singh M, Nizam A, Bhatia R, Sawant G. Acute Intestinal Obstruction Due to Ileocolic Intussusception in an Adult; A Rare Presentation of Inflammatory Myofibroblastic Tumor. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920438. [PMID: 32102989 PMCID: PMC7061931 DOI: 10.12659/ajcr.920438] [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] [Indexed: 11/12/2022]
Abstract
Patient: Female, 40-year-old Final Diagnosis: Inflammatory myofibroblastic tumor Symptoms: Obstipation • pain • vomiting Medication: — Clinical Procedure: Exploratory laparotomy followed by right hemicolectomy Specialty: Surgery
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Affiliation(s)
- Tariq Hameed
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Mohak Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Adiba Nizam
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rahul Bhatia
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Gaurish Sawant
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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18
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Al-Obaidi A, Buess C, Mogire J, Reddy PS. Inflammatory Myofibroblastic Tumor of the Lung: An Extremely Rare Condition in Adults. Cureus 2019; 11:e6432. [PMID: 31970041 PMCID: PMC6970563 DOI: 10.7759/cureus.6432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) of the lung were first reported in 1939. The most common site of predilection is the lungs of the pediatric population. They are extremely rare in adults, constituting less than 1% of adult lung tumors. They are mesenchymal neoplasms that may arise in the soft tissues of almost every organ. IMTs often arise from excessive inflammatory response, and as the name implies, they are composed of myofibroblastic spindle cells accompanied by an inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Charles Buess
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Job Mogire
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
| | - Pavan S Reddy
- Internal Medicine, Kansas University School of Medicine, Wichita, USA
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19
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Alan O, Kuzhan O, Koca S, Telli TA, Basoglu T, Ercelep O, Filinte D, Sengul Y, Arikan H, Kaya S, Babacan NA, Dane F, Yumuk PF. How long should we continue crizotinib in ALK translocation-positive inflammatory myofibroblastic tumors? Long-term complete response with crizotinib and review of the literature. J Oncol Pharm Pract 2019; 26:1011-1018. [PMID: 31615346 DOI: 10.1177/1078155219879757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor is a rare disease which is typically seen in children and young adults. Approximately half of the inflammatory myofibroblastic tumors contain translocations that result in over-expression of anaplastic lymphoma kinase gene. Herein, we present two anaplastic lymphoma kinase-positive cases with long-term remission with crizotinib. We do not know how long these therapies need to be continued. CASE REPORTS We present two cases of inflammatory myofibroblastic tumor treated with anaplastic lymphoma kinase inhibitor therapies: an 8-year-old Turkish boy and a 21-year-old Caucasian man. MANAGEMENT AND OUTCOME Two cases, both with good tumor control under crizotinib, but one who progressed on drug holiday, responded again to the same drug, and had a very short period of response after restarting crizotinib. CONCLUSION A molecular-targeted drug (anaplastic lymphoma kinase inhibitor) was found to be extremely effective as selective therapy for inflammatory myofibroblastic tumor with anaplastic lymphoma kinase translocation. Here, we want to emphasize the continuation of this treatment after achieving a good response until progression or a major side effect.
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Affiliation(s)
- Ozkan Alan
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Okan Kuzhan
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Yeditep University, Istanbul, Turkey
| | - Sinan Koca
- Division of Medical Oncology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Tugba Akin Telli
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Tugba Basoglu
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ozlem Ercelep
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Deniz Filinte
- Department of Pathology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Yildiz Sengul
- Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Huseyin Arikan
- Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Serap Kaya
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nalan Akgul Babacan
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Faysal Dane
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
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20
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Watanabe H, Yamasaki N, Miyazaki T, Matsumoto K, Tsuchiya T, Abe K, Nagayasu T. Successful treatment based on molecular biological assessment of invasive anaplastic lymphoma kinase-positive inflammatory myofibroblastic tumor of the lung. Surg Case Rep 2019; 5:118. [PMID: 31342196 PMCID: PMC6656828 DOI: 10.1186/s40792-019-0674-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) of the lung is rare. This disease often shows neoplastic features with anaplastic lymphoma kinase positiveness as well as inflammatory features, such as steroid-responsive immunoglobulin G4 (IgG4)-related sclerosing disease. Since many cases have been reported as advanced, various treatment strategies should be considered based on clinical and biological features of each case. CASE PRESENTATION We report a 49-year-old male with IMT, which seemed invading the left atrium from preoperative imaging modalities. Serological and pathological examinations from the biopsy specimen revealed high expression of anaplastic lymphoma kinase expression in the tumor. On the other hand, IgG4/IgG ration in the tumor was small, where a therapeutic effect of steroid was not expected, leading to surgical treatment rather than a steroid administration. The tumor was completely resected en bloc with the right lower lobe of the lung and a part of the left atrium. The postoperative course of the patient was uneventful. The patient has remained recurrence free over 5 years from the surgery. CONCLUSION In this case, preoperative biological assessment prior to the treatment led to a good clinical course. We believe that molecular biological examination is important in the determination of treatment strategy for this rare disease as well as imaging modalities.
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Affiliation(s)
- Hironosuke Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Naoya Yamasaki
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takuro Miyazaki
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keitaro Matsumoto
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomoshi Tsuchiya
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kuniko Abe
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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21
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Waghchoure S, Bradley R, Sorrell M, Arya R. Successful rigid bronchoscopic resection of recurrent pulmonary inflammatory myofibroblastic tumor after complete surgical resection. Proc AMIA Symp 2019; 32:408-410. [PMID: 31384203 DOI: 10.1080/08998280.2019.1612688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022] Open
Abstract
Inflammatory myofibroblastic tumor, previously named inflammatory pseudotumor, is a biologically borderline mesenchymal neoplasm often associated with an inflammatory infiltrate. The incidence of inflammatory myofibroblastic tumor has been found to range from 0.04% to 1.2%, with endobronchial cases being extremely rare. The treatment of choice for pulmonary inflammatory myofibroblastic tumor is complete surgical resection. However, disease recurrence has been reported. Modalities used to treat recurrent and metastatic disease include surgical resection and corticosteroids. We present a case of recurrent endobronchial inflammatory myofibroblastic tumor that was successfully treated endoscopically with rigid bronchoscopy and laser debulking without need for further surgical intervention.
