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Zheng Y, Zhao F, Ren Y, Xue Y, Yan B, Huang C. A case report: Pathological complete response to neoadjuvant lorlatinib for Epithelioid inflammatory myofibroblastic sarcoma with EML4-ALK rearrangement. Front Pharmacol 2024; 15:1401428. [PMID: 39144623 PMCID: PMC11321957 DOI: 10.3389/fphar.2024.1401428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare tumor originating from mesenchymal tissue. Epithelioid inflammatory myofibroblastic sarcoma (EIMS) represents a rare and particularly aggressive variant, associated with a worse prognosis. Almost all EIMS cases exhibits activating anaplastic lymphoma kinase (ALK) gene rearrangements, which suggests that EIMS patients may potentially benefit from treatment with ALK tyrosine kinase inhibitors (TKIs). We presented a case involving a 34-year-old woman who was diagnosed with mediastinal EIMS and had a rare echinoderm microtubule-associated protein-like 4 (EML4) -ALK fusion. Following 15 months of neoadjuvant lorlatinib treatment, the patient underwent a complete surgical resection, resulting in a pathological complete response. Given the heightened risk of postoperative recurrence associated with EIMS, the patient's treatment plan included ongoing adjuvant therapy with lorlatinib. As of the present moment, the patient has achieved an overall survival of over 2 years with no observed tumor recurrence. Consequently, the case offers valuable clinical evidence supporting the potential benefits of neoadjuvant lorlatinib treatment for ALK-positive locally mediastinal EIMS patients, with a demonstrated tolerable safety profile.
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Affiliation(s)
- Yang Zheng
- Department of Thoracic Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Fanfei Zhao
- Department of Thoracic Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yaqian Ren
- Department of Thoracic Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yaran Xue
- Department of Oncology, Tianjin Fourth Central Hospital, Tianjin, China
| | - Bing Yan
- Department of Precision Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Chun Huang
- Department of Thoracic Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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2
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Özkan M. Pulmonary tumors in childhood. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S73-S77. [PMID: 38584790 PMCID: PMC10995685 DOI: 10.5606/tgkdc.dergisi.2024.25863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 04/09/2024]
Abstract
Pulmonary tumors in childhood are rare, but the majority are malignant. The histopathologic spectrum is quite diverse, including inflammatory myofibroblastic tumor, hamartoma, primary pulmonary paraganglioma, carcinoid tumor, mucoepidermoid carcinoma, pleuropulmonary blastoma, adenocarcinoma, squamous cell carcinoma, and sarcomas. Nonspecific clinical and radiological findings result in late and incorrect diagnoses. Although surgical resection is the initial and proper treatment method, additional adjuvant therapy is dependent on both tumor stage and histopathologic type.
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Affiliation(s)
- Murat Özkan
- Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
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3
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Chanthong S, Sathitsamitphong L, Natesirinilkul R, Charoenkwan P, Suwansirikul S, Choed-Amphai C. Treatment modalities of ALK-positive relapsed/refractory inflammatory myofibroblastic tumor of the brain and lungs in 7-year-old girl: case-based reviews. Childs Nerv Syst 2023; 39:331-342. [PMID: 36515740 DOI: 10.1007/s00381-022-05789-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Inflammatory myofibroblastic tumor (IMT) belongs to mesenchymal neoplasm of intermediate malignancy in WHO classification. Primary CNS disease or CNS metastases (CNS-IMT) occur in minority. We describe a case of relapsed/refractory IMT of lungs with multiple brain metastases in young child who achieved long-term complete response after alectinib. This systematic review also summarizes treatment modalities and outcome of children and adolescent with CNS-IMT. METHODS PRISMA 2020 guideline was applied to select an article from PubMed, Scopus, and Cochrane databases without time limits. This review focused on children and adolescent 0-24 years of age with CNS-IMT or inflammatory pseudotumor (CNS-IPT). The clinical characteristics and treatment outcome were explored. RESULTS A total of 51 patients in 49 publications were identified. Median age of patients with CNS-IMT/IPT was 15-year-old and 60.8% were male. The most common location of tumor was cerebral cortex (54.9%). Complete resection of CNS-IMT/IPT was performed in 27 cases with 100% complete response and 18.5% recurrence. Nearly half of patients who received partial resection without adjuvant therapy experienced progressive disease, while the contrast group totally achieved partial response. Overall responses in 7 patients treating with ALK inhibitors were 57.1% durable complete response and 42.9% transient partial response. CONCLUSION First-line treatment of CNS-IMT/IPT is complete resection. Patients who received partial tumor removal might have benefit from adjuvant therapy. ALK inhibitors reveal a promising result in unresectable CNS-IMT/IPT. Our case has shown a success in treating relapsed and refractory CNS-IMT as well as the primary site using 2nd-generation ALK inhibitor.
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Durham C, Clemons M, Alias A, Konduri K. Locally Advanced Inflammatory Myofibroblastic Tumor Treated With Targeted Therapy: A Case Report and Literature Review. Cureus 2022; 14:e27223. [PMID: 36035049 PMCID: PMC9400374 DOI: 10.7759/cureus.27223] [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: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are known to be associated with anaplastic lymphoma kinase (ALK) gene rearrangements. Other molecular alterations such as ROS proto-oncogene 1, receptor tyrosine kinase (ROS1), neurotrophic tyrosine receptor kinase (NTRK), and platelet-derived growth factor receptor (PDGFR) have also been identified in IMTs. Although there are no randomized controlled clinical trials comparing chemotherapy, tyrosine kinase inhibitors (TKIs), or other systemic therapies, the literature demonstrates the use of ALK-targeted TKIs as an effective strategy for the treatment of locally advanced or metastatic ALK-rearranged IMTs. This case report describes a patient with an ALK-rearranged locally advanced pulmonary IMT who was treated with neoadjuvant-intent crizotinib. The patient had a very favorable response to therapy, and surgery was declined. It is difficult to determine the duration and sequencing of TKI use in these settings as there is little published data to guide decisions. This report also includes a comprehensive compilation of published IMT cases with molecular alterations treated with systemic therapy, which also highlighted the duration of therapies and clinical outcomes.
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5
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Singh P, Nambirajan A, Gaur MK, Raj R, Kumar S, Malik PS, Jain D. Primary pulmonary epithelioid inflammatory myofibroblastic sarcoma: a rare entity and a literature review. J Pathol Transl Med 2022; 56:231-237. [PMID: 35843628 PMCID: PMC9288894 DOI: 10.4132/jptm.2022.05.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/08/2022] [Indexed: 11/25/2022] Open
Abstract
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an aggressive subtype of inflammatory myofibroblastic tumor (IMT) harboring anaplastic lymphoma kinase (ALK) gene fusions and is associated with high risk of local recurrence and poor prognosis. Herein, we present a young, non-smoking male who presented with complaints of cough and dyspnoea and was found to harbor a large right lower lobe lung mass. Biopsy showed a high-grade epithelioid to rhabdoid tumor with ALK and desmin protein expression. The patient initially received 5 cycles of crizotinib and remained stable for 1 year; however, he then developed multiple bony metastases, for which complete surgical resection was performed. Histopathology confirmed the diagnosis of EIMS, with ALK gene rearrangement demonstrated by fluorescence in situ hybridization. Postoperatively, the patient is asymptomatic with stable metastatic disease on crizotinib and has been started on palliative radiotherapy. EIMS is a very rare subtype of IMT that needs to be included in the differential diagnosis of ALKexpressing lung malignancies in young adults.
