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Nakano K. Inflammatory myofibroblastic tumors: recent progress and future of targeted therapy. Jpn J Clin Oncol 2023; 53:885-892. [PMID: 37394916 DOI: 10.1093/jjco/hyad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
An inflammatory myofibroblastic tumor is a rare component of bone and soft-tissue sarcomas that has distinct pathological features as a lymphoplasmacytic inflammatory infiltrate. As is the case for other non-small round cell sarcomas, surgical resection remains the standard treatment strategy for inflammatory myofibroblastic tumors, but recurrence is possible. Concerning systemic therapy, the available data for conventional chemotherapy (such as those of doxorubicin-based regimens) are limited, and case reports of anti-inflammatory inflammatory myofibroblastic tumor treatments describe some degree of symptom relief and efficacy against tumor progression. However, as more information about cancer genomics accumulates, the potential for molecularly targeted therapies for inflammatory myofibroblastic tumors has become more promising. Approximately half of inflammatory myofibroblastic tumors harbor anaplastic lymphoma kinase (ALK) fusion genes, and the other half could have potentially targetable fusion genes or mutations such as ROS1, NTRK and RET; case reports demonstrating the clinical efficacy of treatments targeted to inflammatory myofibroblastic tumor have been published, as have several prospective clinical trials. Few drugs are approved for the treatment of inflammatory myofibroblastic tumor, and most of them were approved for tumor-agnostic indications. Drugs that could be used for pediatric indications and dosing in inflammatory myofibroblastic tumor have also not been established. To provide effective targeted therapy for rare diseases such as inflammatory myofibroblastic tumor, it is necessary to obtain clinical evidence by designing and performing clinical trials and to find a path toward regulatory approval.
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Affiliation(s)
- Kenji Nakano
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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2
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Schoot RA, Orbach D, Minard Colin V, Alaggio R, Di Carlo D, Corradini N, Mercolini F, Milano GM, van Noesel MM, Rome A, Dall'Igna P, Pajtler K, Sparber-Sauer M, Ferrari A, Casanova M. Inflammatory Myofibroblastic Tumor With ROS1 Gene Fusions in Children and Young Adolescents. JCO Precis Oncol 2023; 7:e2300323. [PMID: 37856763 DOI: 10.1200/po.23.00323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE Inflammatory myofibroblastic tumors (IMTs) are often driven by anaplastic lymphoma kinase fusions and less frequently by alternative fusions such as ROS1. We describe the clinical characteristics, treatment approach, and outcome for a series of young patients with IMTs and ROS1 alterations. METHODS This was a retrospective, international, multicenter study analyzing young patients (younger than 21 years) with ROS1-altered IMTs treated in 10 European referral centers between 2014 and 2022. Patients were included in the European pediatric Soft tissue sarcoma Study Group NRSTS-2005 protocol or registered in the Soft Tissue Sarcoma Registry. Primary surgery was recommended if a microscopic radical resection was feasible without mutilation. No standard systemic treatment protocol was available, but several medical options were recommended. RESULTS A total of 19 patients (median age 8.3 years) were included. Most patients had a biopsy at diagnosis (Intergroup Rhabdomyosarcoma Study [IRS] I; n = 2, IRS II; n = 1, IRS III biopsy; n = 11, IRS III resection; n = 3, IRS IV; n = 2). Twelve patients received neoadjuvant systemic therapy in first line (four received multiple treatments): high-dose steroids (n = 2), vinorelbine/vinblastine with methotrexate (n = 6), or ROS1 inhibitors (n = 8). After a median follow-up of 2.8 years (range, 0.2-13.4), seven patients developed an event. The 3-year event-free survival was 41% (95% CI, 11 to 71), and the 3-year overall survival was 100%. CONCLUSION Outcome for ROS1-altered IMTs appears excellent. A complete resection at diagnosis was often not feasible, and most patients needed neoadjuvant therapy. Patients who developed a tumor event could be cured with reinitiation of systemic therapy and/or surgery. This approach illustrates a switch in treatment philosophy moving from immediate, often mutilating, surgery to systemic (targeted) therapy as a bridge to more conservative surgery later in the treatment course.
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Affiliation(s)
- Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Veronique Minard Colin
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Université Paris-Saclay, Villejuif, France
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Di Carlo
- Pediatric Hematology-Oncology Division, University Hospital of Padova, Padova, Italy
| | - Nadege Corradini
- Department of Pediatric Oncology, Institut d'Hematologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Federico Mercolini
- Pediatric Oncology and Hematology "Lalla Seràgnoli", Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuseppe Maria Milano
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Angelique Rome
- Department of Pediatric Oncology, Timone Children's Hospital, Marseille, France
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Precision and Regenerative Medicine and Jonic Area, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | - Kristian Pajtler
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg University, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg University, Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Monika Sparber-Sauer
- Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin (Olgahospital), Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany
- Medical Faculty, University Tübingen, Tübingen, Germany
| | - Andrea Ferrari
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Majid M, Parker J, Yaker Z, Abdelghaffar B, Agrawal A, Kumar A, Syed AB, Fritchie K, Tornekar V, Klein AL. A Rare Case of Constrictive Pericarditis: Inflammatory Myofibroblastic Tumor. JACC Case Rep 2023; 18:101908. [PMID: 37545674 PMCID: PMC10401052 DOI: 10.1016/j.jaccas.2023.101908] [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: 03/16/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 08/08/2023]
Abstract
A previously healthy 15-year-old adolescent female presented with dependent edema, ascites, and dyspnea on exertion. The result of her initial evaluation was consistent with constrictive pericarditis in the setting of local low-grade spindle cell sarcoma. She was unresponsive to traditional medical management and required concurrent mass resection and radical pericardiectomy for definitive treatment. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Muhammad Majid
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Parker
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary Yaker
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bahaa Abdelghaffar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alveena B. Syed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karen Fritchie
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vineet Tornekar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L. Klein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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4
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Buksh O, Almalki AM, Khogeer A, Al-Maghrabi J, Alakraa M. A Large Inflammatory Myofibroblastic Tumor of the Urinary Bladder in a Parturient Treated by Partial Cystectomy: Case Report and Literature Review. Cureus 2022; 14:e29556. [PMID: 36312673 PMCID: PMC9595141 DOI: 10.7759/cureus.29556] [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] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare type of tumor composed mainly of fibroblastic and myofibroblastic spindle cells, with an inflammatory infiltrate of lymphocytes, plasma cells, and eosinophils. IMT may arise from different organs and sites, but it is infrequent to arise from the urinary bladder and usually manifests as hematuria. We report a case of a 24-year-old pregnant woman who presented to our hospital with gross hematuria. After further workup, we concluded that she had this extremely rare tumor, which was resected eventually with a partial cystectomy. Although the diagnosis of these kinds of tumors is usually made by anaplastic lymphoma kinase (ALK) using immunohistochemistry and detecting ALK gene translocation using fluorescence in situ hybridization (FISH), they were negative in our study; hence, we relied mainly on the morphological features of the tumor for the diagnosis.
