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Hattori T, Tanizawa Y, Shimoda T, Koseki Y, Furukawa K, Fujiya K, Aizawa D, Sugino T, Terashima M, Bando E. Gastric inflammatory myofibroblastic tumor: a case report. Surg Case Rep 2024; 10:62. [PMID: 38485843 PMCID: PMC10940569 DOI: 10.1186/s40792-024-01844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/13/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) of the stomach is an uncommon mesenchymal neoplasm. We present a case of gastric submucosal tumor (SMT) where the final diagnosis was IMT. CASE PRESENTATION A 69-year-old man presented with a 24-mm SMT on the posterior wall of the middle third of the stomach that was detected by screening upper gastrointestinal endoscopy. Abdominal contrast-enhanced computed tomography showed that the tumor was well-enhanced. Although endoscopic ultrasonography-guided biopsy was performed, the histological diagnosis was not confirmed preoperatively. Since the tumor was clinically suspected to be a gastrointestinal stromal tumor, we performed gastric wedge resection by laparoscopic-endoscopic cooperative surgery. Pathologically, proliferative spindle cells with a positive reaction for smooth muscle actin, negativity for c-kit, desmin, s-100, CD34, STAT-6, β-catenin and anaplastic lymphoma kinase 1 were identified. Hence, the tumor was finally diagnosed as an IMT originating from the stomach. CONCLUSIONS When an SMT of the stomach is identified, the possibility of gastric IMT should be considered.
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Affiliation(s)
- Taku Hattori
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Tadakazu Shimoda
- Divisions of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Yusuke Koseki
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Kenichiro Furukawa
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiya
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Daisuke Aizawa
- Divisions of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Takashi Sugino
- Divisions of Pathology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Masanori Terashima
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Divisions of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
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Fernandez Rodriguez M, Artuñedo Pe PJ, Callejas Diaz A, Silvestre Egea G, Grillo Marín C, Iglesias Garcia E, Lucena de La Poza JL. Gastric inflammatory myofibroblastic tumor, a rare mesenchymal neoplasm: A case report. World J Gastrointest Surg 2023; 15:2657-2662. [PMID: 38111778 PMCID: PMC10725540 DOI: 10.4240/wjgs.v15.i11.2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The inflammatory myofibroblastic tumor (IMT) is a rare mesenquimal tumor of doubtful biological behaviour. It's characterised for affecting mainly children and young adults, although it can appear at any age, being the lungs the primary affected organ (in children it represents 20% of all primary pulmonary tumors). CASE SUMMARY We present the case of a 45 year old woman, with a computed tomography (CT) finding of injury on the anterior surface of the fundus/gastric body and a solid perigastric injury of 12 mm in the ecoendoscopy. The case is presented in the tumor committee deciding to perform a laparoscopic wedge resection. The histological diagnosis was a IMT. The diagnosis is based on imaging tests like the abdominal CT, abdominal ecography and the ecoendoscopy but to confirm the diagnosis a pathological study is necessary. CONCLUSION Due to the unpredictable nature of this tumor, surgical resection is the best therapeutic option.