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Affiliation(s)
- Simon Waghchoure
- Department of Pulmonary and Critical Care Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Robert Bradley
- Department of Pathology, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - McKenzie Sorrell
- Department of Internal Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Rohan Arya
- Department of Pulmonary and Critical Care Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
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22
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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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23
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Wei F, Richard SA, Tan J, Lan Z, Ju Y. Inflammatory myofibroblastic lung tumor transforming into intracranial desmoplastic noninfantile ganglioglioma: A case report and literature review. Medicine (Baltimore) 2018; 97:e12668. [PMID: 30290651 PMCID: PMC6200452 DOI: 10.1097/md.0000000000012668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Inflammatory myofibroblastic tumor (IMT) of the lung often arises from excessive inflammatory response. It is one of the rare benign tumors of the lung, while desmoplastic noninfant gangliogliomas (DNIG), on the contrary, are rare intracranial benign tumors often seen in children within the first one and a half years of life. PATIENT CONCERNS We present a 12-year-old girl with 2 months history of none productive cough and right-sided chest pain. DIAGNOSES Computer tomography scan of the chest revealed a soft tissue mass at the right upper lobe which was consistent with IMT. Histopathologic examination confirmed the diagnosis of IMT. INTERVENTIONS Thoracic surgery was successfully carried out and she further received radiotherapy. The patient recovered initially. OUTCOMES Two years later, she complained of seizures during follow-up. Magnetic resonance imaging of the head revealed DNIG. We achieved total resection of the major lesions and she was further treated with radiotherapy. She is currently well and in school. Histopathologic examination confirmed the diagnosis of DNIG. LESIONS We speculate that IMT might have transformed into intracranial DNIG through metastatic process or as a result of genetic mutations or chromosomal abrasions.
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Affiliation(s)
- Fu Wei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
- Department of Surgery, Volta Regional Hospital, Ghana, West Africa
| | - Junya Tan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
| | - Yan Ju
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
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24
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Na YS, Park SG. Inflammatory myofibroblastic tumor of the pleura with adjacent chest wall invasion and metastasis to the kidney: a case report. J Med Case Rep 2018; 12:253. [PMID: 30195334 PMCID: PMC6129296 DOI: 10.1186/s13256-018-1796-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 08/09/2018] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor is a rare benign neoplasm that frequently involves the lung and abdominopelvic region, and is found mainly in children and young adults. Inflammatory myofibroblastic tumor tends to be locally invasive or recurrent, and rarely metastasizes. CASE PRESENTATION A 76-year-old Korean man presented with a history of upper back pain for 2 months and motor weakness in both lower extremities for 2 days. Contrast-enhanced computed tomography of his chest and abdomen showed a large heterogeneous pleural mass involving the right fifth rib and vertebral body and a mass infiltrating the right renal hilum. Computed tomography-guided percutaneous needle biopsy of the pleural mass was performed. The histological findings on hematoxylin and eosin staining showed proliferation of spindle cells with infiltration of lymphocytes and plasma cells. Immunohistochemistry showed neoplastic cells positive for CD68, focally positive for smooth muscle actin, and negative for cytokeratin and desmin. Inflammatory myofibroblastic tumor was diagnosed based on the histological examination. Treatment with glucocorticoids (methylprednisolone 1 mg/kg) and radiotherapy (5 days/week for 3 weeks at 3 Gy/fraction, 45 Gy/15 days) was started. After 1 month, chest computed tomography showed a reduction in the size of the pleural mass, and abdominopelvic computed tomography showed decreased infiltration around the right renal pelvis. CONCLUSIONS Inflammatory myofibroblastic tumor is a rare neoplasm of intermediate malignant potential due to a tendency for local recurrence and it rarely develops distant metastases. Complete surgical resection is the primary treatment. However, unresectable and metastatic inflammatory myofibroblastic tumor can be treated with systemic therapy, including glucocorticoids, radiotherapy, and/or chemotherapy.
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Affiliation(s)
- Yong-Sub Na
- Department of Pulmonology, Chosun University Hospital, Gwangju, Republic of Korea
| | - Sang-Gon Park
- Department of Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 61453, Republic of Korea.
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25
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Sagar AES, Jimenez CA, Shannon VR. Clinical and Histopathologic Correlates and Management Strategies for Inflammatory Myofibroblastic tumor of the lung. A case series and review of the literature. Med Oncol 2018; 35:102. [PMID: 29869302 DOI: 10.1007/s12032-018-1161-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 11/29/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm that may arise in soft tissues of nearly every organ. Although IMTs are the most common lung tumors in pediatric populations, these tumors are extremely rare in adults, constituting less than 1% of adult lung tumors. IMTs are characterized by proliferating spindle cells with variable inflammatory component. The biological behavior of lung IMTs in adults is highly unpredictable, which confounds diagnosis and treatment. We retrospectively investigated patients with pulmonary lesions and the histopathologic diagnosis of inflammatory myofibroblastic tumor or its synonymous names (Plasma Cell Granuloma, xanthogranuloma, inflammatory pseudotumor, fibroxanthoma, and fibrous histiocytoma) at the MD Anderson Cancer Institute in the period between August 2000 and August 2016. We describe 7 adult cases of IMT of the lung that were diagnosed at MD Anderson Cancer Center. These cases highlight the tumor's variability in terms of clinical presentation, histopathology, and biologic behavior, and underscore the challenges in the management of these rare lung neoplasms.