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Affiliation(s)
- Priyanka Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Kumar Gaur
- Department of Surgical Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Raj
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
- Corresponding Author: Deepali Jain, MD, FIAC, Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India Tel: +91-1126549200, E-mail:
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Lourdesamy Anthony AI, Satnam Singh TK, Ng KL, Abdul Rahaman JA. Endotracheal inflammatory myofibroblastic tumour: A rare cause of central airway occlusion in adults. Respirol Case Rep 2022; 10:e0984. [PMID: 35702693 PMCID: PMC9174595 DOI: 10.1002/rcr2.984] [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: 05/07/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) is an unusual myofibroblastic spindle cell neoplasm that is rarely discovered in the airway of adults. Previously, it was regarded as a reactive lesion and was infamously known as inflammatory pseudotumour before recent insights revealed that significant majority of cases harboured neoplastic genes. Diagnosis is difficult as clinical presentation and imaging findings are non-specific. Diagnosis and a favourable prognosis require the complete resection of the tumour. Detection of the anaplastic lymphoma kinase expression via immunohistochemistry expedites diagnosis. We report a young adult with an endotracheal mass occluding the central airway. The patient successfully underwent bronchoscopic resection using interventional techniques. IMT was diagnosed. No recurrence was seen after a year of surveillance. Due to the rarity of the disease, the recurrence rates for large airway disease is unknown. Recurrence rates for pulmonary lesions is reported to be lower compared to extrapulmonary IMTs and recurrence is unlikely if compete surgical excision is achieved.
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Affiliation(s)
| | | | - Khai Lip Ng
- Department of MedicineHospital MelakaMelakaMalaysia
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7
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Jiang JY, Comsa M, Wong VCK, Mansberg R. Steroid responsive inflammatory myofibroblastic tumor of the lung evaluated by FDG PET/CT imaging. Radiol Case Rep 2022; 17:907-910. [PMID: 35069958 PMCID: PMC8762374 DOI: 10.1016/j.radcr.2021.11.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
A 68-year-old gentleman was referred for 18F-FDG PET/CT for a pulmonary mass in the left upper lobe which demonstrated intensely FDG-avid confluent pulmonary consolidation in the left upper lobe (SUVmax 15.1). Histopathologic biopsy of the left upper lobe lung mass was consistent with inflammatory myofibroblastic tumor (IMT). The patient was started on steroid treatment in conjunction with antibiotics. Follow-up FDG PET/CT 3 weeks after commence of treatment showed remarkable response of the IMTs to therapy with much less avid FDG uptake (SUVmax 5.4) and marked improvement in the pulmonary consolidation. Nevertheless, the patient underwent left upper lobe lobectomy due to evidence of persistent cystic disease and malignant potential associated with IMTs. Final histopathology was consistent with IMT with no evidence of malignancy.
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Affiliation(s)
- James Yuheng Jiang
- Departments of Nuclear Medicine and PET, Nepean Hospital, Kingswood, Derby St, NSW 2747, Australia
- Corresponding author.
| | - Monica Comsa
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Veronica Chi Ken Wong
- Departments of Nuclear Medicine and PET, Nepean Hospital, Kingswood, Derby St, NSW 2747, Australia
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Robert Mansberg
- Departments of Nuclear Medicine and PET, Nepean Hospital, Kingswood, Derby St, NSW 2747, Australia
- Faculty of Medicine and Health, University of Sydney, NSW, Australia
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Zhu T, Gao P, Gao J, Liu X, Zhang X. A huge recurrent retroperitoneal inflammatory myofibroblastic tumor implicating renal and ureter: a case report. Transl Cancer Res 2022; 10:4565-4570. [PMID: 35116312 PMCID: PMC8798890 DOI: 10.21037/tcr-21-899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/30/2021] [Indexed: 12/05/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare sarcoma with unique molecular characteristics. It also has typical fasciitis-like, dense spindle cells and hypocellular fibrous histologic patterns and can occur at any age. The etiology of IMT is unknown and a complete treatment and monitoring plan for IMT have not been developed. We have found a rare case about a huge recurrent IMT implicating renal and ureter. The patient was accompanied by a history of a lesion sized 15.5 cm × 11.5 cm × 10.5 cm as a retroperitoneal IMT, and the first tumor resection was performed 12 months ago. The patient, who suffered from tumor recurrence within 1 year and whose recurrent tumor also invaded into the renal parenchymal was given a retroperitoneal neoplasm resection plus right nephrectomy. In order to clarify the pathological features, the histological specimens of recurrent retroperitoneal IMT were examined as well as primary retroperitoneal IMT, and immunohistochemical (IHC) stains showed that the spindle cells were positive for vimentin and negative for anaplastic lymphoma kinase (ALK). At 24 months follow-up, the patient recovered well and there was no evidence of tumor recurrence. This case report is conducive to understanding this rare tumor. When conditions permit, complete surgical resection is the recommended treatment for primary and recurrent IMT.
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Affiliation(s)
- Tianle Zhu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pan Gao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Gao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xi Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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9
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Shieba Y, Khairy M, Elzouk M, Mansour AA. Lifethreatening tracheal obstruction in a child caused by nodular fasciitis: case presentation. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nodular fasciitis (NF) is a rare non-neoplastic inflammatory tumor and usually presents as a painless, rapidly growing subcutaneous soft tissue mass. The head and neck are relatively common locations for nodular fasciitis, particularly in children. NF in the trachea is rare and may evolve to a fatal condition, especially due to its rapidly growing nature that can cause life-threatening tracheal obstruction.
Case presentation
We report the case of a 5-year-old child with NF in the trachea and subtotal tracheal obstruction. Bronchoscopy and biopsy proved the diagnosis, and bronchoscopic excision of the tumor was performed.
Conclusions
NF is a rare airway tumor, occurring mostly in adults, and may presenting with pneumonia-like symptoms. Early detection of the lesion is essential to avoid life-threatening airway obstruction.
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10
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Zarrouki S, Marouf R. Mini-invasive endoscopic approach to tracheal inflammatory myofibroblastic tumor in a young woman: A case report. Ann Med Surg (Lond) 2022; 73:103208. [PMID: 35070283 PMCID: PMC8767228 DOI: 10.1016/j.amsu.2021.103208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) of the trachea is rare tumor mostly found in children and young adults. CASE REPORT We report a case of a 28 year-old woman who presented chronic isolated coughing. Chest CT scan showed a tracheal tumor. Rigid bronchoscopy allowed the complete removal of the tumor, and histology confirmed the diagnosis of IMT. 12 months follow-up found no recurrence. DISCUSSION IMT is a rare tumor exhibiting both benign and aggressive behaviour. The endoscopic approach of tracheal should be considered when there is a minimal tracheal wall invasion. CONCLUSION Through this case, we want to emphasise the role of rigid bronchoscopy in the complete removal of endotracheal IMT.
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Affiliation(s)
- Sara Zarrouki
- Thoracic Surgery Departement, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Marouf
- Thoracic Surgery Departement, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
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Demir Ö, Onal O. Surgical treatment outcomes of pulmonary inflammatory myofibroblastic tumors. Ann Thorac Med 2022; 17:44-50. [PMID: 35198048 PMCID: PMC8809124 DOI: 10.4103/atm.atm_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022] Open
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12
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Operated pulmonary inflammatory myofibroblastic tumors: Our experience with 17 cases. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:101-108. [PMID: 35444850 PMCID: PMC8990154 DOI: 10.5606/tgkdc.dergisi.2022.21263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
Background
In this study, we aimed to evaluate the clinicopathological features of pulmonary inflammatory myofibroblastic tumor cases operated in our clinic.
Methods
A total of 17 inflammatory myofibroblastic tumor patients (5 males, 12 females; median age: 46 years) who were operated in our clinic between February 2000 and July 2019 were included. Data including sex, age, symptoms, accompanying diseases, tumor localization, tumor diameter, endobronchial extension, maximum standard uptake value of the tumors, surgery type, recurrence, and survival data were analyzed.
Results
Two patients were diagnosed preoperatively and two patients were diagnosed during surgery using frozen-section method before resection. Three (17.7%) patients underwent pneumonectomy, five (29.4%) patients lobectomy, three (17.7%) patients segmentectomy, five (29.4%) patients wedge resection, and one (5.8%) patient bronchial sleeve resection. All patients had complete resection with negative margins. None of them had lymph node metastasis. Median follow-up was 122 (range, 8 to 245 months) months. None of the patients received adjuvant therapy, there was no tumor recurrence or tumor-related death.
Conclusion
It is difficult to make a preoperative diagnosis of inflammatory myofibroblastic tumor patients. Systematic lymph node dissection is not required in diagnosed patients. Complete resection is the most important prognostic factor, and it is critical to achieve this with the smallest resection possible.