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Affiliation(s)
- Manuel Fernandez Rodriguez
- Department of General and Digestive Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
| | - Pedro Joaquin Artuñedo Pe
- Department of General and Digestive Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
| | - Alejandro Callejas Diaz
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
| | - Gala Silvestre Egea
- Department of Pathologycal Anatomy, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
| | - Cristián Grillo Marín
- Department of General and Digestive Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
| | - Eva Iglesias Garcia
- Department of General and Digestive Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
| | - Jose Luis Lucena de La Poza
- Department of General and Digestive Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain
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Kimura N, Hiraki M, Akashi M, Miyahara K, Imamura M, Furukawa S, Samejima R. A rare case of inflammatory myofibroblast tumor of the stomach successfully treated by inverted laparoscopic and endoscopic cooperative surgery. Surg Case Rep 2023; 9:189. [PMID: 37902858 PMCID: PMC10616023 DOI: 10.1186/s40792-023-01767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND An Inflammatory myofibroblastic tumor (IMT) is a rare intermediate malignancy characterized by myofibroblast proliferation and inflammatory cell infiltration. Various organs are the primary sites of origin. However, primary tumors originating in the stomach tend to be extremely rare, making the diagnosis difficult. Herein, we present a case of IMT originating in the stomach that was effectively managed using inverted laparoscopic endoscopic cooperative surgery (LECS). CASE PRESENTATION A 47-year-old male who was admitted to the hospital because of a submucosal tumor that was discovered during upper gastrointestinal endoscopy. The diameter of the tumor was approximately 20 mm. A KIT-negative gastrointestinal stromal tumor was suspected based on the biopsy findings. Therefore, partial resection of the stomach was performed using inverted laparoscopic and endoscopic cooperative surgery. Histopathological examination revealed collagen fiber proliferation from the submucosal layer to the muscular layer, accompanied by infiltration of spindle-shaped cells, lymphocytes, and numerous inflammatory cells. Immunohistochemistry results were positive for SMA and negative for CD34, desmin, and c-kit. IgG4-positive cells were observed with an IgG4/IgG ratio > 50%, and specific nuclei were positive for ALK. Therefore, IMT was diagnosed. This condition may be difficult to diagnose both before and after surgery because of its rarity and submucosal tumor-like morphology. CONCLUSION When a submucosal tumor originating in the stomach is observed, IMT should be considered. Partial resection of the stomach with LECS and immunohistochemical diagnosis may be useful.
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Affiliation(s)
- Naoya Kimura
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Masatsugu Hiraki
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan.
| | - Michiaki Akashi
- Department of Pathology, Japan Red Cross Society Karatsu Red Cross Hospital, Karatsu, Saga, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Japan Red Cross Society Karatsu Red Cross Hospital, Karatsu, Saga, Japan
| | - Minori Imamura
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Shunsuke Furukawa
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Ryuichiro Samejima
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
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Desai G, Parikh DM, Wagle PK. A Giant Solid-Cystic Gastric Inflammatory Myofibroblastic Tumor: A Case Report and Literature Review. Cureus 2023; 15:e37167. [PMID: 37168160 PMCID: PMC10166389 DOI: 10.7759/cureus.37167] [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: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
An inflammatory myofibroblastic tumor (IMT) is a very rare tumor of mesenchymal origin with unclear etiopathogenesis, no unique diagnostic features, and no specific management protocol. It is often confused with inflammatory pseudotumor in literature, and the distinction needs further study. The average size, recurrence risk, and metastatic potential differ as per the site of origin. The abdomen is a very rare site for IMTs. Hepatic IMTs (H-IMTs) are reported to be solid tumors with sizes ranging from 1 cm to 20 cm in literature, and gastric IMTs (G-IMTs) range from 3 cm to 10 cm in size and can be solid-cystic. We report here a case of a 36-year-old gentleman with a 34x27x17 cm solid-cystic lesion in the lesser sac with loss of fat planes with stomach and left hemi-liver. The patient was managed by complete surgical resection of the lesion with wedge gastrectomy and wedge hepatectomy and recovered uneventfully. To our knowledge and based on our literature review, this case presents the largest reported and solid-cystic G-IMT with the involvement of left hemi-liver in a young gentleman and discusses its management as well as the relevant literature on this rare entity. This clinical presentation of G-IMT should be kept in the differential diagnosis in a relevant case presenting in the future. Immunohistochemistry is a must to establish the diagnosis, and surgical resection to negative margins is the management option of choice in resectable cases.