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5
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Gros L, Dei Tos AP, Jones RL, Digklia A. Inflammatory Myofibroblastic Tumour: State of the Art. Cancers (Basel) 2022; 14:cancers14153662. [PMID: 35954326 PMCID: PMC9367282 DOI: 10.3390/cancers14153662] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Among sarcomas, which are rare cancers, inflammatory myofibroblastic tumors are extremely rare. Unlike other subtypes, this is a largely oncogene-driven neoplasia, and early gene rearrangement identification is important for accurate advanced stage treatment. In this manuscript, we review the clinicopathologic characteristics of this ultra-rare entity, as well as the current treatment landscape, with a particular focus on opportunities provided by tyrosine kinase inhibitors (TKIs). Abstract An inflammatory myofibroblastic tumor (IMT) is a neoplasm composed of myofibroblastic and fibroblastic spindle cells accompanied by inflammatory cells, including lymphocytes and eosinophils. It is an ultra-rare tumor, the optimal management of which remains to be defined. Surgery is the treatment of choice for localized tumors. The treatment of advanced disease is not precisely defined. Chemotherapy regimens result in an overall response rate of approximately 50% based on retrospective data. The latest pathophysiological data highlight the role played by tyrosine kinase fusion genes in IMT proliferation. Anaplast lymphoma kinase (ALK) oncogenic activation mechanisms have been characterized in approximately 80% of IMTs. In this context, data regarding targeted therapies are most important. The aims of this article are to review the latest published data on the use of systematic therapy, particularly the use of molecular targeted therapy, and to publish an additional case of an IMT with Ran-binding protein 2 (RANPB2)-ALK fusion showing a long response to a tyrosine kinase inhibitor.
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Affiliation(s)
- Louis Gros
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, 35128 Padua, Italy;
- Department of Medicine, University of Padua School of Medicine, 35128 Padua, Italy
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK;
- Division of Clinical Sciences, Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
- Center of Sarcoma, Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence:
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Rich BS, Fishbein J, Lautz T, Rubalcava NS, Kartal T, Newman E, Wok PE, Romao RL, Whitlock R, Naik-Mathuria B, Polites SF, Løfberg K, Lascano D, Kim E, Davidson J, Bütter A, Kastenberg ZJ, Short SS, Meyers RL, Mastropolo R, Malek MM, Weller J, Irfan A, Rhee DS, Utria AF, Rothstein DH, Riehle K, Commander SJ, Tracy E, Becktell K, Hallis B, Lal D, Li O, Dal-Soglio DB, Piché N, Gomez Quevedo O, Murphy AJ, Davidoff AM, Cooke Barber J, Watters E, Dasgupta R, Glick RD. Inflammatory Myofibroblastic Tumor: A Multi-Institutional Study from the Pediatric Surgical Oncology Research Collaborative. Int J Cancer 2022; 151:1059-1067. [PMID: 35604778 DOI: 10.1002/ijc.34132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate malignancy. We describe the largest cohort of IMT patients to date, aiming to further characterize this rare, poorly understood tumor. This is a multi-institutional review of IMT patients ≤39 years, from 2000-2018, at 18 hospitals in the Pediatric Surgical Oncology Research Collaborative. 182 patients were identified with median age of 11 years. 33% of tumors were thoracic in origin. Presenting signs/symptoms included pain (29%), respiratory symptoms (25%), and constitutional symptoms (20%). Median tumor size was 3.9 cm. Anaplastic lymphoma kinase (ALK) overexpression was identified in 53% of patients. 7% of patients had distant disease at diagnosis. 91% of patients underwent resection: 14% received neoadjuvant treatment and 22% adjuvant treatment. 12% of patients received an ALK inhibitor. 66% of surgical patients had complete resection, with 20% positive microscopic margins, and 14% gross residual disease. Approximately 40% had en bloc resection of involved organs. Median follow-up time was 36 months. Overall 5-year survival (OS) was 95% and 5-year event-free survival (EFS) was 80%. Predictors of recurrence included respiratory symptoms, tumor size, and distant disease. Gross or microscopic margins were not associated with recurrence, suggesting that aggressive attempts at resection may not be warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, NY
| | - Joanna Fishbein
- Biostatistics Unit, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Timothy Lautz
- Division of Pediatric Surgery, Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Nathan S Rubalcava
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Tanvi Kartal
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Erika Newman
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Pei En Wok
- Division of Pediatric Surgery, Department of Urology, IWK Health Centre, Halifax, NS
| | - Rodrigo Lp Romao
- Division of Pediatric Surgery, Department of Urology, IWK Health Centre, Halifax, NS
| | - Richard Whitlock
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Katrine Løfberg
- Division of Pediatric Surgery, OHSU Doernbecher Children's Hospital, Portland, OR
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Eugene Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jacob Davidson
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | | | - Marcus M Malek
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh
| | - Jennine Weller
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ahmer Irfan
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alan F Utria
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David H Rothstein
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Kimberly Riehle
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Elisabeth Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Kerri Becktell
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Brian Hallis
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Dave Lal
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Orville Li
- Faculty of Medicine, Université de Montréal
| | | | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine
| | | | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Jo Cooke Barber
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Erin Watters
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, NY
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Couper MR, Eldredge JA, Kirby M, Kirby C, Moore D, Hammond P, Manton N, Glynn A, Couper RT. Paediatric Gastrointestinal, Hepatic and Pancreatic Inflammatory Myofibroblastic Tumours, A Single Centre Experience. J Pediatr Gastroenterol Nutr 2022; 74:253-257. [PMID: 34596604 DOI: 10.1097/mpg.0000000000003311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT Inflammatory myofibroblastic tumours (IMTs) are rare soft tissue tumours. Reports of gastrointestinal tract, liver and pancreas tumours are limited. The objective of this study is to identify presenting features, contributing prognostic / etiological factors and any variability in outcomes in the context of different historical treatments. We retrospectively reviewed the records of seven children treated at our hospital between 2006 and 2019 and assessed the demographic, presentation, treatment, immunohistochemistry, and outcomes of their tumours. Age range at presentation was 4 months-15 years with a male predominance. Presentations were typically due to local mass effect or incidental discovery. Systemic symptoms were rare. Outcomes were good with six out of seven stable or in remission irrespective of treatment. Surgical resection where possible is the treatment of choice. Medical therapy had good outcomes with chemotherapy acting as first line treatment when required. The only negative prognostic factor identified was local spread at the time of presentation.