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Affiliation(s)
- Ala Eddin S Sagar
- Department of Pulmonary Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
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26
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Reddy RZ, Carter YM, Hsia DW. Pulmonary inflammatory pseudotumor causing lung collapse responding to corticosteroid therapy. Respir Med Case Rep 2018; 24:113-116. [PMID: 29977776 PMCID: PMC6010639 DOI: 10.1016/j.rmcr.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 11/17/2022] Open
Abstract
Pulmonary inflammatory pseudotumor (PIP) is a rare benign tumor that represents less than one percent of all tumors found in the lungs. Despite the benign etiology, PIP can cause significant clinical problems due to its growth rate and potential to compromise adjacent pulmonary and thoracic structures. Complete surgical resection is the preferred therapy for PIP to prevent recurrence, however, this is not possible in some patients due to the size or location of the tumor. We present the case of an 18 year-old male presenting with PIP in the proximal left mainstem bronchus causing complete left lung collapse. Surgical resection was not possible due to tumor location, and therefore the patient was treated with corticosteroids with marked response. Corticosteroid use has for PIP has been described in few other situations, and this case demonstrates the potential for this therapeutic option in patients with PIP who have a contraindication to surgical resection.
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Affiliation(s)
- Radhika Z. Reddy
- VA Long Beach Medical Center, Department of Medicine, Division of Pulmonary and Critical Care Medicine, USA1
https://www.longbeach.va.gov/. - Corresponding author.
| | - Yvonne M. Carter
- Sinai Hospital of Baltimore, Department of Surgery, Division of Thoracic Surgery, USA2
http://www.lifebridgehealth.org/Sinai/SinaiDivisionofThoracicSurgery.aspx.
| | - David W. Hsia
- Harbor-UCLA Medical Center, Department of Medicine, Division of Respiratory and Critical Care Physiology and Medicine, USA3
http://www.harbor-ucla.org/respiratory-cc/.
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27
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Saiki M, Ohyanagi F, Ariyasu R, Koyama J, Sonoda T, Nishikawa S, Kitazono S, Yanagitani N, Horiike A, Ninomiya H, Ishikawa Y, Nishio M. Dramatic response to alectinib in inflammatory myofibroblastic tumor with anaplastic lymphoma kinase fusion gene. Jpn J Clin Oncol 2018; 47:1189-1192. [PMID: 28977547 DOI: 10.1093/jjco/hyx133] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/29/2017] [Indexed: 11/14/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a neoplasm characterized by the proliferaton of myofibroblasts with the infiltration of inflammatory cells. There is no standard treatment for patients with recurrent or metastatic IMT. We describe here a patient with hyper-progressive IMT with an anaplastic lymphoma kinase (ALK) fusion gene that dramatically responded to alectinib without adverse events. His dramatic and enduring response supports the observation that alectinib may be considered a good treatment option for rare aggressive ALK-positive tumors.
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Affiliation(s)
- Masafumi Saiki
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Fumiyoshi Ohyanagi
- Division of Pulmonary Medicine, Clinical Department of Internal Medicine, Jichi Medical University Saitama Medical Center, Saitama
| | - Ryo Ariyasu
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Junji Koyama
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Tomoaki Sonoda
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Shingo Nishikawa
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Satoru Kitazono
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Noriko Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Atsushi Horiike
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Hironori Ninomiya
- Division of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuichi Ishikawa
- Division of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
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Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg 2017; 3:88. [PMID: 29078650 DOI: 10.21037/jovs.2017.05.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/05/2017] [Indexed: 12/12/2022]
Abstract
Segmentectomy has become a widely adopted surgical procedure, with recent reports describing the use of video-assisted thoracoscopic surgery (VATS) and robotic surgery. A major feature of segmentectomy is that it requires a three-dimensional (3D) understanding of the patient's pulmonary structure and a thorough preoperative analysis of the patient's individual anatomy. Here, we present our method for VATS segmentectomy based on 3D-computed tomography (3D-CT), with a review of the literature. We focus on techniques for 3D-CT reconstruction, analyses of the individual anatomy and anomalies, preoperative simulations of the procedure and surgical margin, and intraoperative navigation with 3D-CT images. We also reference the roles of members of our multi-disciplinary surgical team.
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Affiliation(s)
- Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Toshiteru Nagashima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
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29
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Santra A, Bandyopadhyay A, Sengupta A, Mondal S. Pulmonary inflammatory pseudotumor with jaundice and anemia: A case report. Lung India 2017; 34:210-212. [PMID: 28360480 PMCID: PMC5351374 DOI: 10.4103/0970-2113.201294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Avradip Santra
- Department of Pulmonary Medicine, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India E-mail:
| | - Abhishek Bandyopadhyay
- Department of Pathology, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Amitabha Sengupta
- Department of Pulmonary Medicine, Murshidabad Medical College and Hospital, Berhampore, Murshidabad, West Bengal, India
| | - Saibal Mondal
- Department of Pulmonary Medicine, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India E-mail:
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30
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Ruiz-Sada P, Arostegui-Uribe N, Palacios-García L, Esquillor-Rodrigo MJ. A case of fever of unknown origin. Br J Hosp Med (Lond) 2017; 78:172-173. [PMID: 28277761 DOI: 10.12968/hmed.2017.78.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pablo Ruiz-Sada
- Consultant, Internal Medicine Department, Hospital Reina Sofía, Carretera Tarazona s/n, Tudela, Navarra, Spain
| | | | - Lara Palacios-García
- 4th Year Resident, Internal Medicine Department, Hospital Basurto, Bilbao, Spain
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31
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Liu L, Kong X, Lu X, Cao D. Pediatric Endobronchial Inflammatory Myofibroblastic Tumor: A Case Report and Review of the Literature. Clin Pract 2016; 6:853. [PMID: 28174621 PMCID: PMC5294928 DOI: 10.4081/cp.2016.853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) belongs to the group of soft tissue tumor and could occur at any anatomical site from the central nervous system to gastrointestinal tract. The lung and abdomen are commonly affected sites, however, pulmonary IMT is predominantly located within the parenchyma rather than presenting as endobronchial lesion. IMTs may occur in any age group, but they are observed most commonly in children and adolescents. Here, we present a case of IMT arising from the left main stem bronchus in a 10-year-old girl.