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Lin YT, Huang SH, Chang CH, Hsu PC, Wang CW, Lee CS. First report of an adult female patient with endobronchial inflammatory myofibroblastic tumor in Taiwan: A case report. Thorac Cancer 2021; 12:2807-2810. [PMID: 34520108 PMCID: PMC8520803 DOI: 10.1111/1759-7714.14104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
An inflammatory myofibroblastic tumor (IMT) of the respiratory system is an uncommon disease. In Taiwan, there is a lack of previous studies on tracheobronchial IMT. The tumor is characterized by overexpression of anaplastic lymphoma receptor tyrosine kinase (ALK)‐1. Surgical resection is the standard treatment of choice nowadays.
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Affiliation(s)
- Yan-Ting Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan
| | - Shih-Hao Huang
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chih-Hao Chang
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Ping-Chi Hsu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan
| | - Chih-Wei Wang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chung-Shu Lee
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.,Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
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14
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Imamura K, Hosoya M, Kasuya K, Shimanuki MN, Shinden S, Ogawa K, Oishi N. Labyrinthine destruction caused by inflammatory pseudotumor of the temporal bone: A report of three cases and review of the literature. Laryngoscope Investig Otolaryngol 2021; 6:857-865. [PMID: 34401513 PMCID: PMC8356880 DOI: 10.1002/lio2.609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumors (IPTs) are rare, idiopathic, and inflammatory lesions that are histopathologically benign. Here, we present three cases of labyrinthine destruction caused by an IPT. METHODS The first patient was a 74-year-old male with a mass lesion extending from the inner ear to the external ear canal. The second patient was a 62-year-old female with a foliated polycystic lesion in the petrous bone on the dorsal side of the left internal auditory canal. The third patient was a 68-year-old female with a mass extending from the inner ear to the middle ear, destroying the semicircular canal and cochlea. RESULTS In two cases, we performed surgical resection successfully with no recurrence. In the other case, the lesion showed shrinkage after chemotherapy for colorectal cancer incidentally found during the examination process. CONCLUSION Surgical technique and indication for IPT should be based on the location and function of the lesion. In addition, there is room to consider pharmacotherapy as a treatment option for IPT of the temporal bone. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Kanako Imamura
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Makoto Hosoya
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Kento Kasuya
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Marie N. Shimanuki
- Department of OtolaryngologySaiseikai Utsunomiya HospitalUtsunomiya‐shiJapan
| | - Seiichi Shinden
- Department of OtolaryngologySaiseikai Utsunomiya HospitalUtsunomiya‐shiJapan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Naoki Oishi
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
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15
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Ma Z, Zhang Y, Huang Q, Fu F, Deng C, Wang S, Li Y, Chen H. Decreasing Prevalence of Benign Etiology in Resected Lung Nodules Suspicious for Lung Cancer over the Last Decade. Semin Thorac Cardiovasc Surg 2021; 34:1093-1099. [PMID: 34216752 DOI: 10.1053/j.semtcvs.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/11/2022]
Abstract
This study investigated treatment strategy for suspicious lung cancer with postoperatively proven benign etiology. In this retrospective study, we collected patients who underwent pulmonary resection for radiologically suspected lung cancer from 2010 to 2019 at Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC). Radiological features, preoperative follow-up time, preoperative pathology and postoperative pathology of these patients were documented. We classified resected benign lesions based on paraffin section and compared the therapy management performed on indeterminate lung nodules of 2 time periods (2010-2014 vs 2015-2019). 17,188 patients were included in this cohort and 1,381 (8.03%) cases were postoperatively proved to be benign lesions. Resected benign lesions proportion significantly decreased by years, from 14.5-6.2%. The respective resected benign lesions proportions for pure GGO nodules, part solid nodules and solid nodules were 5.3%, 3.0% and 11.7%. The resected benign lesions rate for patients with longer preoperative follow-up time was much lower (p < 0.001). Among the benign lesions, 14.2% were benign tumors, 25.7% were granulomatous, 30.2% were pneumonia, 18.0% were fibrosis and 11.9% were other types. If we consider that resections for granulomatous and pneumonia radiologically featured as solid nodules exceeding 2 cm, benign tumor and inflammatory pseudotumor are therapeutic, the nontherapeutic pulmonary resection rate is 4.26%. For patients with GGO nodules, the median preoperative follow-up time increased with the time being and the resected benign rate in period 2 (2015-2019) was significantly lower than that in period 1 (2010-2014). Wedge resection was the most common surgery strategy especially for small nodules and no matter for small or large nodules, the frequency of sublobar resection in period 2 was higher than that in period 1. The resected benign lesions rate at our department was relatively low and decreasing over the last decade. Meanwhile, our follow-up and surgical strategy improved over time. For patients with GGO nodules, 4-6months preoperative follow-up is recommended to avoid surgical intervention for benign lesions. For solid nodules with inconclusive diagnosis, limited resection should be first considered to maintain the balance between reducing the risk of cancer progressing and minimizing the resection for benign lesions.
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Affiliation(s)
- Zelin Ma
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingyuan Huang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaoqiang Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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16
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Miyagi H, Ishii D, Hirasawa M, Yasuda S, Toriumi N, Sarashina T, Tanino M, Tanaka M, Tanaka Y, Miyamoto K. Spontaneous pneumothorax caused by an inflammatory myofibroblastic tumor-like lesion in a 14-year-old girl: a case report. Surg Case Rep 2020; 6:109. [PMID: 32448976 PMCID: PMC7246262 DOI: 10.1186/s40792-020-00873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background Spontaneous pneumothorax occurs more often in younger, slim, and shallow-chested men. Although less common, differential diagnoses for secondary pneumothorax in children are asthma, emphysematous blebs, catamenial pneumothorax, and others. We report a patient who presented with pneumothorax and was found to have an inflammatory myofibroblastic tumor (IMT)-like lesion, and present a review of the related literature. Case presentation A 14-year-old girl visited her physician for chest pain that developed while exercising. Although chest drainage was performed, the symptoms associated with a collapsed lung did not improve, and she was referred to our hospital. Computed tomography revealed the presence of a 19 × 17-mm cyst with a thick wall in the apex of the right lung. She was tested for infectious diseases, namely tuberculosis, but the results were not definitive. Catamenial pneumothorax was also suspected because she was menstruating when she presented to our hospital. As a therapeutic diagnosis, we performed a thoracoscopic partial resection of the right upper lobe of the lung. Three small openings were identified inside the cyst, suggesting connection with the bronchiole. The lesion was pathologically diagnosed as an IMT-like lesion. Considering the progress so far, we considered that the final diagnosis to be an IMT. The patient was discharged on postoperative day 3, and we have followed her for the past 6 months with no local recurrence or metastasis. Conclusions IMT is not uncommon in children. Therefore, this lesion should be considered as a possible diagnosis if children and young adults develop spontaneous pneumothorax.
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Affiliation(s)
- Hisayuki Miyagi
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | - Daisuke Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Masatoshi Hirasawa
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shunsuke Yasuda
- Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Naohisa Toriumi
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Takeo Sarashina
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mishie Tanino
- Department of Pathology, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Mio Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, 232-8555, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, 232-8555, Japan
| | - Kazutoshi Miyamoto
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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17
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Arslan NC, Goksel S, Asoglu O. Multivisceral resection for synchronous inflammatory myofibroblastic tumors of the lung and stomach. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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18
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Liu Q, Wei J, Liu X, Wang J. Anaplastic lymphoma kinase-negative pulmonary inflammatory myofibroblastic tumor with multiple metastases and its treatment by Apatinib: A case report. Medicine (Baltimore) 2019; 98:e18414. [PMID: 31876714 PMCID: PMC6946427 DOI: 10.1097/md.0000000000018414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Primary pulmonary inflammatory myofibroblastic tumor (IMT) with distant metastasis is extremely rare. Moreover, metastasis of pulmonary IMT to bone marrow has never been reported in previous studies. Therapeutic approaches for anaplastic lymphoma kinase (ALK)-negative pulmonary IMT with metastasis are limited. Yet there is no report on the treatment of advanced IMT cases with anti-angiogenesis drugs. PATIENT CONCERNS We described a patient with a complaint of fatigue, with the chest computed tomography (CT) scan revealing 2 masses in bilateral lung. DIAGNOSES The CT-guided lung biopsy examined 1 lesion in the right lung, and the post-operative pathological diagnosis of ALK-negative pulmonary IMT was recommended. However, the lung lesions were found significantly enlarged during the subsequent visit 8 months later, along with multiple metastases to the bone and abdominal cavity. A bone marrow biopsy revealed bone marrow infiltration by spindle cells. INTERVENTIONS The patient began to take Celecoxib due to the rapid progression of IMT, however, resulting in the aggravated gastric ulcer. He stopped taking the medicine 1 month later, with no remarkable change in the lesions by CT. Apatinib was administrated instead of Celecoxib. OUTCOMES After the 5-month treatment of Apatinib, the mass in the abdominal cavity significantly shrank and the lung lesions slightly decreased in size. With the 9-month administration of Apatinib, the lung lesions and the abdominal mass kept stable, compared with the situation in the 5-month follow-up. LESSONS Although pulmonary IMT shows the potential of metastasis, its metastasizing to bone marrow is a highly unusual event. Apatinib is effective for pulmonary IMT, and should be taken into consideration for the treatment of inoperable pulmonary IMT patients who lack ALK rearrangement.