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Affiliation(s)
- Gunjan Desai
- Gastrointestinal Surgery, Asian Cancer Institute and ACI Cumballa Hill Hospital, Mumbai, IND
- Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Deepak M Parikh
- Head and Neck Surgery, Asian Cancer Institute and ACI Cumballa Hill Hospital, Mumbai, IND
- Head and Neck Surgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Prasad K Wagle
- Gastrointestinal Surgery, Asian Cancer Institute and ACI Cumballa Hill Hospital, Mumbai, IND
- Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, IND
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5
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Ajani MA, Fatunla EO, Onakpoma FA, Salami AA. Inflammatory Pseudotumor: A 20-Year Single Institutional Experience. Adv Biomed Res 2020; 9:68. [PMID: 33816387 PMCID: PMC8012865 DOI: 10.4103/abr.abr_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/26/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Inflammatory pseudotumor (IPT) is a relatively rare benign disease. The aim of the study was to demonstrate the demographic distribution, clinical presentation, and histomorphological characteristics of IPT while highlighting its associated diagnostic challenges. Materials and Methods: A retrospective cross-sectional review of all the IPT diagnosed in our institution between January 1999 and December 2018 was conducted. The samples were received from within and outside the hospital facility. The demographic data, clinical history, and histologic reports were reviewed. Results: A total of 25 cases of histologically confirmed IPT were seen. Patients' age ranges from 7 to 74 years with a mean age of 38.96 years and standard deviation ± 17.94 years. There was a bimodal peak occurrence in the third and fifth decades. Most of the patients were adults (23, 92%), whereas only 2 (8%) were children. There was a female preponderance with a male-to-female ratio of 1:2.6. The head and neck had the highest number of cases (44%), followed by the gastrointestinal tract (GIT) (40%). Eight (73%) of head and neck cases occurred in the orbit. The presenting complaints depended on the site of the lesion with pain and swelling being the commonest symptoms irrespective of the site of the lesions. Two cases of bilateral IPT were observed. Immunohistochemistry was used in a certain condition of diagnostic dilemma. Conclusion: This study showed a female preponderance of IPT with the head and neck and GIT being the most common location. It is important to rule out other differentials in the diagnosis of IPT.
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Affiliation(s)
- Mustapha Akanji Ajani
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria.,Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ebenezer O Fatunla
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Francis A Onakpoma
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Ayodeji A Salami
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria.,Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Nakanishi M, Watari J, Tomita T, Nakanishi Y, Tsukamoto Y, Matsuo S, Uchihashi T, Miyazaki J, Tanaka H, Kojima S, Kuroda N, Matsuda I, Miwa H, Shinohara H, Hirota S. Gastric CLTC-ALK fusion-positive inflammatory myofibroblastic tumor showing an endoscopic superficial depressed-type appearance. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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7
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Hayashi M, Kawakubo H, Mayanagi S, Nakamura R, Suda K, Wada N, Kitagawa Y. Gastric inflammatory myofibroblastic tumor treated with combined laparoscopic and endoscopic gastric wedge resection: a case report. World J Surg Oncol 2018; 16:161. [PMID: 30089486 PMCID: PMC6083513 DOI: 10.1186/s12957-018-1460-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/01/2018] [Indexed: 12/02/2022] Open
Abstract
Background Inflammatory myofibroblastic tumor is an uncommon soft tissue neoplasm rarely reported in the stomach. Case presentation We identified a tumor highly suggestive of poorly differentiated gastric adenocarcinoma in the lesser curvature of the stomach of a 53-year-old female during screening endoscopy. Although the patient’s gastric biopsy did not reveal cancer, the tumor configuration was strongly suspicious for malignancy, and we performed a gastric wedge resection using a combined laparoscopic and endoscopic method. The lesion was diagnosed as inflammatory myofibroblastic tumor based on its morphological and immunohistological features. Conclusions Inflammatory myofibroblastic tumor should be considered in the differential diagnosis of soft tissue tumors in the stomach. We present a case of inflammatory myofibroblastic tumor safely treated with combined laparoscopic and endoscopic gastric wedge resection.