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8
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Gross Hematuria in an Adolescent Secondary to a Rare Bladder Tumor: A Case Report and Review of Inflammatory Myofibroblastic Tumors of the Urinary Bladder. Urology 2022; 165:e39-e45. [DOI: 10.1016/j.urology.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
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Ruan H, Yan BD, Tao YM, Ran X, Li SS. Endoscopic therapy combined with photodynamic therapy for intratracheal inflammatory myofibroblastic tumor. Photodiagnosis Photodyn Ther 2022; 38:102784. [DOI: 10.1016/j.pdpdt.2022.102784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
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10
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Qiu L, Trout AT, Ayyala RS, Szabo S, Nathan JD, Geller JI, Dillman JR. Pancreatic Masses in Children and Young Adults: Multimodality Review with Pathologic Correlation. Radiographics 2021; 41:1766-1784. [PMID: 34597223 DOI: 10.1148/rg.2021210008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Masses and masslike lesions of the pancreas are uncommon in the pediatric population. However, owing to overlapping clinical and imaging features, it can be challenging to differentiate the various causes of pediatric pancreatic masses at initial patient presentation. Clinical data such as patient age, signs and symptoms at presentation, laboratory test results, and potential underlying cancer predisposition syndrome can be helpful when formulating a differential diagnosis. US may be the first imaging study to depict a pancreatic mass in a child, as this examination is frequently performed in children with nonspecific abdominal signs and symptoms because of its wide availability and relatively low cost and the lack of a need for sedation or anesthesia. CT or MRI is typically required for more thorough characterization of the mass and surgical planning. Complete characterization of pancreatic masses includes assessment of vascular involvement, local invasion, and extrapancreatic spread of tumor. The authors provide an up-to-date comprehensive review of the clinical manifestations, histopathologic features, and imaging findings of primary and secondary tumors of the pancreas in children and young adults. Advances in imaging, current prognostic information, and treatment paradigms also are highlighted. Finally, nontumorous masslike lesions of the pediatric pancreas, including vascular malformations, cystic disorders (eg, von Hippel-Lindau syndrome, cystic fibrosis), intrapancreatic accessory spleen, and autoimmune pancreatitis, are discussed. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Lisa Qiu
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Andrew T Trout
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Rama S Ayyala
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sara Szabo
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jaimie D Nathan
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - James I Geller
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jonathan R Dillman
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
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11
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Mahajan P, Casanova M, Ferrari A, Fordham A, Trahair T, Venkatramani R. Inflammatory myofibroblastic tumor: molecular landscape, targeted therapeutics, and remaining challenges. Curr Probl Cancer 2021; 45:100768. [PMID: 34244015 DOI: 10.1016/j.currproblcancer.2021.100768] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor of intermediate malignant potential that predominantly affects children, adolescents and young adults. IMT has a predilection for the lung, abdomen, pelvis, and retroperitoneum, however, can affect any part of the body. IMT is typically localized, and multifocal or metastatic disease is uncommon. Complete surgical resection is the treatment of choice when feasible. There is no established standard of care for unresectable and advanced IMT. Approximately half of IMTs harbor anaplastic lymphoma kinase (ALK) gene rearrangements, and fusions involving ROS1, PDGFRβ, RET and NTRK have also been described. Given the molecular landscape of IMT, management of these tumors has evolved to include tyrosine kinase inhibitors and novel targeted therapeutics. This review highlights the molecular characteristics, evolution of targeted therapies and the remaining challenges in the management of IMT.
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Affiliation(s)
- Priya Mahajan
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Ashleigh Fordham
- Children's Cancer Institute, C25 Lowy Cancer Research Centre, UNSW Sydney New South Wales, Australia
| | - Toby Trahair
- Children's Cancer Institute, C25 Lowy Cancer Research Centre, UNSW Sydney New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, UNSW Medicine, New South Wales, Australia
| | - Rajkumar Venkatramani
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas.
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12
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Anaplastic lymphoma receptor tyrosine kinase-negative inflammatory myofibroblastic tumor of triceps brachii: Case report. Jt Dis Relat Surg 2020; 31:605-609. [PMID: 32962596 PMCID: PMC7607928 DOI: 10.5606/ehc.2020.74662] [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: 11/29/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a non-neoplastic benign lesion comprising various inflammatory cells, including myofibroblasts and vascular tissues. It is a rare tumor that sometimes shows similar signs and progression as malignant tumors. The anatomical sites of IMTs include the lungs, liver, orbit, skin, mesentery, and maxillary sinus, but they rarely occur in the limb musculoskeletal system. To our knowledge, no case of neurological symptoms caused by the tumor in the triceps brachii muscle has been reported. In this article, we report the case of a 42-year-old male patient with an IMT that grew rapidly in the triceps brachii muscle and consequently caused symptoms of ulnar nerve lesion owing to its increasing size. The patient showed no ulnar nerve lesion symptoms after undergoing wide excision and was diagnosed with anaplastic lymphoma receptor tyrosine kinase- negative IMT.
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13
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Baldi GG, Brahmi M, Lo Vullo S, Cojocaru E, Mir O, Casanova M, Vincenzi B, De Pas TM, Grignani G, Pantaleo MA, Blay JY, Jones RL, Le Cesne A, Frezza AM, Gronchi A, Collini P, Dei Tos AP, Morosi C, Mariani L, Casali PG, Stacchiotti S. The Activity of Chemotherapy in Inflammatory Myofibroblastic Tumors: A Multicenter, European Retrospective Case Series Analysis. Oncologist 2020; 25:e1777-e1784. [PMID: 32584482 DOI: 10.1634/theoncologist.2020-0352] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aimed to review the activity of cytotoxic chemotherapy in patients with inflammatory myofibroblastic tumors (IMTs) treated at nine European sarcoma reference centers. MATERIALS AND METHODS Patients of any age, with histologically proven IMT, treated with anthracycline-based methotrexate plus/minus vinorelbine/vinblastine (MTX-V) or other chemotherapeutic regimens between 1996 and 2018 were retrospectively reviewed. Diagnosis was confirmed at the local level by an expert pathologist. Response was retrospectively assessed by local investigators by RECIST v1.1. Progression-free survival (PFS), relapse-free survival (RFS), and overall survival (OS) were computed by Kaplan-Meier method. RESULTS Thirty-eight patients were included. Twenty-five patients (8 localized, 17 advanced disease) received an anthracycline-based regimen; 21 were evaluable for response. Overall response rate (ORR) was 10/21 (47.6%). At a 70.8-month median follow-up (FU), median RFS and median OS were not reached (NR) in patients with localized disease; median PFS and median OS were 6.3 (interquartile range [IQR]: 1.9-13.4) and 21.2 (IQR: 7.7-40.7) months in patients with advanced disease. Thirteen patients received MTX-V (4 localized, 9 advanced disease), all evaluable for response. ORR was 7/13 (53.8%). At a 56.6-month median FU, median RFS and median OS were 42.5 (IQR: 12.9-61.2) months and NR (no death events) in patients with localized disease, and NR (IQR: 24.9 to NR) and 83.4 months (IQR: 83.4 to NR) in patients with advanced disease. In the "other-regimens group," responses were seen in 3/4 patients treated with oral cyclophosphamide and 1/2 with docetaxel/gemcitabine. CONCLUSION Anthracycline-based and MTX-V regimens are very effective in IMT, with a similar ORR in both groups. MTX-V achieved a prolonged disease control. Responses were also seen with oral cyclophosphamide and docetaxel/gemcitabine, but few patients were treated with these schedules. IMPLICATIONS FOR PRACTICE Inflammatory myofibroblastic tumor (IMT) is an ultrarare sarcoma with known sensitivity to anaplastic lymphoma kinase (ALK) inhibitors in ALK-fused cases, although ALK inhibitors are not licensed in the disease. The current knowledge on the activity of cytotoxic chemotherapy is limited. This multi-institutional retrospective study on pediatric and adult patients with IMT shows that cytotoxic chemotherapy, and in particular anthracycline-based and methotrexate plus/minus vinorelbine/vinblastine regimens, represents a treatment option and can be considered in IMT patients irrespectively from ALK status. This study provides a benchmark for future studies on new medical therapies.