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Affiliation(s)
| | - Jianguo Wei
- Department of Pathology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Zhejiang
| | - Xizhong Liu
- Institute of Nonlinear Science, Shaoxing University, Shaoxing, China
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19
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Poggi C, Pecoraro Y, Carillo C, Anile M, Amore D, Mantovani S, Naldi G, Pagini A, Bassi M, Cagnetti S, Mottola E, D'Agostino F, Vannucci J, Pernazza A, Cimino G, Savi D, Gomellini S, Pugliese F, De Giacomo T, Rendina EA, Venuta F, Diso D. Inflammatory Myofibroblastic Tumor After Lung Transplant-A Rare and Aggressive Complication: A Case Report. Transplant Proc 2019; 51:2991-2994. [PMID: 31611127 DOI: 10.1016/j.transproceed.2019.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Malignant diseases are well-known complications after lung transplantation (LT). Among these, inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with a not well-known and often aggressive biological behavior. MATERIAL AND METHODS We hereby describe 2 cases of cystic fibrosis patients who underwent bilateral sequential LT (BSLT) complicated by IMT. RESULTS A 26-year-old man presented a right endobronchial lesion 6 months after BSLT. Two consecutive fiber bronchoscopic biopsies showed granulation tissue. For the persistent lesion growth, the patient underwent a transthoracic biopsy showing histologic diagnosis of IMT. Therefore, he underwent to right pneumonectomy that was unfortunately complicated after 6 months with a late bronchopleural fistula and empyema with exitus 6 months later. A 31-year-old woman 1 year after BSLT presented with a left voluminous pleural-parenchymal lesion; the histologic examination after biopsy revealed an IMT. She underwent a removal of the lesion with a macroscopic R0 resection. Histologic, immunophenotypic, and cytogenetic examinations showed a strong overexpression of anaplastic lymphoma kinase requiring biological adjuvant therapies; however, the patient refused it. Four years later, she presented a recurrence treated with debulking procedure and adjuvant radiotherapy. At last follow-up, the patient was alive with stable disease and optimal graft function. CONCLUSIONS Although IMT is a rare complication after lung transplant, to obtain a careful diagnosis, an early and aggressive treatment is mandatory.
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Affiliation(s)
- Camilla Poggi
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I.
| | - Ylenia Pecoraro
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Carolina Carillo
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Marco Anile
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Davide Amore
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Sara Mantovani
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Giuseppe Naldi
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Andreina Pagini
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Massimiliano Bassi
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Sara Cagnetti
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Emilia Mottola
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Federica D'Agostino
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Jacopo Vannucci
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Angelina Pernazza
- Division of Pathology, Sapienza University of Rome, Policlinico Umberto I
| | - Giuseppe Cimino
- Division of Adult Cystic Fibrosis Centre, Department of Public Health and Infectious Diseases, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Daniela Savi
- Division of Adult Cystic Fibrosis Centre, Department of Public Health and Infectious Diseases, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Sara Gomellini
- Division of Oncologic Radiotherapy, AO S. Giovanni Addolorata, Rome
| | - Francesco Pugliese
- Division of Anesthesiology and Intensive Care Unit for Organ's Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Tiziano De Giacomo
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | | | - Federico Venuta
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
| | - Daniele Diso
- Division of Advanced Thoracic Surgery and Lung Transplant, Sapienza University of Rome, AOU Policlinico Umberto I
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20
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Lichtenberger JP, Biko DM, Carter BW, Pavio MA, Huppmann AR, Chung EM. Primary Lung Tumors in Children: Radiologic-Pathologic Correlation From the Radiologic Pathology Archives. Radiographics 2019; 38:2151-2172. [PMID: 30422774 DOI: 10.1148/rg.2018180192] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Primary lung tumors in children are rare, with a narrow range of diagnostic considerations. However, the overlapping imaging appearances of these tumors necessitate attention to key discriminating imaging and pathologic features. In the neonate and infant, the important considerations include pleuropulmonary blastoma (PPB), infantile fibrosarcoma, and fetal lung interstitial tumor. Among these tumors, imaging findings such as air-filled cysts in type 1 PPB and homogeneously low attenuation of fetal lung interstitial tumors are relatively specific. Key pathologic and genetic discriminators among this group of tumors include the DICER1 germline mutation found in PPB and the t(12,15)(p13;q25) translocation and ETV6-NTRK3 fusion gene seen in infantile fibrosarcoma. Primary lung tumors in older children include inflammatory myofibroblastic tumors (IMTs), carcinoid salivary gland-type tumors of the lung, recurrent respiratory papillomatosis, and other rare entities. IMT, a spindle-cell proliferation with inflammatory elements, is the most common lung tumor in children. Anaplastic lymphoma kinase, a receptor-type protein tyrosine kinase, is present in 50% of these tumors, and this finding may support an imaging diagnosis of IMT. Carcinoid tumors account for a substantial portion of childhood lung tumors, and their characteristic avid enhancement on images corresponds to the compressed fibrovascular stroma histologically. Furthermore, novel imaging agents used with somatostatin receptor analogs have an emerging role in the evaluation of carcinoid tumors. Although less common than mucoepidermoid carcinoma, adenoid cystic carcinoma tends to recur given the perineural spread seen histologically. Integrating radiologic and pathologic knowledge is critical to accurate diagnosis, treatment planning, and surveillance of primary lung tumors in children.
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Affiliation(s)
- John P Lichtenberger
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - David M Biko
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Brett W Carter
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Michael A Pavio
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Alison R Huppmann
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Ellen M Chung
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
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21
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Delgado Torralbo JA, Pavón Masa M, Luque Crespo E. Bilateral Pulmonary Involvement. Non-Surgical Options for Inflammatory Pseudotumor - A Case Report. Arch Bronconeumol 2019; 56:49-51. [PMID: 31331707 DOI: 10.1016/j.arbres.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - María Pavón Masa
- Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, España
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22
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Waghchoure S, Bradley R, Sorrell M, Arya R. Successful rigid bronchoscopic resection of recurrent pulmonary inflammatory myofibroblastic tumor after complete surgical resection. Proc AMIA Symp 2019; 32:408-410. [PMID: 31384203 DOI: 10.1080/08998280.2019.1612688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022] Open
Abstract
Inflammatory myofibroblastic tumor, previously named inflammatory pseudotumor, is a biologically borderline mesenchymal neoplasm often associated with an inflammatory infiltrate. The incidence of inflammatory myofibroblastic tumor has been found to range from 0.04% to 1.2%, with endobronchial cases being extremely rare. The treatment of choice for pulmonary inflammatory myofibroblastic tumor is complete surgical resection. However, disease recurrence has been reported. Modalities used to treat recurrent and metastatic disease include surgical resection and corticosteroids. We present a case of recurrent endobronchial inflammatory myofibroblastic tumor that was successfully treated endoscopically with rigid bronchoscopy and laser debulking without need for further surgical intervention.