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Affiliation(s)
- Leilei Liu
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
| | - Xianglei Kong
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
| | - Xiaoqian Lu
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
| | - Dianbo Cao
- Department of Radiology, The First Hospital of Jilin University , Changchun, China
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32
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Kim KN, Kim DW. Complete resection of a huge hypervascular inflammatory myofibroblastic tumor in right hemithorax after embolization. World J Pediatr 2016; 12:498-500. [PMID: 27286690 DOI: 10.1007/s12519-016-0038-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a rare and mostly benign tumor that has the possibility of malignant change. METHODS Radiological findings revealed a huge mass that filled most of the right hemithorax of a 17-monthold female infant. Tumor extirpation was stopped due to massive bleeding and limited exposure of the tumor. Embolization was conducted to obstruct the arteries feeding the mass. Complete resection was performed. RESULTS Histopathologic examination led to the diagnosis of IMT. Postoperative recovery was uneventful. CONCLUSION Hypervascularity of IMT should be considered. Preoperative embolization can be effective to reduce intraoperative blood loss and facilitate the surgical procedure.
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Affiliation(s)
- Kyu-Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222-1 Wangsimni-ro, Seongdong gu, Seoul, 133-792, Republic of Korea
| | - Dong-Won Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222-1 Wangsimni-ro, Seongdong gu, Seoul, 133-792, Republic of Korea.
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33
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Aydoğmuş Ü, Uğurlu E, Bir F, Türk F, Yuncu G. The Right Inferior Pulmonary Vein Related Inflammatory Myofibroblastic Tumor in an Adult Case. Turk Thorac J 2016; 17:128-131. [PMID: 29404141 DOI: 10.5578/ttj.30511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/14/2015] [Indexed: 11/15/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, which is derived of mesenchymal origin. Here we present an adult case with IMT, the origin of which was considered to be right inferior pulmonary vein. A male patient who was 52 years old, admitted to our outpatient clinic with the complaint of shortness of breath. He had cigarette smoking history for 30 years. On direct posterior - anterior X-Ray of the chest, a well-circumscribed mass with calcification in right hilum of the lung was observed. There was a mass which was extending to the inferior inferior pulmonary vein from right hilum of the lung, was measured 70 × 60 mm on computed tomography of the chest. Hamartoma, teratoma and Castleman Disease were among the possible diagnoses. On diagnostic bronchoscopy, signs of pressure from outside to the bronchi of the right middle and lower lobe was observed. Surgical excision is decided and the mass was totally excised through a muscle-sparing thoracotomy. The mass thought to arise from the inferior pulmonary vein on intraoperative inspection and right inferior lobe excision is undertaken by intrapericardial approach. No postoperative complication is encountered. Histological examination of the mass indicated inflammatory myofibroblastic tumor. Main treatment of IMT is surgical excision with negative surgical margin. Here in we present an IMT which is encountered at an unexpected location is excised completely with right lower lobe excision by an intrapericardial approach.
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Affiliation(s)
- Ümit Aydoğmuş
- Department of Chest Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Erhan Uğurlu
- Department of Chest Diseases, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ferda Bir
- Department of Medical Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Figen Türk
- Department of Chest Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Gökhan Yuncu
- Department of Chest Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Owen WT, Karampini E, Breen RA, Moonim M, Nair A, Barrington SF, Santis G. A rare intravascular tumour diagnosed by endobronchial ultrasound. Thorax 2016; 71:869-70. [PMID: 27118811 DOI: 10.1136/thoraxjnl-2016-208487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/30/2016] [Indexed: 11/03/2022]
Affiliation(s)
- William T Owen
- Department of Respiratory Medicine and Allergy, Kings College London, Guy's Hospital, London, UK
| | - Elena Karampini
- Department of Respiratory Medicine and Allergy, Kings College London, London, UK
| | - Ronan A Breen
- Department of Respiratory Medicine, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Mufaddal Moonim
- Department of Cellular Pathology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Arjun Nair
- Department of Radiology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Sally F Barrington
- PET Imaging Centre at St. Thomas' Hospital, King's College London, London UK
| | - George Santis
- Department of Respiratory Medicine and Allergy, Kings College London, Guy's Hospital, London, UK
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Asciak R, Gouder C, Bilocca D, Montefort S. A diagnostic dilemma in a case of pulmonary inflammatory myofibroblastic tumour. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-215168. [PMID: 27090550 DOI: 10.1136/bcr-2016-215168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 18-year-old man presented to the local hospital in Malta, with dyspnoea, cough, mild haemoptysis, chest pain and night sweats. CT revealed a right hilar mass. Pleural tap, bronchoscopy and open lung biopsy were inconclusive. Biopsies obtained at repeat bronchoscopy and endobronchial ultrasound (EBUS) revealed a likely diagnosis of inflammatory myofibroblastic tumour (IMT). The patient subsequently underwent right pneumonectomy, and histology revealed the presence of two further nodules apart from the main tumour. Follow-up with positron emission tomography (PET)/CT showed the development of a right basal paracardial lesion due to recurrence and the presence of lymph node, pleural and skeletal disease. Despite radiotherapy to the recurrent nodule and chemotherapy, there was skeletal disease progression. Treatment with an anaplastic lymphoma kinase inhibitor, ceritinib, resulted in very good metabolic response. This case report highlights the importance of keeping IMT in mind when the diagnosis of lung tumours is difficult, as delayed diagnosis may lead to worsened prognosis.
