Inflammatory myofibroblastic tumor of the ascending colon in adults manifested by positive fecal occult blood test

A large and pedunculated inflammatory pseudotumor with pseudosarcomatous change of the cecum mimicking a malignant polyp: a case report and literature review

Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown etiology that can occur in almost any organ system. It has neoplastic features such as local recurrence, invasive growth, and vascular invasion, leading to the possibility of malignant sarcomatous changes. The clinical presentations of colonic IPT may include abdominal pain, anemia, a palpable mass, and intestinal obstruction. A few cases of colonic IPT have been reported, but colonic IPT with pedunculated morphology is very rare. Furthermore, since it can mimic malignant polyps, understanding the endoscopic findings of colonic IPT is important for proper treatment. Herein, we present a case of colonic IPT with pseudosarcomatous changes, presenting as a large polyp, mimicking a malignant polyp in the cecum, along with a literature review.

A case report of inflammatory myofibroblastic tumor of cecum mimicking malignant wall thickening

Introduction

Inflammatory myofibroblastic tumors (IMT) are an uncommon mesenchymal solid tumor commonly documented in children and young adults (Kim et al., 2012 [1]). Cecum is a rare location of this entity, may simulating a malignant tumor process.

Presentation of case

A 71 year old patient was admitted for pain in the right iliac fossa with chronic constipation evolving for two months associated with weight loss.

As a diagnosic step, an abdominal computed tomography (CT) scan was performed showing a thickening of the cecal wall. There was no regional or distant metastasis. During a colonoscopy, many biopsies have been returned to a non-specific chronic colitis; as a result, the IMT of the cecum was confirmed pathologically after ilio-coecal resection.

Discussion

IMT is difined as a solid mesenchymal tumor basically affects the soft parts as well as the visceral organs. The litterature show that frequent localisations are pulmonary and intra-orbital (Krzysztof Siemion et al., 23 February 2022); therefore, the cecal location is very rare may mimic a malignant tumor (Mauricio Gonzalez-Urquijo et al., January 20, 2020),

It is worth recalling that the imaging outcomes are polymorphic and inconclusive; in addition, Surgical excision is the treatment of choice for IMT (Alireza Mirshemirani et al., Dec 2011) and the histopathology is still required for the final diagnosis.

Conclusion

Radiologic features of IMT present a diagnostic challenge to the radiologist; also, mimic malignancy may lead to unnecessary investigations.

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Inflammatory myofibroblastic tumors (IMTs) are an unusual solid tumor derived from mesenchymal origin and grouped into a mix of fibroinflammatory disorders.

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Clinical manifestations are not specific, dependent on the location of the tumor, an inflammatory syndrome may be associated.

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Their radiological appearance is polymorphic and not conclusive.

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The final diagnostic is based on histopathology.

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Surgical treatment is the preferred treatment; complete excision with negative margin has a lower risk of recurrence.

"How long does crizotinib work? a rare case of recurrent inflammatory myofibroblastic tumor"

Inflammatory myofibroblastic tumors (IMTs) are mesenchymal solid tumors, in which anaplastic lymphoma kinase (ALK) gene rearrangement might be detected. A 48-year-old female presented with IMT of lung, treated with surgery. After a 39-month disease-free survival metastatic recurrence was occurred involving soft tissues both infra- and supradiaphragmatic regions. The biopsies obtained from metastatic regions confirmed the recurrence with ALK rearrangement in immunohistochemistry. Initial partial response observed early in treatment course remained as a stable disease with crizotinib treatment. Although an excellent outcome with overall survival of 57 months was observed in our case, there is not enough information about survivals with crizotinib and the treatment options beyond progression. Therefore, every individual case has a unique value paving the way for more effective treatment.

Untypical symptoms for rather uncommon surgical entities: report of two rare cases of secondary intussusception in children (a case report)

Intussusception in infants and children represents a relatively usual challenge for the pediatric surgeon. However, the incidence of lymphoma of the small intestine or inflammatory myofibroblastic tumor, acting as a lead point for invagination, are rather rare. We hereby present two cases of secondary intussusception, with the aforementioned lead points.