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Affiliation(s)
- Simon Waghchoure
- Department of Pulmonary and Critical Care Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Robert Bradley
- Department of Pathology, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - McKenzie Sorrell
- Department of Internal Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
| | - Rohan Arya
- Department of Pulmonary and Critical Care Medicine, University of South Carolina School of MedicineColumbiaSouth Carolina
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23
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Gupta S, Goyal P, Yang Y, Fitzgerald W. Tracheal Inflammatory Myofibroblastoma: A Rare Tumor of the Trachea. Cureus 2019; 11:e4484. [PMID: 31259102 PMCID: PMC6581385 DOI: 10.7759/cureus.4484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs), also known as inflammatory pseudotumor are rarely reported in the trachea. Although initially considered benign, with the recent evidence of local recurrence after surgical resection, cases of metastatic spread, and advance in cytogenetic analysis, they are now categorized as tumors with malignant potential. Correct histological diagnosis is of utmost importance, as they closely resemble other benign and malignant spindle cell tumors with myofibroblasts predominance. Treatment remains challenging taking into account the location involving the airway. Here, we describe a case of tracheal IMF in an apparently healthy young adult presenting with recurrent hemoptysis.
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Affiliation(s)
- Sonali Gupta
- Internal Medicine, St. Vincent's Medical Center, Bridgeport, USA
| | - Pradeep Goyal
- Radiology, St. Vincent's Medical Center, Bridgeport, USA
| | - Yifeng Yang
- Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA
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24
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Lisi R, Abate G, D'Urso P, Martinetti MT, Siniscalchi B, Marampon F, Bulzonetti N, Tombolini V. Successful role of adjuvant radiotherapy in a rare case of tracheal inflammatory myofibroblastic tumor: a case report. TUMORI JOURNAL 2019; 105:NP1-NP3. [PMID: 30900517 DOI: 10.1177/0300891619838333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a rare benign cancer that can express a more aggressive phenotype related to the genetic mutation of the anaplastic lymphoma kinase receptor (ALK). Involvement of trachea is extremely rare and due to the clinical and radiologic nonspecificity, the definitive diagnosis is based on the histologic evaluation of tissue specimens. Total surgical excision is curative and chemotherapy or radiotherapy has been employed in the treatment of unresectable tumors or as adjuvant therapies. CASE PRESENTATION The case described here is being reported because of the rare tracheal location and the atypical treatment approach used for an ALK-positive IMT. A 7-week pregnant woman voluntary interrupted pregnancy and underwent total surgical excision that resulted to have close margins. Although ALK-positive expression indicated the use of ALK inhibitors, she refused any type of adjuvant therapy that could affect ovarian function. Thus, 3D conformational external beam radiotherapy was performed with a daily dose of 180 cGy, 5 times per week, up to 45 Gy at the level of trachea. A total of 62 months of follow-up showed and no signs of disease recurrence or late radiation therapy-related toxicity. CONCLUSIONS This report describes an extremely rare case of a tracheal IMT, underlying the key role of radiotherapy as adjuvant treatment able to definitively cure IMT, limiting systemic chemotherapy-related toxicity.
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Affiliation(s)
- Roberto Lisi
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Gessica Abate
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Pasqualina D'Urso
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Maria Teresa Martinetti
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Benedetta Siniscalchi
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Francesco Marampon
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Nadia Bulzonetti
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
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25
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Successful Treatment of Recurrent Inflammatory Pseudotumor With High-dose Prednisone. J Bronchology Interv Pulmonol 2019; 25:e52-e54. [PMID: 30247297 DOI: 10.1097/lbr.0000000000000496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Laser Treatment of a Tracheal Inflammatory Myofibroblastic Tumor. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Reddy RZ, Carter YM, Hsia DW. Pulmonary inflammatory pseudotumor causing lung collapse responding to corticosteroid therapy. Respir Med Case Rep 2018; 24:113-116. [PMID: 29977776 PMCID: PMC6010639 DOI: 10.1016/j.rmcr.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 11/17/2022] Open
Abstract
Pulmonary inflammatory pseudotumor (PIP) is a rare benign tumor that represents less than one percent of all tumors found in the lungs. Despite the benign etiology, PIP can cause significant clinical problems due to its growth rate and potential to compromise adjacent pulmonary and thoracic structures. Complete surgical resection is the preferred therapy for PIP to prevent recurrence, however, this is not possible in some patients due to the size or location of the tumor. We present the case of an 18 year-old male presenting with PIP in the proximal left mainstem bronchus causing complete left lung collapse. Surgical resection was not possible due to tumor location, and therefore the patient was treated with corticosteroids with marked response. Corticosteroid use has for PIP has been described in few other situations, and this case demonstrates the potential for this therapeutic option in patients with PIP who have a contraindication to surgical resection.
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Affiliation(s)
- Radhika Z. Reddy
- VA Long Beach Medical Center, Department of Medicine, Division of Pulmonary and Critical Care Medicine, USA1
https://www.longbeach.va.gov/. - Corresponding author.
| | - Yvonne M. Carter
- Sinai Hospital of Baltimore, Department of Surgery, Division of Thoracic Surgery, USA2
http://www.lifebridgehealth.org/Sinai/SinaiDivisionofThoracicSurgery.aspx.
| | - David W. Hsia
- Harbor-UCLA Medical Center, Department of Medicine, Division of Respiratory and Critical Care Physiology and Medicine, USA3
http://www.harbor-ucla.org/respiratory-cc/.
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Sponholz S, Schirren M, Baldes N, Schreiner L, Fisseler-Eckhoff A, Schirren J. [Thoracic inflammatory pseudotumors : A rare differential diagnosis]. Chirurg 2018; 89:296-301. [PMID: 29305634 DOI: 10.1007/s00104-017-0581-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammatory pseudotumors are a rare and in the main benign tumor entity but infiltrative growth, recurrence and metastases are described. Generally, a complete resection is needed to exclude lung cancer. This study analyzed our data and experiences with this rare tumor entity. MATERIAL AND METHODS We performed a retrospective study of all our patients who had been operated on between 2002 and 2016 in our institution for an inflammatory pseudotumor of the lungs. The extent of resection, morbidity, mortality and long-term results were analyzed. RESULTS Altogether, in this period 13 patients were operatively treated (5 women and 8 men). The median age was 52 years (range 34-74 years). A reoperation was carried out in one patient for recurrence after enucleation of the tumor in another hospital. In no case could lung cancer be excluded prior to complete resection. In total, 11 pulmonary, 1 tracheal and 1 chest wall pseudotumor could be resected by thoracotomy (9×) and thoracoscopy (3×) and 1 by ventral chest wall resection. In eight patients the resections were performed by standard resection (wedge resection or anatomic resection) and five times by extended resection. In all cases a R0 resection was achieved. Due to one case of postoperative pneumonia the morbidity and mortality rates were 7.7% and 0%, respectively. CONCLUSION The differential diagnosis between inflammatory pseudotumors and lung cancer cannot be definitely made preoperatively. For an exact diagnosis by the pathologist a complete histological preparation is needed. Due to infiltrative growth and recurrence, extended resection can be necessary for a R0 resection. This can be achieved with low morbidity and mortality. Important is an en bloc R0 resection, which is associated with good long-term results.
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Affiliation(s)
- S Sponholz
- Klinik für Thoraxchirurgie, HELIOS Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Deutschland.
| | - M Schirren
- Klinik für Thoraxchirurgie, HELIOS Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Deutschland
| | - N Baldes
- Klinik für Thoraxchirurgie, HELIOS Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Deutschland
| | - L Schreiner
- Institut für Pathologie und Zytologie, HELIOS Dr. Horst Schmidt Klinik Wiesbaden, Wiesbaden, Deutschland
| | - A Fisseler-Eckhoff
- Institut für Pathologie und Zytologie, HELIOS Dr. Horst Schmidt Klinik Wiesbaden, Wiesbaden, Deutschland
| | - J Schirren
- Klinik für Thoraxchirurgie, HELIOS Dr. Horst Schmidt Klinik Wiesbaden, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Deutschland
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Chauhan RS, Sodhi KS, Nada R, Virk R, Mathew J. Pediatric inflammatory myofibroblastic tumor of the trachea: Imaging spectrum and review of literature. Lung India 2018; 35:516-519. [PMID: 30381563 PMCID: PMC6219126 DOI: 10.4103/lungindia.lungindia_405_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inflammatory myofibroblastic tumor of the airway is a very uncommon benign primary neoplasm in pediatric age group with increased local recurrence rate and potential metastatic spread. We describe a case of a 6-year boy who was brought to the pediatric emergency with severe respiratory distress, dry cough, and stridor. Contrast-enhanced computed tomography and magnetic resonance imaging (MRI) of the neck showed a polypoidal mass lesion in the right anterolateral trachea causing significant airway narrowing. Bronchoscopic findings correlated with the imaging. The lesion was confirmed at surgery and was completely removed by surgical excision. Histopathology revealed an inflammatory myofibroblastic tumor. MRI findings of this entity in a child have not been reported before.