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Affiliation(s)
- Rachelle Asciak
- Department of Respiratory Medicine, Mater Dei Hospital, Triq Dun Karm Psaila, Tal-Qroqq MSD 2090, Malta
| | - Caroline Gouder
- Department of Respiratory Medicine, Mater Dei Hospital, Triq Dun Karm Psaila, Tal-Qroqq MSD 2090, Malta
| | - David Bilocca
- Department of Respiratory Medicine, Mater Dei Hospital, Triq Dun Karm Psaila, Tal-Qroqq MSD 2090, Malta
| | - Stephen Montefort
- Department of Respiratory Medicine, Mater Dei Hospital, Triq Dun Karm Psaila, Tal-Qroqq MSD 2090, Malta
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Richardsen I, Eckermann C, Schreyer C, Schwab R, Schaaf S, Willms AG. Ein seltener inflammatorisch myofibroblastärer Tumor der Lunge. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-015-0059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maturu VN, Bal A, Singh N. Inflammatory myofibroblastic tumor of the lung in pregnancy mimicking carcinoid tumor. Lung India 2016; 33:82-4. [PMID: 26933315 PMCID: PMC4748673 DOI: 10.4103/0970-2113.173058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMT) are uncommon neoplasms of the lung in adults. They constitute less than 1% of all lung neoplasms and usually present as parenchymal masses. Diagnosis requires a high index of suspicion. They are characterized by spindle-shaped tumor cells (fibroblasts/myofibroblasts) in a background of lymphoplasmacytic infiltrate. About 50% of the tumors harbor an ALK gene rearrangement. They have to be differentiated from inflammatory pseudotumors (IPT), which show increased number of IgG4 plasma cells on immunostaining and are negative for anaplastic lymphoma kinase (ALK) protein. Herein, we present a case of a 28-year old female who presented with hemoptysis and was diagnosed with an IMT of lung in the first trimester of pregnancy. We have not only reviewed the occurrence of IMT during pregnancy but also discuss the management options for IMT during pregnancy.
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Affiliation(s)
- Venkata Nagarjuna Maturu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Oguz B, Ozcan HN, Omay B, Ozgen B, Haliloglu M. Imaging of childhood inflammatory myofibroblastic tumor. Pediatr Radiol 2015; 45:1672-81. [PMID: 26135643 DOI: 10.1007/s00247-015-3377-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 03/06/2015] [Accepted: 04/22/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumor is a rare benign neoplasm and most commonly involves the lung but occurs in extrapulmonary locations. OBJECTIVE To present imaging findings in inflammatory myofibroblastic tumors in children based on a single-centre experience. MATERIALS AND METHODS We retrospectively reviewed CT and MRI findings of children diagnosed with inflammatory myofibroblastic tumor in a single institution. RESULTS We identified 15 children (range: 1-17 years) with inflammatory myofibroblastic tumor. The tumor was localized to the lung (n = 5), mediastinum (n = 3), trachea (n = 1), bronchus (n = 1), abdomen (n = 2) and orbit (n = 3). All the extraorbital tumors were solid masses with homogeneous or heterogeneous enhancement. Four lung tumors and one posterior mediastinal tumor contained calcification. Local recurrence following surgical removal occurred in two children with invasion of the esophagus and of the left atrium in one. Localized masses were seen in all children with orbital tumour. Two of these had episcleritis and perineuritis; one had episcleritis, tendonitis, perineuritis, myositis and dacryoadenitis. CONCLUSION The locations and imaging features of inflammatory myofibroblastic tumors are variable.
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Affiliation(s)
- Berna Oguz
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey.
| | - Hatice Nursun Ozcan
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
| | - Burak Omay
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
| | - Burce Ozgen
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
| | - Mithat Haliloglu
- Hacettepe University Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, Altindag / Sihhiye, 06230, Ankara, Turkey
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Inflammatory myofibroblastic tumor of the lung indistinguishable from adenocarcinoma on imaging studies. Clin Nucl Med 2015; 39:740-1. [PMID: 24873793 DOI: 10.1097/rlu.0000000000000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of a right lung nodule discovered on routine chest x-ray in an asymptomatic 62-year-old man. CT revealed a spiculated nodule in segment 1 of the right upper lobe, 2.2 cm in diameter and without calcification. The nodule showed high focal FDG uptake (SUVmax, 17.8) on PET. Right upper lobectomy was performed under the diagnosis of adenocarcinoma; however, the histopathologic findings were of inflammatory myofibroblastic tumor.
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Al-Hussaini H, Azouz H, Abu-Zaid A. Hepatic inflammatory pseudotumor presenting in an 8-year-old boy: A case report and review of literature. World J Gastroenterol 2015; 21:8730-8738. [PMID: 26229415 PMCID: PMC4515854 DOI: 10.3748/wjg.v21.i28.8730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatic inflammatory pseudotumors are uncommon benign lesions. Accurately diagnosing hepatic inflammatory pseudotumor can be very challenging because the clinical presentation and radiological appearances are nonspecific and cannot be certainly distinguished from malignant neoplastic processes. Herein, we present a case of hepatic IPT in an 8-year-old boy who presented to clinic with a 3-mo history of a tender hepatic mass, fever of unknown origin, and 9-kg weight loss. The physical examination was notable for tender hepatomegaly. Laboratory investigations were notable for a normal hepatic profile and elevated erythrocyte sedimentation rate and C-reactive protein. A T2-attenuated magnetic resonance imaging scan of the abdomen showed a 4.7 cm × 4.7 cm × 6.6 cm, contrast-enhancing, hyper-intense, well-defined lesion involving the right hepatic lobe. In view of the unremitting symptoms, tender hepatomegaly, thrombosed right hepatic vein, nonspecific radiological findings, and high suspicion of a deep-seated underlying infection or malignancy, a right hepatic lobectomy was recommended. Microscopically, the hepatic lesion exhibited a mixture of inflammatory cells (histiocytes, plasma cells, mature lymphocytes, and occasional multinucleated giant cells) in a background of dense fibrous tissue. Immunohistochemically, the cells stained negative for SMA, ALK-1, CD-21 and CD-23, diffusely positive for CD-68, and focally positive for IgG4. The final histopathological diagnosis was consistent with hepatic IPT. At the postoperative 4-mo follow-up, the patient was asymptomatic without radiological evidence of recurrence.