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Affiliation(s)
- Masato Hayashi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Shuhei Mayanagi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Suda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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8
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Lee JE, Choi SY, Lee HK, Yi BH, Lee MH, Lee S, Lee SJ, Lee J, Jeong WK. Computed tomographic features of inflammatory myofibroblastic tumour of the stomach in adult patients: An analysis of five multicentre cases with literature review. J Med Imaging Radiat Oncol 2018; 62:769-776. [DOI: 10.1111/1754-9485.12780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/04/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Ji Eun Lee
- Department of Radiology; Soonchunhyang University College of Medicine; Bucheon Hospital; Bucheon Korea
| | - Seo-Youn Choi
- Department of Radiology; Soonchunhyang University College of Medicine; Bucheon Hospital; Bucheon Korea
| | - Hae Kyung Lee
- Department of Radiology; Soonchunhyang University College of Medicine; Bucheon Hospital; Bucheon Korea
| | - Boem Ha Yi
- Department of Radiology; Soonchunhyang University College of Medicine; Bucheon Hospital; Bucheon Korea
| | - Min Hee Lee
- Department of Radiology; Soonchunhyang University College of Medicine; Bucheon Hospital; Bucheon Korea
| | - Sunyoung Lee
- Department of Radiology and Center for Imaging Science; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Radiology and Research Institute of Radiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jisun Lee
- Department of Radiology; Chungbuk National University Hospital; Cheongju Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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9
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Albayrak F, Dursun H, Albayrak Y, Altas S, Uyanik A, Yildirim R. Inflammatory Myofibroblastic Tumor of the Stomach in an Adult Woman: A Rare Intermittent Cause of Gastric Outlet Obstruction. TUMORI JOURNAL 2018; 96:492-5. [DOI: 10.1177/030089161009600320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Inflammatory myofibroblastic tumor is a neoplasm of intermediate biological potential that frequently recurs and rarely metastasizes. Case report We report a rare case of intermittent gastric outlet obstruction by an inflammatory myofibroblastic tumor of the cardia. Results A 56-year-old woman presented at the gastroenterology department with a two-day history of hematemesis and melena. She had intermittent nausea and vomiting complaints, which had manifested periodically for about five months. Upper gastrointestinal endoscopy demonstrated a mass of 6 cm in diameter, which was resected. Histological examination revealed ulcerated mucosal granulation-like tissue with myofibroblastic spindle cell proliferation in a storiform pattern. Conclusions In order to avoid unnecessary aggressive therapy, gastric IMT should be taken into account when a gastric mass accompanied by the various clinical manifestations of IMT is found in an adult.
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Affiliation(s)
- Fatih Albayrak
- Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Hakan Dursun
- Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Yavuz Albayrak
- Department of General Surgery and Burn Unit, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Sare Altas
- Department of Pathology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Abdullah Uyanik
- Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Rahsan Yildirim
- Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Petrovic I, Augustin G, Hlupic L, Nedic A, Romic I, Skegro M. Inflammatory myofibroblastic tumors of the duodenum. Asian J Surg 2016; 39:247-52. [PMID: 24210542 DOI: 10.1016/j.asjsur.2013.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 07/26/2013] [Accepted: 09/23/2013] [Indexed: 02/08/2023] Open
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Dhull V, Passah A, Rana N, Arora S, Mallick S, Kumar R. Paraneoplastic pemphigus as a first sign of metastatic retroperitoneal inflammatory myofibroblastic tumor: 18 F-FDG PET/CT findings. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Mohammad Hoseini-Azar M, Mokhtare M, Zare-Mirzaie A, Gholami A, Agah S, Ghafoori SMS. Fever,Weight Loss and Early Satiety due to Gastric Inflammatory Myofibroblastic Tumor; Case Report and Literature Review. Middle East J Dig Dis 2016; 8:138-42. [PMID: 27252821 PMCID: PMC4885613 DOI: 10.15171/mejdd.2016.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Gastric inflammatory myofibroblastic tumor (IMT) is a rare tumor with and
unpredictable prognosis usually find in young adults. We present an 18-yearold
man with gastric IMT. He complained of epigastric pain, intermittent fever
and night sweating associated with weight loss since two years ago. Physical
examination showed anemic and cachestic features with mild abdominal tenderness
in palpitation as well as an abdominal mass in epigastrium. Abdominal
CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy
revealed a submucosal lesion in fundus of stomach of approximately
8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous
fundal mass with areas of calcification. The patient underwent laparoscopic
partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed
an IMT.