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Affiliation(s)
- Richa Singh Chauhan
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhara Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Virk
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Joseph Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Camela F, Gallucci M, di Palmo E, Cazzato S, Lima M, Ricci G, Pession A. Pulmonary Inflammatory Myofibroblastic Tumor in Children: A Case Report and Brief Review of Literature. Front Pediatr 2018; 6:35. [PMID: 29535991 PMCID: PMC5835069 DOI: 10.3389/fped.2018.00035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear etiology and variable clinical course, consisting of a proliferation of fibroblasts and myofibroblasts, mixed with inflammatory cells. Synonyms of IMT are inflammatory pseudotumor and plasma cell granuloma reflecting the alleged inflammatory nature attributed to this lesion, even though this heterogeneity in the disease denomination is probably involved in a dispersion of the literature data. Among primary pulmonary neoplasms, it represents the most frequent endobronchial tumor of childhood and beyond the lung it has been described mainly in the bladder, mediastinum and mesentery. Despite having a tendency for local recurrence, the risk of distant metastasis is low. Clinical presentation depends on localization therefore lung peripheral lesions are often asymptomatic resulting in a delayed diagnosis. Radiological findings can suggest the diagnosis that must be confirmed by histopathology assessment. The tumor has been characterized by the application of immunohistochemical techniques, molecular biology and cytogenetics, which are very precious for the diagnosis. The therapeutic approach consists in the complete surgical excision of the lesion that normally ensures excellent survival. Due to the potential risk of recurrence, close clinical trial is indicated. To date only 24 cases of pulmonary IMT have been described, although the prevalence is probably higher. We present a case report of a 3-year-old girl with pulmonary IMT and a brief review of known literature cases in order to highlight the most common clinical presentations, the most useful diagnostic tools and therapeutic approach.
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Affiliation(s)
- Federica Camela
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Mario Lima
- Department of Pediatric Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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31
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Nair VV, Singh KK, Kathayanat JT, Radhakrishnan R, Babu A, Thanathu Krishnan Nair J. Inflammatory myofibroblastic lung tumor with dysphagia in a 4-year-old child. Asian Cardiovasc Thorac Ann 2017; 25:653-655. [DOI: 10.1177/0218492317738672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inflammatory myofibroblastic tumors of the lung are rare in adults but common among pediatric lung tumors. A 4-year-old girl was evaluated for respiratory symptoms, dysphagia, and weight loss. Radiology revealed a right hilar mass that persisted despite antibiotic treatment. On exploration, a hilar mass involving the pulmonary vasculature, diaphragm and gastroesophageal junction was found. Aggressive surgical excision including a right pneumonectomy was performed. Histopathology confirmed an inflammatory myofibroblastic tumor with no features of malignancy. At the 2-year follow-up, the child was clinically stable with no recurrence. Dysphagia is a very rare presentation of such tumors.
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Affiliation(s)
- Vinitha V Nair
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Kunal Krishna Singh
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Joseph Thomas Kathayanat
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Ratish Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Akash Babu
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
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Peretti M, Radu DM, Pfeuty K, Dujon A, Riquet M, Martinod E. Surgical resection of pulmonary inflammatory pseudotumors: long-term outcome. Asian Cardiovasc Thorac Ann 2017; 25:440-445. [PMID: 28605954 DOI: 10.1177/0218492317716587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pulmonary inflammatory pseudotumors are rare lesions that remain problematic in several aspects, especially regarding the therapeutic strategy. The goal of this study was to evaluate long-term survival in a multicenter series of patients who required surgery for pulmonary inflammatory pseudotumors. Methods Thirty-six cases of pulmonary inflammatory pseudotumors, operated on in 3 French thoracic surgery departments between 1989 and 2015, were studied retrospectively. We recorded pre-, peri- and postoperative data for each patient, and long-term survival was analyzed. Results There were 22 men and 14 women. Mean age was 53.5 years (range 14-81 years). Three pneumonectomies, 1 bilobectomy, 19 lobectomies, 2 segmentectomies, 10 wedge resections, and 1 biopsy were performed. Complete resection was carried out in 32 (88.8%) patients. Median follow-up was 76 months. Five-year and 10-year survival rates were respectively 86.8% and 81.7% (96% and 90% for patients with R0 resection). Conclusions Long-term survival was excellent for patients with pulmonary inflammatory pseudotumors who benefited from surgery, especially when surgical resection was complete. These results confirm that surgical resection must be proposed as the first-line treatment for patients with pulmonary inflammatory pseudotumors.
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Affiliation(s)
- Marine Peretti
- 1 Department of Thoracic and Vascular Surgery, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, SMBH Faculty of Medicine, Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
| | - Dana M Radu
- 1 Department of Thoracic and Vascular Surgery, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, SMBH Faculty of Medicine, Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
| | - Karel Pfeuty
- 2 Department of Thoracic and Vascular Surgery, Saint-Brieuc Hospital, France
| | - Antoine Dujon
- 3 Department of Thoracic and Vascular Surgery, Cedar Surgical Center, Bois Guillaume, France
| | - Marc Riquet
- 4 Department of Thoracic Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou European Hospital, Paris Descartes University, COMUE Sorbonne Paris Cité, Paris, France
| | - Emmanuel Martinod
- 1 Department of Thoracic and Vascular Surgery, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, SMBH Faculty of Medicine, Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
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33
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Degheili JA, Kanj NA, Koubaissi SA, Nasser MJ. Indolent lung opacity: Ten years follow-up of pulmonary inflammatory pseudo-tumor. World J Clin Cases 2017; 5:61-66. [PMID: 28255550 PMCID: PMC5314263 DOI: 10.12998/wjcc.v5.i2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 11/30/2016] [Accepted: 12/14/2016] [Indexed: 02/05/2023] Open
Abstract
Inflammatory pseudotumor (IPT) has always been considered a diagnostic challenge. Its rarity and resemblance to other more common pathological entities imposes that neither clinical nor radiological characteristics can lead to a definitive diagnosis. The surgical excision of the lesion is the ultimate approach for accurate diagnosis and cure. Moreover the true nature of IPT, its origin as a neoplastic entity or an over-reactive inflammatory reaction to an unknown trigger, has been a long debated matter. Surgery remains the treatment of choice. IPT is mostly an indolent disease with minimal morbidity and mortality. Local invasion and metastasis predict a poor prognosis. We hereby present a unique case of pulmonary IPT that was surgically excised, but recurred contralaterally, shortly thereafter. Despite no medical or surgical treatment for ten years, the lesion has remained stable in size, with neither symptoms nor extra-pulmonary manifestations.
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Acosta Martínez J, Beato López J, Domínguez Blanco A, López Romero JL, López Villalobos JL. Anaesthetic management in thoracoscopic distal tracheal resection. ACTA ACUST UNITED AC 2016; 64:168-171. [PMID: 27938935 DOI: 10.1016/j.redar.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/06/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management.
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Affiliation(s)
- J Acosta Martínez
- Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J Beato López
- Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Domínguez Blanco
- Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L López Romero
- Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L López Villalobos
- Unidad de Gestión Clínica de Enfermedades Respiratorias, Sección de Cirugía Torácica, Hospital Universitario Virgen del Rocío, Sevilla, España
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35
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Zhang X, Tang S, Huang L, Yu H. Contrast-Enhanced Sonographic Characteristics of Hepatic Inflammatory Pseudotumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2039-2047. [PMID: 27503756 DOI: 10.7863/ultra.15.10057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/07/2015] [Indexed: 06/06/2023]
Abstract
A hepatic inflammatory pseudotumor, which can be misdiagnosed as a malignant tumor, is a relatively uncommon tumor with nonspecific imaging manifestations. As a new diagnostic technique, contrast-enhanced sonography has become increasingly important in the diagnosis of liver focal lesions. Here we present 3 cases of histologically confirmed hepatic inflammatory pseudotumors diagnosed with contrast-enhanced sonography. "Fast-in and centrifugal-out" may be a characteristic contrast-enhanced sonographic enhancement pattern in the diagnosis of hepatic inflammatory pseudotumors, which needs confirmation in further studies.