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Affiliation(s)
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Cojocaru
- Sarcoma Unit, Royal Marsden NHS Foundation Trust/ Institute of Cancer Research, Chelsea, London, United Kingdom
| | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Tommaso Martino De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Maria Abbondanza Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Jean Yves Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - Robin Lewis Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust/ Institute of Cancer Research, Chelsea, London, United Kingdom
| | - Axel Le Cesne
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anna Maria Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology and Paediatric Pathology Unit, Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
Urothelial pediatric neoplasms are relatively rare. Papillary urothelial neoplasms of low malignant potential (PUNLMPs) and rhabdomyosarcoma (RMS) are the most common bladder malignancies in the pediatric population. Clinical presentation encompasses macroscopic hematuria or lower urinary tract symptoms (or both) or is detected incidentally at imaging. Tumors arising from the bladder can originate from any of its four histological layers (urothelium, lamina propria, detrusor, and adventitia) and are divided into tumors that have an epithelial origin (arising from the urothelium) and those that have a non-epithelial origin (mesenchymal neoplasms). RMS is the most common malignant tumor of the urinary bladder in children younger than 10 years. Deriving from the embryonic mesenchymal cell, the histopathologic subtypes of RMS are embryonal RMS (>90%) and alveolar histology (<10%). Pre-treatment imaging should be carried out by computed tomography (CT) or at present is more likely with magnetic resonance imaging of the pelvis. Chest CT and bone scintigraphy are used to screen for metastases. In selected cases, a positron emission tomography scan may be recommended to evaluate suspicious lesions. The current prognostic classification considers age, histologic subtype, tumor site, size, and extent (nodal or distant metastases). Staging is based on pre-operative findings, group is based on intra-operative findings and pathology, and risk stratification is derived from both stage and group data. Pre-operative chemotherapy is the most common first-line intervention for bladder/prostate RMS, before surgery or radiation therapy. Collaborative groups such as the Soft Tissue Sarcoma Committee of the Children’s Oncology Group and the European Pediatric Soft Tissue Sarcoma Study Group endorse this therapy. PUNLMPs are generally solitary, small (1–2 cm), non-invasive lesions that do not metastasize. Therapy is usually limited to a transurethral resection of the bladder tumor. About 35% are recurrent and around 10% of them increase in size if they are not treated.
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Affiliation(s)
- Roberto Iglesias Lopes
- Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, 05402-000, Brazil
| | - Marcos Figueiredo Mello
- Pediatric Urology Unit, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, 05402-000, Brazil
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON, Canada
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15
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Kube S, Vokuhl C, Dantonello T, Scheer M, Hallmen E, Feuchtgruber S, Escherich G, Niggli F, Kuehnle I, von Kalle T, Bielack S, Klingebiel T, Koscielniak E. Inflammatory myofibroblastic tumors-A retrospective analysis of the Cooperative Weichteilsarkom Studiengruppe. Pediatr Blood Cancer 2018; 65:e27012. [PMID: 29480552 DOI: 10.1002/pbc.27012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are a rare subgroup of soft tissue tumors. The outcome of patients with IMT has been reported as favorable when the tumor is completely resected. If surgical resection is not possible, systemic therapy has to be considered. However, the best systemic treatment and response rates are currently unclear. METHODS Thirty-eight patients under the age of 21, who were registered between 2000 and 2014 with a primary diagnosis of IMT, were analyzed. RESULTS IMT was typically localized intra-abdominally or in the pelvis. In 20 patients, the tumor was resected without further therapy; 17 patients were in complete remission at last evaluation and two patients were in partial remission. Eighteen patients received systemic therapy, 15 of whom had macroscopically incomplete resection. Systemic therapy most commonly consisted of regimens with dactinomycin, ifosfamide or cyclophosphamide, and vincristine, with or without doxorubicin, and it seemed to reduce tumor extension in individual cases. Five-year event-free survival was 74 ± 14% and 5-year overall survival was 91 ± 10% for all patients. The patients who died due to the disease were those with incomplete resection (n = 3). CONCLUSIONS Surgery without further systemic therapy was a feasible and acceptable therapeutic option for every second patient with IMT. Standard chemotherapy for pediatric soft tissue sarcoma produced favorable results in individual cases and was able to shrink the tumor enough to enable resection. Superior efficacy of new targeted therapies such as anaplastic lymphoma kinase-inhibitors compared to standard chemotherapy has to be proven in the future.
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Affiliation(s)
- Stefanie Kube
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Christian Vokuhl
- Kiel Pediatric Tumor Registry, Department of Pediatric Pathology, University of Kiel, Kiel, Germany
| | - Tobias Dantonello
- Pediatrics 3 (Cardiology, Intensive Care Medicine, Pulmonology, and Allergology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Monika Scheer
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Erika Hallmen
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Simone Feuchtgruber
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Gabriele Escherich
- Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, University Children's Hospital, Zürich, Switzerland
| | - Ingrid Kuehnle
- Department of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Thekla von Kalle
- Department of Pediatric Radiology, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Thomas Klingebiel
- Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt am Main, Germany
| | - Ewa Koscielniak
- Pediatrics 5 (Oncology, Hematology, and Immunology), Stuttgart Cancer Center, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
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16
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sultana J. Inflammatory Myofibroblastic Tumour, an Unusual Presentation in Maxilla and Paranasal Sinuses: Review of Literature and a Case Report. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/jdhodt.2017.08.00277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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18
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Özbalak M, Torun ES, Özdemirli M, Uçar AR, Akpınar TS, Taşçıoğlu C, Ferhanoğlu B. Inflammatory myofibroblastic tumor mimicking a relapse in a patient with Hodgkin's lymphoma: report of an unusual case and review of the literature. Clin Case Rep 2017; 5:945-949. [PMID: 28588845 PMCID: PMC5458016 DOI: 10.1002/ccr3.976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/15/2016] [Accepted: 03/24/2017] [Indexed: 11/08/2022] Open
Abstract
New PET-positive lesions in previously treated patients with lymphomatous malignancies need further investigations. Relapse, sarcoidosis and secondary malignancies are the most important differential diagnosis. Inflammatory myofibroblastic tumors (IMT) is a rare complication after treatment of Hodgkin's disease and every PET-positive lesion should be biopsied to prevent unnecessary intervention.
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Affiliation(s)
- Murat Özbalak
- Istanbul University Cerrahpaşa Medical Faculty Department of Internal Medicine Istanbul Turkey
| | - Ege Sinan Torun
- Istanbul University Istanbul Medical Faculty Department of Internal Medicine Istanbul Turkey
| | - Metin Özdemirli
- Georgetown University Hospital Department of Pathology Washington DC
| | - Ali Rıza Uçar
- Istanbul University Istanbul Medical Faculty Department of Internal Medicine Istanbul Turkey
| | - Timur Selçuk Akpınar
- Istanbul University Istanbul Medical Faculty Department of Internal Medicine Istanbul Turkey
| | - Cemil Taşçıoğlu
- Istanbul University Istanbul Medical Faculty Department of Internal Medicine Istanbul Turkey
| | - Burhan Ferhanoğlu
- Koç University School of Medicine Department of Internal Medicine Division of Hematology Istanbul Turkey
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19
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Neoadjuvant Treatment With Cyclooxygenase-2 Inhibitor and Prednisolone Allows Conservative Surgery for Inflammatory Myofibroblastic Tumor of the Bladder. J Pediatr Hematol Oncol 2016; 38:e283-e285. [PMID: 27322717 DOI: 10.1097/mph.0000000000000604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT), which expresses cyclooxygenase-2 (COX-2), can be effectively treated with COX-2 inhibitor. Here, we report a case of urinary bladder IMT in a 13-year-old boy. Although total cystectomy was initially planned for complete resection of the tumor, neoadjuvant treatment with COX-2 inhibitor and prednisolone reduced the size of the tumor and enabled complete resection of the tumor by partial cystectomy. Neoadjuvant treatment with COX-2 inhibitor and prednisolone for IMT of the bladder allowed a more conservative surgical procedure that preserved bladder function.