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Subbiah V, McMahon C, Patel S, Zinner R, Silva EG, Elvin JA, Subbiah IM, Ohaji C, Ganeshan DM, Anand D, Levenback CF, Berry J, Brennan T, Chmielecki J, Chalmers ZR, Mayfield J, Miller VA, Stephens PJ, Ross JS, Ali SM. STUMP un"stumped": anti-tumor response to anaplastic lymphoma kinase (ALK) inhibitor based targeted therapy in uterine inflammatory myofibroblastic tumor with myxoid features harboring DCTN1-ALK fusion. J Hematol Oncol 2015; 8:66. [PMID: 26062823 PMCID: PMC4467062 DOI: 10.1186/s13045-015-0160-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/25/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recurrent, metastatic mesenchymal myxoid tumors of the gynecologic tract present a management challenge as there is minimal evidence to guide systemic therapy. Such tumors also present a diagnostic dilemma, as myxoid features are observed in leiomyosarcomas, inflammatory myofibroblastic tumors (IMT), and mesenchymal myxoid tumors. Comprehensive genomic profiling was performed in the course of clinical care on a case of a recurrent, metastatic myxoid uterine malignancy (initially diagnosed as smooth muscle tumor of uncertain malignant potential (STUMP)), to guide identify targeted therapeutic options. To our knowledge, this case represents the first report of clinical response to targeted therapy in a tumor harboring a DCTN1-ALK fusion protein. METHODS Hybridization capture of 315 cancer-related genes plus introns from 28 genes often rearranged or altered in cancer was applied to >50 ng of DNA extracted from this sample and sequenced to high, uniform coverage. Therapy was given in the context of a phase I clinical trial ClinicalTrials.gov Identifier: ( NCT01548144 ). RESULTS Immunostains showed diffuse positivity for ALK1 expression and comprehensive genomic profiling identified an in frame DCTN1-ALK gene fusion. The diagnosis of STUMP was revised to that of an IMT with myxoid features. The patient was enrolled in a clinical trial and treated with an anaplastic lymphoma kinase (ALK) inhibitor (crizotinib/Xalkori®) and a multikinase VEGF inhibitor (pazopanib/Votrient®). The patient experienced an ongoing partial response (6+ months) by response evaluation criteria in solid tumors (RECIST) 1.1 criteria. CONCLUSIONS For myxoid tumors of the gynecologic tract, comprehensive genomic profiling can identify clinical relevant genomic alterations that both direct treatment targeted therapy and help discriminate between similar diagnostic entities.
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Affiliation(s)
- Vivek Subbiah
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | | | - Shreyaskumar Patel
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Ralph Zinner
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Elvio G Silva
- Division of Diagnostic Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Julia A Elvin
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
| | - Ishwaria M Subbiah
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Chimela Ohaji
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Dhakshina Moorthy Ganeshan
- Division of Diagnostic Imaging and Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Deepa Anand
- Division of Diagnostic Imaging and Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Charles F Levenback
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jenny Berry
- Division of Cancer Medicine, Department of Investigational Cancer Therapeutic (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, FC8.3038, Box 0455, Houston, TX, 77030, USA.
| | - Tim Brennan
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
| | | | | | - John Mayfield
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
| | | | | | | | - Siraj M Ali
- Foundation Medicine, Inc, Cambridge, MA, 02141, USA.
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Ghandi N, Ghanadan A, Azizian MR, Hejazi P, Aghazadeh N, Tavousi P, Daneshpazhooh M. Paraneoplastic pemphigus associated with inflammatory myofibroblastic tumour of the mediastinum: A favourable response to treatment and review of the literature. Australas J Dermatol 2014; 56:120-3. [DOI: 10.1111/ajd.12264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 09/17/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Narges Ghandi
- Autoimmune Bullous Diseases Research Centre; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
- Department of Dermatology; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Alireza Ghanadan
- Dermatopathology Department; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
- Pathology Department; Cancer Institute, Imam Khomeini Complex Hospital; Tehran Iran
| | | | - Pardis Hejazi
- Autoimmune Bullous Diseases Research Centre; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
- Department of Dermatology; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Nessa Aghazadeh
- Autoimmune Bullous Diseases Research Centre; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
- Department of Dermatology; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Parvin Tavousi
- Autoimmune Bullous Diseases Research Centre; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
- Department of Dermatology; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Centre; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
- Department of Dermatology; Razi Hospital, Tehran University of Medical Sciences; Tehran Iran
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Durmus T, Kamphues C, Blaeker H, Grieser C, Denecke T. Inflammatory myofibroblastic tumor of the liver mimicking an infiltrative malignancy in computed tomography and magnetic resonance imaging with Gd-EOB. Acta Radiol Short Rep 2014; 3:2047981614544404. [PMID: 25298878 PMCID: PMC4184414 DOI: 10.1177/2047981614544404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/26/2014] [Indexed: 12/23/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMT) are a benign tumor entity, which rarely develop in the liver. Surgery is the most common treatment for these lesions as it is difficult to distinguish them from malignant liver tumors and local recurrent growth may occur. IMT is a diagnostic challenge for imaging. Only a limited number of reports of single cases or small number of patients described the imaging features on computed tomography. Reports on IMT appearance on magnetic resonance imaging are scarce. We present a case of IMT of the liver with infiltration of the abdominal wall treated with surgery and describe the imaging features with the use of the hepatobiliary contrast agent, gadoxetic acid (Gd-EOB).