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Affiliation(s)
- Xiaoyue Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaoshan Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liping Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongwei Yu
- Department of Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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36
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Aydoğmuş Ü, Uğurlu E, Bir F, Türk F, Yuncu G. The Right Inferior Pulmonary Vein Related Inflammatory Myofibroblastic Tumor in an Adult Case. Turk Thorac J 2016; 17:128-131. [PMID: 29404141 DOI: 10.5578/ttj.30511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/14/2015] [Indexed: 11/15/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, which is derived of mesenchymal origin. Here we present an adult case with IMT, the origin of which was considered to be right inferior pulmonary vein. A male patient who was 52 years old, admitted to our outpatient clinic with the complaint of shortness of breath. He had cigarette smoking history for 30 years. On direct posterior - anterior X-Ray of the chest, a well-circumscribed mass with calcification in right hilum of the lung was observed. There was a mass which was extending to the inferior inferior pulmonary vein from right hilum of the lung, was measured 70 × 60 mm on computed tomography of the chest. Hamartoma, teratoma and Castleman Disease were among the possible diagnoses. On diagnostic bronchoscopy, signs of pressure from outside to the bronchi of the right middle and lower lobe was observed. Surgical excision is decided and the mass was totally excised through a muscle-sparing thoracotomy. The mass thought to arise from the inferior pulmonary vein on intraoperative inspection and right inferior lobe excision is undertaken by intrapericardial approach. No postoperative complication is encountered. Histological examination of the mass indicated inflammatory myofibroblastic tumor. Main treatment of IMT is surgical excision with negative surgical margin. Here in we present an IMT which is encountered at an unexpected location is excised completely with right lower lobe excision by an intrapericardial approach.
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Affiliation(s)
- Ümit Aydoğmuş
- Department of Chest Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Erhan Uğurlu
- Department of Chest Diseases, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ferda Bir
- Department of Medical Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Figen Türk
- Department of Chest Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Gökhan Yuncu
- Department of Chest Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Lamas-Pinheiro R, Rodesch G, Devalck C, Segers V, Khelif K, Cappello M, Steyaert H. Pulmonary Myofibroblastic Tumour Involving the Pericardium and Left Atrium in an 18 Month Infant. Ann Thorac Cardiovasc Surg 2016; 22:312-314. [PMID: 26853245 DOI: 10.5761/atcs.cr.15-00360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is the most frequent primary lung tumor in children and it may be locally aggressive. The management of a locally advanced pulmonary IMT in an 18 month-old female child is presented.A left pulmonary mass was incidentally found on the computerized tomography (CT) scan of a child with persistent systemic inflammatory syndrome. Biopsy confirmed the diagnosis; after preoperative corticotherapy, left pneumonectomy was performed. The pericardium and left atrium were invaded and resected, requiring pericardial reconstruction. There is no relapse at four years of follow-up.Steroids play a role in tumor size reduction, but marginal resection is the gold standard. Extended approaches are feasible and often required in advanced cases.
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Carinal resection and reconstruction following inflammatory myofibroblastic tumor resection: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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39
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Inflammatory myofibroblastic tumor of the lung indistinguishable from adenocarcinoma on imaging studies. Clin Nucl Med 2015; 39:740-1. [PMID: 24873793 DOI: 10.1097/rlu.0000000000000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of a right lung nodule discovered on routine chest x-ray in an asymptomatic 62-year-old man. CT revealed a spiculated nodule in segment 1 of the right upper lobe, 2.2 cm in diameter and without calcification. The nodule showed high focal FDG uptake (SUVmax, 17.8) on PET. Right upper lobectomy was performed under the diagnosis of adenocarcinoma; however, the histopathologic findings were of inflammatory myofibroblastic tumor.
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40
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Fu X, Jiang J, Tian XY, Li Z. Pulmonary epithelioid inflammatory myofibroblastic sarcoma with multiple bone metastases: case report and review of literature. Diagn Pathol 2015; 10:106. [PMID: 26178751 PMCID: PMC4504132 DOI: 10.1186/s13000-015-0358-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/09/2015] [Indexed: 12/22/2022] Open
Abstract
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of inflammatory myofibroblastic tumor with distinctive morphological features and malignant clinical behavior. Only a few such cases have been described in the literature. We report here a case of unusual pulmonary EIMS with multiple bone metastases. A 21-year-old Chinese male patient presented with complaints of general fatigue and rapid weight loss, and a huge tumor arising in the left lower lobe of lung was detected by chest computed tomography. The mass of lung was totally resected. Microscopically, the tumor cells were rounded and epithelioid in shape. Myxoid stroma and inflammatory infiltration was also present. The tumor cells were immunopositive to anaplastic lymphoma kinase (ALK) in smooth cytoplasmic pattern. Fluorescence in situ hybridization (FISH) assay revealed the presence of rearrangement of ALK gene. Three months after lung surgery, there were multiple bone metastases and intraspinal mass found by positron emission tomography. The second surgical treatment was performed to remove the intraspinal lesion. The histological and immunohistochemical features of intraspinal mass were similar to those of pulmonary tumor. The diagnosis of pulmonary EIMS with multiple bone metastases was made. To the best of our knowledge, it may be the first case of an EIMS arising in lung. Awareness of EIMS in respiratory tract and its distinctive features is important for pathologists to avoid a diagnostic pitfall caused by histologic similarities to other ALK-positive tumors. ALK inhibitor is a promising treatment for this aggressive tumor regardless of its potential acquired resistance.
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Affiliation(s)
- Xinge Fu
- Department of Pathology, The First Affiliated Hospital, Guangzhou Medical University, 151, Yanjiang Road, Guangzhou, 510120, China
| | - Juhong Jiang
- Department of Pathology, The First Affiliated Hospital, Guangzhou Medical University, 151, Yanjiang Road, Guangzhou, 510120, China
| | - Xiao-ying Tian
- School of Chinese Medicine, Hong Kong Baptist University, 7, Baptist University Road, Kowloon Tong, Hong Kong, China
| | - Zhi Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58, Zhongshan Road II, Guangzhou, 510080, China.
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41
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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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42
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Pecoraro Y, Diso D, Anile M, Russo E, Patella M, Venuta F. Primary inflammatory myofibroblastic tumor of the trachea. Respirol Case Rep 2014; 2:147-9. [PMID: 25530866 PMCID: PMC4263498 DOI: 10.1002/rcr2.81] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/19/2014] [Accepted: 08/26/2014] [Indexed: 12/05/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare neoplasms that can involve the airway. Recent studies have shown their malignant behavior with local recurrence and potential metastatic spread; half of the cases are associated with anaplastic lymphoma kinase gene rearrangement. Complete surgical resection is recommended, when feasible. We present a case of a 26-year-old woman admitted to our institution with severe respiratory failure; she was affected with primary IMT of the trachea and underwent complete surgical resection.
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Affiliation(s)
- Ylenia Pecoraro
- Department of Thoracic Surgery, University of Rome "Sapienza" Rome, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, University of Rome "Sapienza" Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, University of Rome "Sapienza" Rome, Italy
| | - Emanuele Russo
- Department of Thoracic Surgery, University of Rome "Sapienza" Rome, Italy
| | - Miriam Patella
- Department of Thoracic Surgery, University of Rome "Sapienza" Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, University of Rome "Sapienza" Rome, Italy ; Fondazione Eleonora Lorillard Spencer Cenci Rome, Italy
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43
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Inflammatory myofibroblastic tumor: an unusual mimicker of childhood intrathoracic tuberculosis. J Pediatr Hematol Oncol 2014; 36:e426-9. [PMID: 24072244 DOI: 10.1097/mph.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammatory myofibroblastic tumors are rare lesions of uncertain etiology that are often difficult to diagnose because of their myriad clinical presentations. Not uncommon, they mimic persistent pneumonia. We report a 4-year-old girl who presented with prolonged pyrexia, weight loss, severe anemia, hepatosplenomegaly, and nonresolving pneumonia. Initial investigations including flexible bronchoscopy and bronchial washing for usual causes of persistent pneumonia, such as tuberculosis and other infections, were negative. Chest computed tomography revealed a well-defined lesion involving the lingula and left upper lobe with extension into the subpleural space. Pleural tap and biopsy was also noncontributory. Thoracoscopic biopsy was suggestive of an inflammatory myofibroblastic tumor. As the lesion was encasing the major vessels, it was considered inoperable. The patient did not respond to steroid therapy and etoricoxib and later succumbed to the illness. This uncommon tumor should be considered in the differential diagnosis of children who presented with unresolving consolidation with pyrexia.