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20
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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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21
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Saoud M, Patil M, Dhillon SS, Pokharel S, Picone A, Hennon M, Yendamuri S, Harris K. Rare airway tumors: an update on current diagnostic and management strategies. J Thorac Dis 2016; 8:1922-34. [PMID: 27621844 DOI: 10.21037/jtd.2016.07.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Marwan Saoud
- Department of Medicine, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA
| | - Monali Patil
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA
| | - Samjot Singh Dhillon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA;; Department of Medicine, Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Saraswati Pokharel
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Anthony Picone
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Mark Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA;; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA;; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kassem Harris
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Buffalo, New York, USA;; Department of Medicine, Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, New York, USA
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22
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Etani T, Naiki T, Nagai T, Iida K, Ando R, Naiki-Ito A, Kawai N, Tozawa K, Mizuno K, Okada A, Mogami T, Yasui T. Inflammatory Myofibroblastic Tumor of the Urinary Bladder: A Case Report. Case Rep Oncol 2016; 9:464-469. [PMID: 27721769 PMCID: PMC5043250 DOI: 10.1159/000448550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 11/19/2022] Open
Abstract
An inflammatory myofibroblastic tumor (IMT) is a distinctive neoplasm composed of myofibroblastic and fibroblastic spindle cells, accompanied by inflammatory infiltration of plasma cells, lymphocytes, and eosinophils. IMTs rarely occur in the urinary bladder. It is important to distinguish this tumor from other malignant spindle cell tumors. Herein, we report a patient with an IMT showing muscle invasion, who underwent a transurethral resection of the bladder tumor and, at a later date, partial cystectomy. The resected tumor specimen revealed a proliferation of spindle-shaped cells on a background of plasma cells and lymphocytes. Immunohistochemical staining showed the tumor to be positive for anaplastic lymphoma kinase (ALK), smooth muscle actin, and vascular endothelial growth factor (VEGF). Such histopathological findings were indicative of an IMT, suggesting the use of inhibitors of ALK and VEGF as pharmacotherapy.
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Affiliation(s)
- Toshiki Etani
- Department of Urology, JA Mie Komono Kosei Hospital, Komono, Japan; Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Takashi Nagai
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Keitaro Iida
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Aya Naiki-Ito
- Department of Experimental Pathology and Tumor Biology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Kentaro Mizuno
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
| | - Tohru Mogami
- Department of Urology, JA Mie Komono Kosei Hospital, Komono, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya City, Japan
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23
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Ding D, Bu X, Tian F. Inflammatory myofibroblastic tumor in the head of the pancreas with anorexia and vomiting in a 69-year-old man: A case report. Oncol Lett 2016; 12:1546-1550. [PMID: 27446468 DOI: 10.3892/ol.2016.4787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/21/2016] [Indexed: 12/23/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare condition of unclear etiology that is commonly observed in the lung but rarely in the pancreas. WHO classified IMT as a potentially malignant or aggressive tumor. In the present report, the case of a 69-year-old male patient with an IMT in the head of the pancreas, who experienced anorexia, nausea and vomiting, is presented. The patient's clinical symptoms were nonspecific, and the imaging findings revealed a hypovascularized pancreatic mass with stenosis of the descending duodenum. The electronic endoscopy findings revealed protruding lesions in the duodenal bulb and the descending duodenum. Biopsies of the mass were conducted with an electronic endoscope, but were not diagnostic. Subsequent duodenopancreatectomy aided in determining a pathological diagnosis of IMT, based on the histology and immunohistochemistry results. The patient experienced a recovery without further incident, as observed during a regular follow-up 3 years later. IMT in the head of the pancreas is rare, particularly in adults. In the present study, an extremely rare case of IMT involving the head of the pancreas in an adult patient is presented, and the therapeutic options for this condition are discussed.
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Affiliation(s)
- Ding Ding
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xianmin Bu
- Department of Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Feng Tian
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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24
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Pneumonectomy-Sparing NSAID Therapy for Pulmonary Inflammatory Myofibroblastic Tumor. J Thorac Oncol 2016; 10:e89-e90. [PMID: 26291018 DOI: 10.1097/jto.0000000000000574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Deepak J, Aravind KL, Gowrishankar, Ramesh S. A Case of Rare Small Bowel Tumor in a Child and Review of Literature. Indian J Surg Oncol 2016; 6:292-5. [PMID: 27217683 DOI: 10.1007/s13193-015-0417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 05/19/2015] [Indexed: 01/25/2023] Open
Affiliation(s)
- J Deepak
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India ; No.1247, 8th cross, Chandra layout, Vijayanagar Bangalore, 560040 India
| | - K L Aravind
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| | - Gowrishankar
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
| | - S Ramesh
- Department of Pediatric Surgery, South Hospital Complex, Dharmaram College Post, Indira Gandhi Institute of Child Health, Near NIMHANS, Bangalore, 560029 India
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26
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[Abdominal inflammatory myofibroblastic tumor]. Arch Pediatr 2016; 23:210-2. [PMID: 26724981 DOI: 10.1016/j.arcped.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 10/29/2015] [Accepted: 11/13/2015] [Indexed: 11/21/2022]
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27
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Xu LF, Zhou J, Liang CZ. Inflammatory Myofibroblastic Tumor of Genitourinary Tract Beyond Collecting System: A Rare Case Report With Literature Review. Medicine (Baltimore) 2015; 94:e1706. [PMID: 26496281 PMCID: PMC4620822 DOI: 10.1097/md.0000000000001706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) rarely arises in genitourinary tract especially beyond collecting system, which determines the unspecific clinic symptoms and sometimes can mimic malignancy. Therefore, IMT's diagnosis may usually be a pitfall. This case report characterizes a 35-year-old woman with a history of lower quadrant lasting pain followed by fever. Furthermore, radiologic examinations revealed that there were 2 lesions located in left adrenal area and left renalis. Owing to the anatomic complexity, the surgical resection was not complete. The pathologic diagnosis of the lesions was IMT. Adjuvant nonsteroids anti-inflammatory drugs were administrated after the operation. The symptoms were controlled finally and no further growing lesion was observed during a 1-year follow-up.Inflammatory myofibroblastic tumor is rare in genitourinary tract beyond the collecting system. Diagnosis should be based on histopathology. Presently, the authors report this rare case with the aim to share the experience regarding differential diagnosis and therapy.