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Affiliation(s)
- Tahir Durmus
- Institut für Radiologie und Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany
| | - Carsten Kamphues
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany
| | - Hendrik Blaeker
- Institut für Pathologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Christian Grieser
- Institut für Radiologie und Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany
| | - Timm Denecke
- Institut für Radiologie und Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany
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Xing P, Li J, Jin F, Wu Y, Zheng X, Chen B, Yao F, Wei X. Metaplastic breast carcinoma development following surgical resection of an inflammatory myofibroblastic tumor in the right breast: A case report. Oncol Lett 2014; 8:1345-1347. [PMID: 25120721 PMCID: PMC4114583 DOI: 10.3892/ol.2014.2261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 05/29/2014] [Indexed: 11/06/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are uncommon, mesenchymal lesions, and malignant transformation is extremely rare. The current study presents the case of a 56-year-old female with a rapidly growing mass in the right breast, which was diagnosed as IMT. Immunohistochemically, the mass was positive for smooth muscle actin (SMA) and Ki-67 (positive staining in 30% of the cells), and negative for S-100, cluster of differentiation (CD)34, p63 and cytokeratin. Malignant transformation to metaplastic carcinoma of the spindle-cell type was observed following surgical resection. This metaplastic carcinoma demonstrated positive immunoreactivity for cytokeratin, vimentin, CD34, p63 and Ki-67 (>30%), and was negative for cytokeratin 7, SMA, desmin and S-100. The patient underwent total mastectomy of the right breast, followed by palliative chemotherapy with capecitabine; however, the patient succumbed to the disease after 12 weeks. The unusual case presented in the current study emphasizes the importance of pre-operative examinations to determine the benign or malignant nature of IMTs, which aids in the choice of appropriate surgical procedures.
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Affiliation(s)
- Peng Xing
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Jiguang Li
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Feng Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunfei Wu
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xinyu Zheng
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Bo Chen
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Fan Yao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xiaolin Wei
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Inflammatory pseudotumor of the thymus: A case report and review of the literature. Oncol Lett 2014; 7:1414-1418. [PMID: 24765147 PMCID: PMC3997730 DOI: 10.3892/ol.2014.1895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 01/30/2014] [Indexed: 11/29/2022] Open
Abstract
Inflammatory pseudotumors are rare benign tumors consisting of cellular and stromal elements of a localized reactive process. While inflammatory pseudotumors are commonly detected in the lung and occasionally in other organs, only one case of inflammatory pseudotumor of the thymus has been reported in the literature to date. This report presents a 54-year-old male patient with inflammatory pseudotumor of the thymus accompanied by pulmonary inflammation. The patient presented with chest pain and moderate fever for 12 days. Enhanced computed tomography of the thorax revealed an anterior mediastinal solid and cystic mass, which constricted the left brachiocephalic vein accompanied by bilateral lung inflammation and marginal pleural effusion. The patient underwent a median sternotomy for the surgical removal of the mass. Histologically, the resected mass was composed of necrotic and fibrous tissues and inflammatory infiltrates, and the diagnosis was confirmed as an inflammatory pseudotumor of the thymus. The patient’s symptoms were resolved following surgery and the patient remained asymptomatic during the six-month follow-up period. In addition, we reviewed the previous literature and discussed the diagnosis and management of our patient. This report provides further insights into the pathogenesis and underlying mechanisms of inflammatory pseudotumors of the thymus to aid in the diagnosis and development of effective therapies.
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Rai B, Din FHM, O'Byrne JJ, Sharif F. Twelve-year-old boy with recurrent presentations of shortness of breath: an intraluminal tracheal tumour. BMJ Case Rep 2014; 2014:bcr-2013-203183. [PMID: 24759160 DOI: 10.1136/bcr-2013-203183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 12-year-old boy was admitted with symptoms of recurrent shortness of breath since 12 months along with mild intermittent retrosternal chest pain that had developed 3 weeks ago prior to admission. He was previously treated for asthma with no improvement. Initial posteroanterior chest X-ray (CXR) revealed no abnormality on two occasions. Lateral CXR showed a mass lesion in the distal trachea which was subsequently confirmed by a CT scan of the chest.
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Affiliation(s)
- Birendra Rai
- Department of Pediatrics, Midland Regional Hospital, Westmeath, Ireland
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Park JY, Choi MS, Lim YS, Park JW, Kim SU, Min YW, Gwak GY, Paik YH, Lee JH, Koh KC, Paik SW, Yoo BC. Clinical features, image findings, and prognosis of inflammatory pseudotumor of the liver: a multicenter experience of 45 cases. Gut Liver 2013; 8:58-63. [PMID: 24516702 PMCID: PMC3916688 DOI: 10.5009/gnl.2014.8.1.58] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/07/2013] [Accepted: 05/04/2013] [Indexed: 12/23/2022] Open
Abstract
Background/Aims Inflammatory pseudotumor (IPT) of the liver is a rare disease characterized by chronic infiltration of inflammatory cells. However, the clinical characteristics and outcomes of IPT remain uncertain. Methods Clinical features, image findings, and outcomes of 55 patients with histologically proven IPT were evaluated. Results They consisted of 26 men and 19 women with median age of 65 years. Serum carcinoembryonal antigen and carbohydrate antigen 19-9 levels were normal in 42 patients (93.3%). Enhanced CT scans indicated poorly defined peripheral enhancement (82.5%) at the arterial phase and poorly defined hyperattenuating lesions with internal hypoattenuating areas at the equilibrium phase (77.0%). Gadolinium-enhancement MRI revealed poorly defined peripheral rim-like enhancement (77.8%). Ten patients underwent surgical resection and 35 were treated conservatively with or without antibiotics. No recurrence was noted after surgical resection during follow-up (1 to 48 months). In all patients who received conservative treatment, complete resolution or size reduction was noted during follow-up (1 to 192 months). Conclusions CT and MRI provide clues to the diagnosis of IPT in patients with liver masses and normal tumor markers. However, due to the lack of pathognomonic findings, the clinician's suspicion and histological diagnosis are necessary to make an accurate diagnosis of IPT.