Inflammatory myofibroblastic tumour of the colon: 2 case reports and a comprehensive review of the literature

PURPOSE

Inflammatory myofibroblastic tumour (IMT), which is also named as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a rare tumour which rarely develops in the colorectal region. We aimed to review all reported cases to draw attention about this rare tumour.

METHODS

We present two new cases of colonic IMT with no recurrence during the follow-up period. We also reviewed previously reported colorectal IMT/IPT/PCG patients to investigate demographics, diagnosis and treatment modalities.

RESULTS

A total of 60 patients which including our 2 patients and 58 patients from 42 published articles were analysed. Male/female ratio was 34/26. Mean age was found to be 31.84 ± 22.26 years (9 months-82 years). Abdominal pain (56.7%) and fever (23.3%) were the most common complaints in the first admission. Fifty-nine (98.3%) out of 60 patients underwent surgery. During follow-up, 7 (14.3%) patients developed a local recurrence.

CONCLUSION

IMT may occur at any age. IMT is considered to be a borderline tumour with the potential for recurrence or distant metastasis. Complete resection of the tumour is recommended for treatment. Long-time follow-up is necessary due to recurrence potential of the tumour even many years after complete surgical resection.

TRIAL REGISTRATION

The study follows the regulation of the Institutional Review Board for human research at Izmir Katip Celebi University Ataturk Training and Research Hospital. Written informed consents were obtained from the patients who participated in this study.

Aggressive Inflammatory Myofibroblastic Tumor without Anaplastic Lymphoma Kinase Gene Rearrangement in the Rectum with Liver Metastasis

Inflammatory myofibroblastic tumor is a rare intermediate-grade tumor. We herein report the case of an 81-year-old man with rectal ulceration and abnormal retroperitoneal soft tissue with a high serum level of IgG4. The administration of prednisolone reduced the retroperitoneal lesion; however, the rectal ulceration expanded. Surgical resection was performed. A histopathological examination revealed proliferating spindle cells accompanied by inflammatory cells and plasma cells. Liver metastasis emerged two months after surgical resection, and the histology of the proliferating spindle cells sampled by a fine-needle biopsy was similar to that of the rectal tissue. The patient ultimately died of inflammatory myofibroblastic tumor.

How long should we continue crizotinib in ALK translocation-positive inflammatory myofibroblastic tumors? Long-term complete response with crizotinib and review of the literature

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.

Inflammatory Myofibroblastic Tumors in a Case with Hypogastric Discomfort

Patient: Male, 68

Final Diagnosis: Inflammatory myofibroblastic tumor

Symptoms: 2–3 kg weight loss • Helicobacter pylori positive which were eradicated after treatment course • hypogastric region discomfort • no association between the pain, defecation and eating • no history of HIV, diabetes, smoking and alcohol consumption was recorded • no symptoms of nausea, vomiting, fever and shaking chills • normal vital signs • tenderness in the right lower quadrant of the abdomen with no rebound state was noted

Medication: —

Clinical Procedure: Lab examinationt-imaging-colonoscopy-surgery

Specialty: Gastroenterology and Hepatology

Colonic inflammatory myofibroblastic tumours: an institutional review

AIM

The aim of the study was to present the largest series of colonic inflammatory myofibroblastic tumour (C-IMFT) in the literature so far and to provide a review of this condition.

METHOD

A retrospective review was carried out of a consecutive series of patients diagnosed with a C-IMFT at a community-based hospital with a specialized gastrointestinal unit between 2002 and 2011. The main outcome measures were success rate and postoperative complications. Using a set of terms we searched the PubMed database for papers published on C-IMFT. We reviewed the data from these studies and case reports.

RESULTS

There were seven patients with a histopathologically proven C-IMFT. The patients' mean age was 39 ± 11.3 years. Four presented with clinical features of intestinal obstruction of varying severity and three with symptoms of anaemia. Complete surgical resection with end-to-end anastomosis was performed. The gross morphology included polypoidal myxoid tumours that served as a lead point for intussusception in two cases, a whorled mass in two and a circumferential infiltrative tumour in three. Microscopically, all tumours had typical features of IMFT with a variable expression of anaplastic lymphoma kinase (ALK-1) and tumour-free resection margins. All patients were well without local recurrence or metastasis at a mean follow-up of 46.8 ± 11.9 months.