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Affiliation(s)
| | - Marjan Mokhtare
- Assistant Professor, Colorectal Research center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zare-Mirzaie
- Associate Professor,Department of Pathology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Gholami
- Assistant Professor,Department of Internal Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Agah
- Professor, Colorectal Research center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Sadegh Ghafoori
- Medical student, Colorectal Research center, Medical Student Research Committee (MSRC), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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13
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Dhull VS, Passah A, Rana N, Arora S, Mallick S, Kumar R. Paraneoplastic pemphigus as a first sign of metastatic retroperitoneal inflammatory myofibroblastic tumor: (18)F-FDG PET/CT findings. Rev Esp Med Nucl Imagen Mol 2016; 35:260-2. [PMID: 26740314 DOI: 10.1016/j.remn.2015.09.005] [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: 07/29/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
A 30-year-old female presented with a 3-month history of erosive stomatitis and bullous lesions, along with recurrent episodes of abdominal pain. She was found to have a retroperitoneal lump in left lumbar region. Skin biopsy revealed bullous disorder. CT guided biopsy of the retroperitoneal mass was suggestive of inflammatory myofibroblastic tumor (IMT). She was started on oral steroids and supportive care, and surgery was being planned when she developed respiratory failure. CT chest revealed vertebral metastases. PET/CT for whole body work up revealed a left para-aortic mass along with multiple skeletal metastases. The patient was kept on conservative management. After 3 months, the patient has shown clinical improvement, and an exploratory laparotomy is now being planned for the excision of the tumor, followed by chemotherapy. This case of retroperitoneal IMT is rare in terms of skeletal metastases with paraneoplastic pemphigus.
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Affiliation(s)
- V S Dhull
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Passah
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - N Rana
- Department of Radiodiagnosis, M S Ramaiah Medical College, Bengaluru, India
| | - S Arora
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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14
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Co-existence of acute appendicitis and inflammatory myofibroblastic tumor of the small intestine: A case report. Ann Med Surg (Lond) 2015; 4:217-20. [PMID: 26236476 PMCID: PMC4513189 DOI: 10.1016/j.amsu.2015.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/01/2015] [Accepted: 07/06/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor as a rare neoplastic lesion is seen most commonly in the pulmonary system. Beside the presence of limited number of inflammatory myofibroblastic tumors of the gastrointestinal tract in the literature, co-existence with acute appendicitis has not been reported before. PRESENTATION OF CASE A 27-year-old woman admitted to emergency department with acute abdominal pain at the right lower quadrant. The initial diagnosis was as acute appendicitis. Intraoperatively, a mass with a diameter of almost 5 cm originated from the distal ileal segments neighboring the appendix was seen. The patient was managed by segmental resection of the small intestine including the mass with appendectomy. Histologically, there were bundles of spindle cells accompanied by lymphoplasmocytic infiltration. The immunohistochemical studies showed that tumor cells were positive for smooth muscle actin, vimentin, perinuclear activity for anaplastic lymphoma kinase and CD 68. The final pathologic diagnosis was inflammatory myofibroblastic tumor. DISCUSSION Concomitant resection of tumoral lesions detected in the neighbor intestinal segments during appendectomy should be considered to diagnose and treat. For the diagnosis of inflammatory myofibroblastic tumor, immunohistochemistry pattern including positivity for actin, vimentin, CD 68 and anaplastic lymphoma kinase plays a crucial role. Therefore, detailed immunohistochemistry analysis should be performed in suspicious cases. CONCLUSION Coexistence of inflammatory myofibroblastic tumor located in the gastrointestinal system with acute appendicitis is a rare event. Complete surgical excision should be regarded as the mainstay of the treatment. Long-term follow up with serial imaging techniques is recommended.
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15
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Inflammatory myofibroblastic tumor of the thigh: presentation of a rare case and review of the literature. Case Rep Orthop 2015; 2015:814241. [PMID: 25945274 PMCID: PMC4402203 DOI: 10.1155/2015/814241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/14/2015] [Indexed: 01/28/2023] Open
Abstract
Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. We present a case of a 47-year-old male with fever, fatigue, and a slow-growing thigh mass. The inflammatory markers were elevated and the MR images showed a well-defined intermuscular lesion with mild heterogeneous enhancement. The lesion was excised and histologic examination was consistent with an inflammatory myofibroblastic tumor. No adjuvant therapy was needed and the patient remained asymptomatic with no evidence of tumor recurrence during the 2 years of follow-up.
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Katakwar A, Gedam BS, Mukewar S, Agasti A. Primary gastric inflammatory myofibroblastic tumor in an adult-case report with brief review. Indian J Surg Oncol 2014; 5:66-70. [PMID: 24669167 DOI: 10.1007/s13193-014-0296-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/27/2014] [Indexed: 12/13/2022] Open
Abstract
The term inflammatory myofibroblastic tumor more commonly referred to as "pseudostumor ", denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 45-year-old diabetic man with a gastric Inflammatory myofibroblastic tumor. The histopathological and immunohistochemical analysis was the key to reach diagnosis.