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Affiliation(s)
- Ling-Fan Xu
- From the Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China (LFX, JZ, C-ZL)
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Collin M, Charles A, Barker A, Khosa J, Samnakay N. Inflammatory myofibroblastic tumour of the bladder in children: a review. J Pediatr Urol 2015; 11:239-45. [PMID: 25982020 DOI: 10.1016/j.jpurol.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/30/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumours of the bladder (IMTB) are rare, and feature a benign and reactive proliferation of myofibroblasts. 25% of the reported IMTB cases in the literature occur in children. The present study presents a review of IMTB in children. DISCUSSION The data from 42 reported cases of paediatric IMTB in the world literature are summarised, including two recent cases from the present centre. Paediatric IMTB equally affects males and females. It mainly presents with haematuria, dysuria or abdominal pain. Lesions can vary in size, but mean size is 5.5 cm. Mean age is 7.5 years. The aetiology of IMTB is poorly understood, but includes infective or traumatic aetiologies, or a possible clonal lesion. IMTB may specifically show clonal gene rearrangements involving the anaplastic lymphoma kinase (ALK-1) gene. To differentiate IMTB from rhabdomyosarcoma, tissue diagnosis and careful histological analysis are essential. Tumour biopsy can be achieved by a transurethral approach or a transcutaneous approach with ultrasound guidance. Between 35 and 89% of cases of IMTB express ALK-1 by immunohistochemistry. ALK-1 expression is much less common in other bladder soft tissue tumours. ALK-1 is thus useful in the diagnosis of IMTB. The treatment of choice for IMTB is complete surgical resection of the lesion. In children, no proven recurrent or metastatic IMTB episodes are reported after excision. However IMTB recurrences are reported in adults, likely due to incomplete excision. Follow-up after excision is therefore recommended. CONCLUSIONS Paediatric IMTB is uncommon. Tissue biopsy is essential for diagnosis. Careful histological assessment is required to differentiate IMTB from malignant paediatric bladder tumours such as rhabdomyosarcoma. ALK-1 expression is useful in confirming the diagnosis of IMTB. Treatment of choice is complete surgical resection of the lesion. Recurrence is reported in adult IMTB. Follow-up is therefore recommended.
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Affiliation(s)
- Michael Collin
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia, 6008, Australia.
| | - Adrian Charles
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia, 6008, Australia.
| | - Andrew Barker
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia, 6008, Australia.
| | - Japinder Khosa
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia, 6008, Australia.
| | - Naeem Samnakay
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia, 6008, Australia; University of Western Australia, Hackett Drive, Nedlands, Western Australia 6009, Australia.
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Inadomi K, Kumagai H, Takayoshi K, Ariyama H, Kusaba H, Nishie A, Yamamoto H, Takase K, Tanaka M, Sagara K, Okumura Y, Nio K, Nakano M, Arita S, Oda Y, Akashi K, Baba E. Successful combination chemotherapy for metastatic inflammatory myofibroblastic tumor: A case report. Oncol Lett 2015; 10:2981-2985. [PMID: 26722275 DOI: 10.3892/ol.2015.3708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 05/29/2015] [Indexed: 12/21/2022] Open
Abstract
A 64-year-old male presented with increased abdo-minal fullness and fever. Radiological examination revealed moderate ascites, a tumor with a diameter of 12.5 cm in the mesenteric region, as well as multiple tumors in the thoracic and abdominal para-aortic regions and in the left supraclavicular regions. Pathohistological findings of the biopsy specimen revealed atypical spindle cells accompanied by infiltration of lymphocytes. The plasmacytes were positive for CD68, murine double minute 2 and S-100, while they were negative for α-smooth muscle actin, cyclin-dependent kinase 4 and anaplastic lymphoma kinase. Clinically, the patient presented systemic symptoms and laboratory results indicated an elevation in the inflammatory response, while the CT and MRI findings were consistent with an inflammatory myofibroblastic tumor (IMT). Based on the clinical and histological findings, the patient was diagnosed with IMT. In total, 4 cycles of combination chemotherapy with doxorubicin and ifosfamide were administered. Tumor size reduction by 50% was achieved subsequent to the 4th chemotherapy cycle. In conclusion, successful control of this rare metastatic IMT was achieved by systemic chemotherapy.
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Affiliation(s)
- Kyoko Inadomi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Hozumi Kumagai
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kotoe Takayoshi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Hiroshi Ariyama
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Hitoshi Kusaba
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Akihiro Nishie
- Department of Clinical Radiology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ken Takase
- Department of Hematology, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
| | - Mamoru Tanaka
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kosuke Sagara
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yuta Okumura
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kenta Nio
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Michitaka Nakano
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Shuji Arita
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Koichi Akashi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Fraggetta F, Doglioni C, Scollo P, Pecciarini L, Ippolito M, Amico P, Pelosi G, Ponzoni M. Uterine Inflammatory Myofibroblastic Tumor in a 10-Year-Old Girl Presenting As Polypoid Mass. J Clin Oncol 2015; 33:e7-e10. [DOI: 10.1200/jco.2013.48.8304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Özgül MA, Toru Ü, Acat M, Özgül G, Çetinkaya E, Dinçer HE, Omaygenç DÖ, Ürer HN. A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment. Respir Med Case Rep 2014; 13:57-60. [PMID: 26029563 PMCID: PMC4246357 DOI: 10.1016/j.rmcr.2014.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.
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Affiliation(s)
- Mehmet Akif Özgül
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, İstanbul 34020, Turkey
| | - Ümran Toru
- Dumlupınar University Faculty of Medicine, Department of Chest Diseases, Kütahya 43100, Turkey
| | - Murat Acat
- Karabük University Faculty of Medicine, Department of Chest Diseases, Karabük 78050, Turkey
| | - Güler Özgül
- Bağcılar Education and Research Hospital, Department of Chest Diseases, İstanbul 34200, Turkey
| | - Erdoğan Çetinkaya
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, İstanbul 34020, Turkey
| | - H Erhan Dinçer
- University of Minnesota Division of Pulmonary, Allergy, Sleep and Critical Care, MN OH 43210, United States
| | - Derya Özden Omaygenç
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, İstanbul 34020, Turkey
| | - Halide Nur Ürer
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pathology, İstanbul 34020, Turkey
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Eilers AL, Nazarullah AN, Shipper ES, Jagirdar JS, Calhoon JH, Husain SA. Cardiac Inflammatory Myofibroblastic Tumor. World J Pediatr Congenit Heart Surg 2014; 5:556-64. [DOI: 10.1177/2150135114546203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although inflammatory myofibroblastic tumors (IMTs) can be found in virtually every major organ, cardiac origin is rare. After recently providing care to a child who presented with a significant myocardial infarction, interest in this rare tumor was piqued. We describe a comprehensive review of cardiac IMT, including information on nomenclature, epidemiology, clinical features, pathogenesis, gross/histological features, immunohistochemical profile, diagnosis, treatment, and prognosis. Fifty-seven cases were identified in the literature. Interestingly, our case represents the seventh case of coronary artery involvement reported. Moreover, it was found that an initial presentation of sudden death most commonly involves the coronary arteries.
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Affiliation(s)
- Amanda L. Eilers
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alia N. Nazarullah
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Edward S. Shipper
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jaishree S. Jagirdar
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John H. Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S. Adil Husain
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Zhao JJ, Ling JQ, Fang Y, Gao XD, Shu P, Shen KT, Qin J, Sun YH, Qin XY. Intra-abdominal inflammatory myofibroblastic tumor: Spontaneous regression. World J Gastroenterol 2014; 20:13625-13631. [PMID: 25309095 PMCID: PMC4188916 DOI: 10.3748/wjg.v20.i37.13625] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/01/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumors are usually treated by surgical resection. We herein report two cases of intra-abdominal inflammatory myofibroblastic tumors that were unresectable and underwent spontaneous regression without any treatment. Our case report and literature review show that regression is more common in the middle-aged and older male populations. Abdominal discomfort and fever were the most common symptoms, but the majority of patients had no obvious physical signs. There was no specific indicator for diagnosis. The majority of the lesions regressed within 3 mo and nearly all of the masses completely resolved within 1 year. We conclude that the clinical characteristics of inflammatory myofibroblastic tumors are variable and, accordingly, the disease needs to be subdivided and treated on an individual basis. Surgery is always the first-line treatment; however, for those masses assessed as unresectable, conservative therapy with intense follow-up should be considered.