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Affiliation(s)
- Jun Young Park
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Seok Choi
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Won Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yang Won Min
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geum-Youn Gwak
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Han Paik
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Hyoek Lee
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Cheol Koh
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Chul Yoo
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Amini B, Huang SY, Tsai J, Benveniste MF, Robledo HH, Lee EY. Primary lung and large airway neoplasms in children: current imaging evaluation with multidetector computed tomography. Radiol Clin North Am 2013; 51:637-57. [PMID: 23830790 DOI: 10.1016/j.rcl.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Multidetector computed tomography (MDCT) offers an important noninvasive imaging modality for confirmation and further characterization of primary lung and large airway neoplasms encountered in pediatric patients. Children represent a unique challenge in imaging, not only because of unique patient factors (eg, inability to follow instructions, motion, need for sedation) but because of the technical factors that must be optimized to reduce radiation dose. This article reviews an MDCT imaging algorithm, up-to-date imaging techniques, and clinical applications of MDCT for evaluating benign and malignant primary neoplasms of lung and large airway in infants and children.
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Affiliation(s)
- Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Demirhan O, Ozkara S, Yaman M, Kaynak K. A rare benign tumor of the lung: Inflammatory myofibroblastic tumor - Case report. Respir Med Case Rep 2013; 8:32-5. [PMID: 26029612 PMCID: PMC3920374 DOI: 10.1016/j.rmcr.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/24/2012] [Accepted: 01/07/2013] [Indexed: 11/18/2022] Open
Abstract
A fifty year old lady who was operated for thyroid cancer two years ago and completed adjuvant therapy, underwent a computer tomography (CT) of the chest during her follow up. The CT showed a mass lesion in the right lung, located to the lateral segment of the middle lobe. There were no intrabronchial lesions on bronchoscopy. Positron emission CT (PET CT) showed a dense hypermetabolic mass located in the right middle lobe lateral segment and having malignant characteristics. A videothorascopic wedge resection was performed and the specimen was sent for frozen section, which showed no evidence of malignancy. Pathology report revealed an inflammatory myofibroblastic tumor (IMT). Since IMT is a rare benign tumor of the lung, we herein report this patient along with a discussion of the relevant literature.
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Affiliation(s)
- Ozkan Demirhan
- Istanbul Bilim University, Medical Faculty, Department of Thoracic Surgery, Istanbul
- Corresponding author. Mehmetcik cad, Cahit Yalcın Sok, No: 1, Mecidiyekoy, Istanbul. Tel.: +90 532 348 31 03; fax: +90 212 212 88 11.
| | - Selvinaz Ozkara
- Haydarpasa Numune Hospital, Department of Pathology, Istanbul
| | - Mustafa Yaman
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Pulmonary Medicine, Istanbul
| | - Kamil Kaynak
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Thoracic Surgery, Istanbul
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Ahn KS, Kang KJ, Kim YH, Lim TJ, Jung HR, Kang YN, Kwon JH. Inflammatory pseudotumors mimicking intrahepatic cholangiocarcinoma of the liver; IgG4-positivity and its clinical significance. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:405-12. [PMID: 21894477 DOI: 10.1007/s00534-011-0436-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) of the liver is a benign condition with a good prognosis. However, it is difficult to distinguish clinical and radiological findings of IPT from those of malignancies. The aims of this study are to determine the clinical, radiological, and pathological characteristics, particularly relating to the role of the autoimmune mechanism in the development of inflammatory pseudotumours (IPTs) of the liver, and to suggest appropriate diagnostic and therapeutic strategy. STUDY DESIGN The clinical, diagnostic, and pathological characteristics including IgG4 immunohistochemical stain and follow-up data of 22 IPT patients were retrospectively analyzed. RESULTS The patients were 16 men and 6 women with a mean age of 59 years. Fifteen patients (68.2%) had associated biliary diseases. Of the 16 patients treated conservatively, the masses completely resolved in 10 patients, and reduced in size in 5 patients within the first 6 months. The remaining 6 patients were treated by surgical resection. IgG4 staining of 17 tissue samples from 22 patients were negative, most of the infiltrate being of fibrohistiocytic type, whereas 4 of 5 lymphoplasmacytic cells of dominant tumors show positive staining of IgG4. Although IgG4-related sclerosing cholangitis was mostly of lymphoplasmacytic type, other histological and clinical characteristics were similar in both types of IPTs. CONCLUSIONS IPTs of the liver can be diagnosed based on radiological and pathological findings by needle biopsy. Although the lymphoplasmacytic type of IPTs seems to correspond to IgG4-related disease, as assessed by IgG4 immunohistochemical stain, its clinical significance is unknown. Although most IPTs can be resolved with conservative therapy, surgical resection should be considered in cases of uncertain biopsy result, presumed malignant lesion, combination with other pathology, or lack of response to conservative management.
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Affiliation(s)
- Keun Soo Ahn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea
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