CONCLUSION

Surgical resection is effective for this rare tumour which mostly behaves in a benign manner. Our review supports the need for patients to be followed up for long periods because of the possibility of metastasis or late recurrence.

Inflammatory myofibroblastic tumor of the esophagus treated by endoscopy

Inflammatory myofibroblastic tumors are rare lesions that have been described in virtually every organ including the gastrointestinal tract. The esophagus is an extremely unusual site for these tumors, with only a few cases described in the literature. Surgery has been the most common therapeutic approach used for the resection of these lesions. In the present case, a patient diagnosed with an inflammatory myofibroblastic tumor of the upper esophagus was reported, and it was successfully removed by endoscopy with no complications.

Adult intussusception of the descending colon due to inflammatory myofibroblastic proliferation

We present a case of an asymptomatic 70-year-old man with intussusception of the descending colon due to inflammatory myofibroblastic proliferation. Abdominal ultrasound examination showed a hypoechoic mass, 32 × 19 mm in size, accompanied by intussusception in the descending colon, and power Doppler sonography detected blood flow signals in the mass. Computed tomography revealed a hypervascular lesion, which was confirmed by barium enema and colonoscopy. The surgically excised mass was histologically diagnosed as inflammatory myofibroblastic proliferation. Although intussusception due to inflammatory myofibroblastic proliferation is rare, it should be considered in cases of adult colonic intussusception.

Inflammatory myofibroblastic tumor in colon

Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal solid tumor commonly documented in children and young adults. Here, we report a case of IMT in colon confirmed pathologically after laparoscopic anterior resection. A 35-year-old man presented with anal bleeding after defecation for 2 weeks. Colonoscopy demonstrated a mass with shallow ulceration in the central area and irregular margin accompanied by intact mucosa in the descending colon. Computer tomography showed a well-demarcated and homogenous solitary mass in the descending colon. We performed laparoscopic anterior resection. This case was diagnosed as IMT after microscopic examination. The tumor was composed of a proliferation of spindle-shaped cells arranged in the hyaline material with chronic inflammatory cells, composed mainly of plasma cells and lymphocytes. Immunohistochemically, tumor cells were positive for smooth muscle actin, and vimentin, and negative for desmin, CD117 (c-kit), anaplastic lymphoma kinase-1.

First case of primary phyllodes tumor of the pancreas: case report and findings of immunohistochemical and ultrastructural studies

A 37-year-old Japanese man with a solid and cystic pancreatic mass was referred to our hospital. Computed tomography revealed a well-demarcated solid and cystic mass measuring approximately 3.0 cm in diameter in the pancreatic body. The patient underwent middle segment pancreatectomy, and the retrieved tumor specimen was found to be a well-demarcated solid and cystic lesion measuring 3.0 x 3.0 cm. On histological examination, the cyst walls were found to be lined with a monolayer of non-atypical tall columnar epithelial cells. The solid areas surrounded the cystic ones and showed storiform proliferation of spindle cells that contained round, oval, or elongated nuclei and were present among abundant collagen fibers. The solid areas sent phylloid projections into the cystic spaces and the main pancreatic duct. The spindle cells were found to be diffusely positive for alpha-smooth muscle actin, desmin, and h-caldesmon on immunohistochemical analysis. Electron microscopy revealed that these cells possessed well-developed myofilaments with dense bodies, pinocytic vesicles, and basal lumina. Neither metastasis nor local invasion was detected. After the operation (4 years), tumor recurrence has not occurred. The main differential diagnoses of spindle cell tumors are leiomyomas, leiomyosarcomas, inflammatory myofibroblastic tumors, solitary fibrous tumors, extra-gastrointestinal stromal tumors, and schwannomas. However, the histological findings in the present case differed from those of these tumors. The present lesion is the first reported case of a primary pancreatic phyllodes tumor.