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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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35
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Ferrari A, Alaggio R, Meazza C, Chiaravalli S, de Pava MV, Casanova M, Cavaliere E, Bisogno G. Fibroblastic tumors of intermediate malignancy in childhood. Expert Rev Anticancer Ther 2014; 13:225-36. [DOI: 10.1586/era.12.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Moon CH, Yoon JH, Kang GW, Lee SH, Baek JS, Kim SY, Kim HR, Kim CH. A case of recurrent pulmonary inflammatory myofibroblastic tumor with aggressive metastasis after complete resection. Tuberc Respir Dis (Seoul) 2013; 75:165-9. [PMID: 24265646 PMCID: PMC3833938 DOI: 10.4046/trd.2013.75.4.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/26/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022] Open
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs. It is thought to be a neoplastic or reactive inflammatory condition, controversially. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. The optimal treatment method is not well-known for patients ineligible for surgery. We report a 47-year-old patient with aggressive recurrent IMT of the lungs. The patient had been admitted for an evaluation of back-pain two years after a complete resection of pulmonary IMT. Radiation therapy was performed for multiple bone recurrences, and the symptoms were improved. However the patient presented again with aggravated back-pain six months later. High-dose steroid and non-steroidal anti-inflammatory drugs were administered, but the disease progressed aggressively, resulting in spinal cord compression and metastasis to intra-abdominal organs. This is a very rare case of aggressively recurrent pulmonary IMT with multi-organ metastasis.
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Affiliation(s)
- Chae Ho Moon
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Successful treatment of recurrent pediatric inflammatory myofibroblastic tumor in a single patient with a novel chemotherapeutic regimen containing celecoxib. J Pediatr Hematol Oncol 2013; 35:414-6. [PMID: 23669730 DOI: 10.1097/mph.0b013e3182915cef] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inflammatory myofibroblastic tumors are rare tumors characterized as low-to-intermediate grade sarcomas. This is a case of a 7-year-old male with a 5-cm lung mass, which recurred 11 months after complete resection. The recurrence manifested as multifocal metastatic disease involving the ipsilateral parietal and visceral pleura. A novel chemotherapeutic regimen, which included vincristine, ifosfamide, doxorubicin, and celecoxib was utilized for the disease recurrence. The patient had complete and durable remission of the disease and has been disease-free for >4 years. This novel regimen including a cyclooxygenase 2 inhibitor may be an effective regimen for metastatic inflammatory myofibroblastic tumors.
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38
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Unique clinicopathologic and molecular characteristics of urinary bladder tumors in children and young adults. Urol Oncol 2013; 31:414-26. [DOI: 10.1016/j.urolonc.2010.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/02/2010] [Indexed: 01/22/2023]
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Chavez C, Hoffman MA. Complete remission of ALK-negative plasma cell granuloma (inflammatory myofibroblastic tumor) of the lung induced by celecoxib: A case report and review of the literature. Oncol Lett 2013; 5:1672-1676. [PMID: 23761833 PMCID: PMC3678867 DOI: 10.3892/ol.2013.1260] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/29/2013] [Indexed: 12/14/2022] Open
Abstract
We report a case in which a 52-year-old female developed a multifocal inflammatory myofibroblastic tumor (IMT) of the lung. The tumor did not overexpress the anaplastic lymphoma kinase (ALK) protein, indicating a lack of ALK rearrangement. The patient required two wedge resections in 15 months due to recurrent disease. Recurrence after the second surgery was treated with corticosteroids, which only led to a transient response (6 months). Introduction of celecoxib, a cyclooxygenase-2 inhibitor, induced a complete remission in the patient. Maintenance on celecoxib further led to a progression-free survival of 34 months. A literature review retrieved a total of eight case reports, comprising ten patients, of IMT of various anatomical sites successfully treated with non-steroidal anti-inflammatory agent (NSAID) therapy. Nine of the ten patients achieved durable complete remission. Remission occurred rapidly and persisted even after termination of NSAID therapy. Although such a successful outcome may only be achieved rarely, a trial of an NSAID should be considered in any patient in whom complete resection is not an option. Our case also demonstrates that NSAID therapy may be successful in a non-ALK rearranged tumor in which ALK inhibition is not an option.
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Affiliation(s)
- Cinderella Chavez
- Division of Hematology-Oncology, Department of Medicine, Long-Island Jewish Medical Center, North Shore-LIJ Health System, New Hyde Park, NY 11040, USA
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Liu C, Zhao X, Zhao Z, Lu P, Jin F, Li G. Malignant inflammatory myofibroblastic tumor of the prostate. J Clin Oncol 2013; 31:e144-7. [PMID: 23401456 DOI: 10.1200/jco.2012.44.4851] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Caigang Liu
- First Hospital of China Medical University, Shenyang, China
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Andersen ND, DiBernardo LR, Linardic CM, Camitta MGW, Lodge AJ. Recurrent inflammatory myofibroblastic tumor of the heart. Circulation 2012; 125:2379-81. [PMID: 22586293 DOI: 10.1161/circulationaha.111.066191] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas D Andersen
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Box 3340, Durham, NC 27710, USA
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42
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Kim DY, Park HS, Kim SM, Park JH, Hong YS, Lee JL, Suh C. Inflammatory Myofibroblastic Tumor Showing Durable Remission after Anthracycline-Containing Cytotoxic Chemotherapy: Report of a Case. ACTA ACUST UNITED AC 2012. [DOI: 10.3904/kjm.2012.82.6.749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dal Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han-Seung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Lyun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fragoso AC, Eloy C, Estevão-Costa J, Campos M, Farinha N, Lopes JM. Abdominal inflammatory myofibroblastic tumor a clinicopathologic study with reappraisal of biologic behavior. J Pediatr Surg 2011; 46:2076-82. [PMID: 22075336 DOI: 10.1016/j.jpedsurg.2011.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Inflammatory myofibroblastic tumor (IMT) is a proliferative lesion of controversial nosology and uncertain prognosis. In an attempt to acquire further understanding of pathogenesis and biologic behavior, we surveyed abdominal IMTs managed over the last 12 years at a single institution. METHODS Intra-abdominal IMTs treated between 1995 and 2007 were reviewed concerning demographic, clinical, and pathologic features as well as therapeutic management and outcome. All specimens were reevaluated by histologic examination and immunohistochemistry. RESULTS There were 7 patients (4 males; age range, 28 days to 14 years). Five lesions were located in alimentary tract: 1 gastric presenting with bleeding, 1 hepatic presenting with a thoracic wall mass, 1 pancreatic and 2 colonic presenting with obstructive symptoms. One splenic IMT was found incidentally. The remaining case arose from the adrenal gland and presented with a palpable mass. The gastric and adrenal IMTs had evidence of a previous or concomitant infectious setting. Five lesions were excised. The pancreatic IMT underwent a drainage procedure followed by steroid administration, and the hepatic lesion received antibiotics. Histopathology revealed characteristic findings of IMT. Expression of anaplastic lymphoma kinase was negative in all cases. At a median follow-up of 6 years (range, 3-15), all children were asymptomatic with no recurrences. The hepatic and pancreatic IMT displayed complete and near total regression, respectively. CONCLUSION A benign behavior of abdominal IMTs was observed even in patients not undergoing surgical excision. Although IMT remains a surgical disease, a conservative approach may be reasonable in select cases.