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Affiliation(s)
- Abhishek Katakwar
- Department of Surgical Gastroenterology, Midas Multispecialty Hospital and Research Centre, Nagpur, India 440010 ; Midas Multispecialty Hospital Pvt. Ltd., Ramdaspeth, Central Bazaar Road, Nagpur, Maharashtra India 440010
| | - B S Gedam
- Department of Surgical Gastroenterology, Midas Multispecialty Hospital and Research Centre, Nagpur, India 440010
| | - Shrikant Mukewar
- Department of Medical Gastroenterology, Midas Multispecialty Hospital and Research Centre, Nagpur, India 440010
| | - Ananta Agasti
- Department of Medical Gastroenterology, Midas Multispecialty Hospital and Research Centre, Nagpur, India 440010
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Inflammatory myofibroblastic tumor: a rarely seen submucosal lesion of the stomach. Case Rep Oncol Med 2013; 2013:328108. [PMID: 23573435 PMCID: PMC3615588 DOI: 10.1155/2013/328108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/24/2013] [Indexed: 11/18/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal benign tumor which is generally seen in children and in young adults. It is especially located in the lungs. In histopathological examination, neoplastic fusiform cells originating from a subtype of accessory immune system cells which are called fibroblastic reticulum cells are seen (Kouichi and Youichirou, 2008). Although IMT is histopathologically benign, imaging methods show its tendency for local recurrence and invasion. In most of the cases, it may not be possible to make a distinction whether it is malign or benign. Complete surgical resection is the most important treatment method. In this study, we have discussed the findings of our case having a gastric submucosal located IMT in light of the current literatures.
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Bjelovic M, Micev M, Spica B, Babic T, Gunjic D, Djuric A, Pesko P. Primary inflammatory myofibroblastic tumor of the stomach in an adult woman: a case report and review of the literature. World J Surg Oncol 2013; 11:35. [PMID: 23374227 PMCID: PMC3570320 DOI: 10.1186/1477-7819-11-35] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/13/2013] [Indexed: 12/30/2022] Open
Abstract
Inflammatory myofibroblastic tumor has been defined as a histologically distinctive lesion with uncertain behaviour. The term inflammatory myofibroblastic tumor more commonly referred to as "pseudostumor ", denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor mostly occurs in the soft tissue of children and young adults, and the lungs are the most commonly affected site, but it has been recognized that any anatomic localization can be involved. Inflammatory myofibroblastic tumors in adults are very rare, especially in the stomach. We present a case of a 43-year old woman with primary inflammatory myofibiroblastic tumor in the stomach and a review of the literature.
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Rare gastric inflammatory myofibroblastic tumor in an adult woman: a case report with review of the literature. Case Rep Med 2012; 2012:374070. [PMID: 22570660 PMCID: PMC3337595 DOI: 10.1155/2012/374070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 02/15/2012] [Indexed: 12/29/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 37-year-old woman with a gastric IMT. She presented epigastric pain since 2 months, anemia and weight loss associated. Physical examination showed cutaneous pallor and mild abdominal tenderness in the epigastrium. Abdominal ultrasonography showed a tumor near the pancreas and the CT scan revealed that the lesion was arising from the stomach. Upper endoscopy showed a submucosal lesion of approximately 7.5 cm located in the posterior wall of the gastric body such as a gastrointestinal stromal tumor (GIST). The patient underwent a subtotal gastrectomy and Billroth I reconstruction. The histopathological and immunohistochemical analysis revealed an IMT that originated from the gastric wall.