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44
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Pavithran K, Manoj P, Vidhyadharan G, Shanmughasundaram P. Inflammatory myofibroblastic tumor of the lung: unusual imaging findings. World J Nucl Med 2014; 12:126-8. [PMID: 25165425 PMCID: PMC4145155 DOI: 10.4103/1450-1147.136739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, most commonly seen in children and adolescents. It can occur in nearly every part of the body. Imaging properties and the clinical presentation of IMT can mimic malignant process. A 41-year-old female presented with cough of 3 months duration. Chest X-ray showed a coin shadow in the right upper lobe. Positron emission tomography/computed tomography scan showed a 3.2 × 2.4 cm lesion with homogeneous appearance with a very high fluorodeoxyglucose uptake value, suggesting a neoplastic process. She underwent lobectomy and the final diagnosis was IMT.
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Affiliation(s)
- K Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - P Manoj
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - G Vidhyadharan
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - P Shanmughasundaram
- Department of Nuclear Medicine, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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Wang J, Sun Z, Zhuo S, Wang K. Sigmoid sinus occlusion infiltrated by inflammatory myofibroblastic tumor from mastoid. Head Neck 2014; 37:E4-7. [PMID: 24753301 DOI: 10.1002/hed.23704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/10/2014] [Accepted: 04/04/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) and some types of immunoglobulin (Ig) G4-related disease are often involved in the spectrum of inflammatory pseudotumor (IPT) and the concept of IgG4-related IPT/IMT has recently been proposed. METHODS A 38-year-old man complained of initial symptoms of blurred vision and headache. RESULTS A tumor was found in the right mastoid, which caused occlusion of the right sigmoid sinus and intracranial hypertension. A diagnosis of IMT with IgG4+ plasma cell infiltration was established by surgical, pathological, and immunohistochemistry findings. His symptoms were completely relieved after corticosteroid therapy and no recurrence was detected during 22 months of follow-up. CONCLUSION A case with cerebral venous sinus infiltrated by IMTs in the head and neck has never been reported; corticosteroid therapy proved satisfactory in IMT with IgG4+ plasma cell infiltration.
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Affiliation(s)
- Jingye Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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46
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Rai B, Din FHM, O'Byrne JJ, Sharif F. Twelve-year-old boy with recurrent presentations of shortness of breath: an intraluminal tracheal tumour. BMJ Case Rep 2014; 2014:bcr-2013-203183. [PMID: 24759160 DOI: 10.1136/bcr-2013-203183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 12-year-old boy was admitted with symptoms of recurrent shortness of breath since 12 months along with mild intermittent retrosternal chest pain that had developed 3 weeks ago prior to admission. He was previously treated for asthma with no improvement. Initial posteroanterior chest X-ray (CXR) revealed no abnormality on two occasions. Lateral CXR showed a mass lesion in the distal trachea which was subsequently confirmed by a CT scan of the chest.
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Affiliation(s)
- Birendra Rai
- Department of Pediatrics, Midland Regional Hospital, Westmeath, Ireland
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Ilic V, Dunet V, Beck-Popovic M, Boubaker A. Pulmonary inflammatory myofibroblastic tumour after Hodgkin's lymphoma. BMJ Case Rep 2014; 2014:bcr-2013-202491. [PMID: 24473428 DOI: 10.1136/bcr-2013-202491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Positron emission tomography (PET)/CT plays a major role in staging, assessing response to treatment and during follow-up of paediatric Hodgkin's lymphoma (HL). Owing to high sensitivity to detect viable tumoural tissue, negative PET/CT is highly predictive of survival. However, (18)F-FDG is not specific for malignant disease and may concentrate in numerous benign/inflammatory lesions that may cause 'false-positive' results and follow-up PET/CT studies should be interpreted with caution. We report a case of pulmonary inflammatory myofibroblastic tumour, which developed during follow-up in a young patient with complete remission of a stage IIB HL and was fully treated with surgical resection.
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Affiliation(s)
- Vesna Ilic
- Department of Nuclear Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Amini B, Huang SY, Tsai J, Benveniste MF, Robledo HH, Lee EY. Primary lung and large airway neoplasms in children: current imaging evaluation with multidetector computed tomography. Radiol Clin North Am 2013; 51:637-57. [PMID: 23830790 DOI: 10.1016/j.rcl.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Multidetector computed tomography (MDCT) offers an important noninvasive imaging modality for confirmation and further characterization of primary lung and large airway neoplasms encountered in pediatric patients. Children represent a unique challenge in imaging, not only because of unique patient factors (eg, inability to follow instructions, motion, need for sedation) but because of the technical factors that must be optimized to reduce radiation dose. This article reviews an MDCT imaging algorithm, up-to-date imaging techniques, and clinical applications of MDCT for evaluating benign and malignant primary neoplasms of lung and large airway in infants and children.
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Affiliation(s)
- Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Kozu Y, Isaka M, Ohde Y, Takeuchi K, Nakajima T. Epithelioid inflammatory myofibroblastic sarcoma arising in the pleural cavity. Gen Thorac Cardiovasc Surg 2013; 62:191-4. [PMID: 23345154 DOI: 10.1007/s11748-013-0204-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/07/2013] [Indexed: 12/27/2022]
Abstract
A 57-year-old Japanese man presented with massive right pleural effusion, and a huge tumor arising in the pleural cavity was detected by chest computed tomography. A thoracoscopic tumor biopsy revealed that the tumor protruded extensively into the pleural cavity, and its gross appearance was cystic and glossy. Microscopically, the tumor cells were rounded and epithelioid in shape. Prominent and abundant myxoid stroma was also present together with an inflammatory infiltrate, and the tumor was anaplastic lymphoma kinase (ALK)-immunopositive. Fluorescence in situ hybridization revealed that the Ran-binding protein 2-ALK fusion gene was present. Taken together, these findings supported the diagnosis of epithelioid inflammatory myofibroblastic sarcoma (EIMS), which is a variant of an inflammatory myofibrobrastic tumor. This is the first reported case of an EIMS arising in the pleural cavity.
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Affiliation(s)
- Yoshiki Kozu
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi, Shizuoka, 411-8777, Japan,
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Diagnostic and therapeutic challenges of a large pleural inflammatory myofibroblastic tumor. Case Rep Pulmonol 2012; 2012:102196. [PMID: 23346443 PMCID: PMC3549377 DOI: 10.1155/2012/102196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 12/16/2012] [Indexed: 12/20/2022] Open
Abstract
We report a 48-year-old woman with a pleural pseudoneoplasm requiring different diagnostic and therapeutic strategies. After initial presentation with increasing dyspnoea, temperature, dry cough, and interscapular pain diagnostic processing showed a large mediastinal mass with marked pleural effusion and high metabolic activity in the 18F-FDG-PET/CT. Extensive CT-guided biopsy of the tumor reaching from the visceral pleura into the right upper lobe revealed no malignancy, but a marked inflammatory tissue reaction containing foam cells. Initial empiric antibiotic therapy was temporarily successful. However, in the further course the mass relapsed and was resistant to antibiotics and a corticosteroid trial. With the working hypothesis of an inflammatory myofibroblastic tumor the patient underwent surgical tumor resection, finally confirming the suspected diagnosis. Due to residual disease intravenous immunoglobulins were administered leading to sustained response. This case with a pleural localisation of a large inflammatory pseudotumor with responsiveness to immunomodulation after incomplete resection extends the reported spectrum of thoracopulmonary manifestations of this rare entity.
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