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Affiliation(s)
- Ana Catarina Fragoso
- Division of Pediatric Surgery, Faculty of Medicine, University of Porto, Hospital S. João, 4200-319 Porto, Portugal
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Diop B, Konate I, Ka S, Sall I, Fall D, Dieng M, Wone Y. Mesenteric myofibroblastic tumor: NSAID therapy after incomplete resection. J Visc Surg 2011; 148:e311-4. [PMID: 21872549 DOI: 10.1016/j.jviscsurg.2011.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Myofibroblastic tumors are inflammatory tumors that arise in viscera and soft tissue; their etiopathology is poorly understood. They are capable of infiltration of adjacent organs, local recurrence after surgical resection, and even of distant metastasis. These characteristics result in persistent debate as to the nature of these lesions - whether they are inflammatory or neoplastic, benign or malignant lesions? Diagnosis is almost always made based on histopathological findings. Traditional management is complete surgical excision, but this may be difficult or impossible when the lesion develops in proximity to vital structures. We report the case of a 59-year-old man who was treated in our institution for mesenteric myofibroblastic tumor. Complete resection was not possible due to local infiltration of the mesentery. Recurrence was noted 3 months after surgery; treatment with steroidal and then non-steroidal anti-inflammatory medications (NSAIDs) resulted in clinical and radiologic regression of the tumor.
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Affiliation(s)
- B Diop
- Service de chirurgie, hôpital militaire de Ouakam, Dakar, Senegal.
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Shatzel J, Wooten K, Ankola A, Cheney RT, Morrison CD, Skitzki JJ. Inflammatory myofibroblastic tumor of the mesentery: a clinical dilemma. Int J Clin Oncol 2011; 17:380-4. [PMID: 21823041 DOI: 10.1007/s10147-011-0297-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/18/2011] [Indexed: 12/31/2022]
Abstract
Although rare, extra-pulmonary inflammatory myofibroblastic tumors (IMTs) are becoming increasingly recognized. While surgical resection is currently an effective and accepted treatment for IMTs, the optimal management of unresectable or residual IMTs remains a clinical dilemma. We present the case of an incompletely resected IMT treated successfully with anti-inflammatory therapy alone, and describe the rationale for this approach.
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Affiliation(s)
- Joseph Shatzel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Zhou X, Luo C, Lv S, Gan M. Inflammatory myofibroblastic tumor of the rectum in a 13-month-old girl: a case report. J Pediatr Surg 2011; 46:E1-4. [PMID: 21763818 DOI: 10.1016/j.jpedsurg.2011.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/05/2011] [Accepted: 03/11/2011] [Indexed: 12/17/2022]
Abstract
Inflammatory myofibroblastic tumor is a rare benign neoplasm. It is common in children and has been reported in various locations throughout the body but rarely in the rectum. A 13-month-old girl presented with a short history of a painless anal mass and no hematochezia. The mass was completely excised, and histologic examination of the initial biopsy showed fascicles of spindle cells in a mixed inflammatory background with predominance of plasma cells, typical of an inflammatory pseudotumor. The spindle cells were positive for smooth muscle actin and anaplastic lymphoma kinase staining. There is no evidence of recurrence or metastasis after a follow-up of 4.5 years.
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Affiliation(s)
- Xuewu Zhou
- Department of Pediatric Surgery, Taizhou Hospital, Zhejiang Province, China.
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[Guidelines for management of localized inflammatory myofibroblastic tumours in children]. Bull Cancer 2011; 98:209-16. [PMID: 21382773 DOI: 10.1684/bdc.2011.1311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND METHODOLOGY The paediatric rare tumours group from the Société française des cancers de l'enfant makes syntheses and guidelines for diagnosis and treatment for localized paediatric inflammatory myofibroblastic tumours according to international articles. MAIN UPDATING All ages are concerning. Localizations are ubiquitous, more frequently in the superior and inferior airway. Histology showed a majority of fusiform cells, corresponding to myofibroblastic cells and an inflammatory infiltrate. Inflammatory myofibroblastic tumour diagnosis should only be confirmed in the absence of sarcoma molecular markers. CONCLUSIONS Distinction between inflammatory myofibroblastic tumour and sarcoma is essential due to the different care. The curative treatment of inflammatory myofibroblastic tumour consists on surgery with before or after corticotherapy. In case of unresectability, chemotherapy may be helpful to avoid mutilating surgery.
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Bertocchini A, Lo Zupone C, Callea F, Gennari F, Serra A, Monti L, de Ville de Goyet J. Unresectable multifocal omental and peritoneal inflammatory myofibroblastic tumor in a child: revisiting the role of adjuvant therapy. J Pediatr Surg 2011; 46:e17-e21. [PMID: 21496520 DOI: 10.1016/j.jpedsurg.2011.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/09/2010] [Accepted: 01/05/2011] [Indexed: 01/25/2023]
Abstract
Inflammatory myofibroblastic tumor is an uncommon lesion, also called pseudotumor, with a variable natural course from benign with spontaneous regression to mimicking malignant tumors. We report a case of diffuse peritoneal and omental pseudotumor in a 10-year-old boy characterized by aggressive behavior at the onset followed by stability after subtotal resection and chemotherapy. Total excision was not possible because of the tumor dissemination over the whole peritoneal surface. Adjuvant antiinflammatory drug (ketorolac tromethamine) and chemotherapy (methotrexate-vinblastine followed by ifosfamide-adriamycin and ifosfamide alone) were helpful to obtain rapidly complete resolution of clinical symptoms and anatomic stability of the residual lesions. Long-term evolution, in the absence of continued therapy, has been characterized by progressive involution and reduction of the residual masses.
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Affiliation(s)
| | - Cristina Lo Zupone
- Hepatobiliary Radiology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Francesco Callea
- Pathology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Fabrizio Gennari
- Liver Surgery Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Annalisa Serra
- Oncology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Lidia Monti
- Hepatobiliary Radiology Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy
| | - Jean de Ville de Goyet
- Liver Surgery Unit, Bambino Gesù Children's Hospital, Rome - 00165, Italy; Paediatric surgery, University of Roma Tor Vergata, Roma - 00133, Italy.
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Colangelo M, Di Renzo D, Persico A, Chiesa PL. Case report: Inflammatory myofibroblastic tumor of pancreatic origin in a patient with down syndrome: The role of diagnostic ultrasound. J Ultrasound 2010; 14:7-9. [PMID: 23396992 DOI: 10.1016/j.jus.2010.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) is a benign solid tumor of uncertain etiology. MATERIALS AND METHODS We report a case of a 4-year-old Down syndrome affected child, who had a pancreatic mass identified by ultrasonography (US) and confirmed by computed tomography (CT). RESULTS Monitoring of IMT was performed by serial US studies, and at follow-up after 4 years there was no relapse. DISCUSSION As radical removal of the lesion was not possible, the patient was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs). It was decided to monitor the lesion by serial US in order to reduce the number of CT examinations and thereby avoid excessive exposure to ionizing radiation. It is widely reported in the literature that repeated CT scans are associated with increased exposure to radiation which may cause cancer, a fact which should not be overlooked in children.
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Affiliation(s)
- M Colangelo
- Pediatric Surgical Unit, "G. d'Annunzio" University of Chieti, "Spirito Santo" Hospital of Pescara, Italy
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