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Papadopoulou D, Chatziralli I, Papadopoulos V, Filitantzi C, Demertzidis C. Synchronous gastric inflammatory myofibroblastic tumour with gastrointestinal stromal tumour of the stomach and hepatic syringious haemangioma. J Surg Case Rep 2012; 2012:7. [PMID: 24960722 PMCID: PMC3649450 DOI: 10.1093/jscr/2012.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Inflammatory myofibroblastic tumour of the stomach is a very rare lesion. A case of a gastric inflammatory myofibroblastic tumour associated with gastrointestinal stromal tumour of the stomach and hepatic syringious haemangioma is described. We report an 80-year-old male who had an exophytic mass in the area of the pylorus and the duodenum, where hepatic cysts were found in the magnetic resonance (MRI) scan on examination of hypochromic microcytic anaemia, and prolapsus and torsion of the bulb of the stomach found during gastroscopy. During surgical excision of the exophytic mass, a gastrointestinal stromal tumour from the gastric fundus and a syringious haemangioma from the superior hepatic surface were resected. All tumours were treated successfully by surgical excision. The patient had an uneventful recovery. Neither recurrence nor metastasis was found after a 12-month follow-up. To our knowledge, this is the first time that such an association is reported in the literature.
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Park SH, Kim JH, Min BW, Song TJ, Son GS, Kim SJ, Lee SW, Chung HH, Lee JH, Um JW. Exophytic inflammatory myofibroblastic tumor of the stomach in an adult woman: A rare cause of hemoperitoneum. World J Gastroenterol 2008; 14:136-9. [PMID: 18176977 PMCID: PMC2673379 DOI: 10.3748/wjg.14.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) of the stomach in adults is extremely rare, with unpredictable prognosis. We present a 55-year-old woman with a gastric IMT. She experienced sudden abdominal pain 4 d previously. Physical examination showed mild abdominal tenderness in the hypogastrium, but no palpable abnormal abdominal mass. Abdominal CT showed a mass of approximately 8 cm in the gastrocolic ligament. On laparoscopic exploration, unexpected hemoperitoneum of approximately 1.5 L of blood was found, and an exophytic gastric mass of approximately 10 cm, appeared from the anterior wall of the gastric body along the greater curvature. Laparoscopy further showed that non-clotting blood in the abdominal cavity seemed to be from the gastric tumor. After conversion to open surgery for more precise evaluation of the cause of hemoperitoneum and the large friable tumor, gastric wedge resection, including the tumor, was conducted. The final diagnosis was consistent with IMT that originated from the gastric wall.
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Kirsch R, Gao ZH, Riddell R. Gastrointestinal stromal tumors: diagnostic challenges and practical approach to differential diagnosis. Adv Anat Pathol 2007; 14:261-85. [PMID: 17592256 DOI: 10.1097/pap.0b013e3180ca826a] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the last decade, gastrointestinal stromal tumors (GISTs) have evolved from histogenetically obscure gastrointestinal mesenchymal tumors to well-defined tumors with distinctive clinical, morphologic, ultrastructural, histogenetic, and molecular characteristics, for which targeted therapy is available. This is largely attributable to the discovery of CD117 overexpression and activating mutations in c-kit or platelet-derived growth factor alpha genes in most of GISTs. The availability of specific diagnostic tests and targeted therapy for GISTs has led to an increased awareness of these tumors. At the same time, the list of potential GIST mimics has lengthened considerably and it has become increasingly important that GISTs be distinguished from their mimics because correct diagnosis has implications for both treatment and prognosis. The purpose of this review is to provide an update of the expanding differential diagnosis of GISTS, to draw attention to unusual GIST variants, to provide a practical approach the differential diagnosis of GISTs and to highlight some of the challenges faced by pathologists in resolving this differential diagnosis.
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Affiliation(s)
- Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm composed of transformed myofibroblastic spindle cells with infiltration of a large number of inflammatory cells and/or lymphocytes. The etiology of IMT remains unknown. IMT occurs at various sites and often affects young adults and children. IMT of the liver mostly arises in the right lobe of liver. Biopsy, computed tomography (CT) and magnetic resonance imaging (MRI) are beneficial to diagnosis and differential diagnosis. Vimentin, smooth muscle actin (SMA), muscle-specific actin (MSA) are often positive by immunohistochemistry. The prognosis of most patients is favorable after surgery. In this article, we reviewed the overseas and domestic literatures and summarized the advancement of research on the IMT of the liver about etiology, pathogenesis, clinical presentations, imaging feature, histological appearance, immunohistochemical and electron microscopic feature, diagnosis, differential diagnosis and therapy.
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