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Zhang M, Liu H, Zhu Z, Zhang Y, Zhang Y, Hu X. HIV-related bilateral inflammatory myofibroblastic tumors of the adrenal gland: a case report and literature review. AIDS Res Ther 2022; 19:66. [PMID: 36566196 PMCID: PMC9789583 DOI: 10.1186/s12981-022-00492-x] [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: 07/18/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a rare disease that mostly occurs in younger people and is located in the lungs in the general population. We report a rare case of adrenal IMT in a patient with HIV infection, which is believed to be the first of its kind worldwide. CASE PRESENTATION We present a rare case of a 44-year-old man with HIV infection who was diagnosed with adrenal IMT. The patient refused regular highly active antiretroviral therapy 13 years ago until he was admitted to hospital after an adrenal mass was found. The patient underwent successful computed-tomography-guided needle biopsy, and pathological analysis showed fibroblastic-myofibroblastic proliferation with inflammatory infiltration, which confirmed a diagnosis of IMT. We failed to perform complete resection of the tumor because of its diffuse invasion. The patient was complicated with severe multiple pulmonary infections postoperatively because of immunodeficiency, which eventually caused his death 2 months later. CONCLUSION Differential diagnosis of IMT is difficult, and tumor biopsy is an essential means of diagnosis. Surgical resection is preferred for both adrenal and HIV-related IMTs. Conservative treatment should be considered when there are technical difficulties with complete resection, and most patients have achieved good outcomes. However, more cases and longer follow-up are warranted to confirm long-term outcomes of HIV-related IMT.
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Affiliation(s)
- Mengmeng Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- grid.24696.3f0000 0004 0369 153XDepartment of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhiqiang Zhu
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yu Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yanyan Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaopeng Hu
- grid.24696.3f0000 0004 0369 153XDepartment of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Fiacchini G, Cambi C, Tavoni AG, Bruschini L, Castellana R, Dallan I, Berrettini S. Skull-Base Inflammatory Pseudotumor Involving the Trigeminal and Facial Nerves: A Singular Presentation of a Rare Disease. Surg J (N Y) 2020; 6:e33-e36. [PMID: 32133412 PMCID: PMC7054056 DOI: 10.1055/s-0040-1702921] [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: 08/29/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare disease that is often misinterpreted as a lymphoma or carcinoma. It may involve different body regions but most commonly the lungs and the orbital cavity. We report the case of a patient affected by an IPT of the trigeminal and facial nerves. A 69-year-old male presented to our hospital with a right facial palsy arisen suddenly 2 days before. A magnetic resonance imaging (MRI) of the head showed an abnormal mass with homogeneous enhancement involving the deep lobe of the parotid gland, the parapharyngeal space, and the infratemporal fossa, extending along the trigeminal nerve and the facial nerve. The patient was planned for multiple transnasal biopsies in the nasopharynx, the region of the foramen ovale, and the deep lobe of the parotid gland, but the results were inconclusive, with no evidence of a malignant process. We considered the possibility that the lesion could be an IPT, and the patient was treated with prednisone and cyclophosphamide. Three months after the conclusion of the treatment, an MRI showed a complete radiological response.
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Affiliation(s)
- Giacomo Fiacchini
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Christina Cambi
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Antonio Gaetano Tavoni
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Roberto Castellana
- Radiology Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Iacopo Dallan
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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Gulati R, Ratre MS, Khetarpal S, Varma M. A Case Report of a Gingival Plasma Cell Granuloma in a Patient on Antihypertensive Therapy: Diagnostic Enigma. Front Dent 2019; 16:144-148. [PMID: 31777856 PMCID: PMC6874842 DOI: 10.18502/fid.v16i2.1366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/25/2018] [Indexed: 12/23/2022] Open
Abstract
The aim of the present report was to discuss a unique case of gingival plasma cell granuloma (PCG) in a hypertensive patient on Amlodipine therapy. Also, we attempt to emphasize the importance of considering primary and advance investigations before making a definite diagnosis. PCG is an extremely rare, reactive, non-neoplastic lesion characterized by the predominance of polyclonal plasma cells. Drug-induced gingival overgrowth is a known side effect of Amlodipine. A hypertensive 60-year-old female patient reported with a chief complaint of swollen gums and discomfort in the upper front teeth region. A provisional diagnosis of Amlodipine-induced gingival overgrowth, combined gingival overgrowth, and fibroma was suggested. Surprisingly, histopathology revealed it to be a plasma cell lesion which was confirmed by advanced investigations, thereby establishing a confirmatory diagnosis of PCG.
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Affiliation(s)
- Ruchi Gulati
- Department of Periodontology, Government College of Dentistry, Madhya Pradesh, India
| | - Madhu Singh Ratre
- Department of Periodontology, Government College of Dentistry, Madhya Pradesh, India
| | - Shaleen Khetarpal
- Department of Periodontology, Government College of Dentistry, Madhya Pradesh, India
| | - Manish Varma
- Department of Periodontology, Government College of Dentistry, Madhya Pradesh, India
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Al-Zahid S, Wright T, Reece P. Laryngeal Inflammatory Pseudotumour Secondary to Mycobacterium kansasii. Case Rep Pathol 2018; 2018:9356243. [PMID: 30105112 PMCID: PMC6076934 DOI: 10.1155/2018/9356243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumours (IPT) are rare benign tumours characterised by spindle-shaped histiocyte proliferation often mimicking a soft tissue sarcoma. They can occur in different parts of the body and various aetiological factors have been proposed. To our knowledge this is the first case report of IPT of the larynx caused by mycobacterial disease. CASE REPORT We report a case of IPT of the larynx in an immunocompromised 81-year-old lady presenting with stridor and dysphagia with known disseminated Mycobacterium kansasii of the lungs. CONCLUSION This case demonstrates both the clinical and histological difficulties in making the diagnosis of IPT. A high index of suspicion is needed, and the importance of a multidisciplinary approach in the work-up, diagnosis, and management is highlighted.
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Affiliation(s)
- Saif Al-Zahid
- University Hospitals Bristol NHS Foundation Trust, UK
| | | | - Philip Reece
- Department of Otolaryngology, Torbay Hospital, UK
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Agarwal M, Nabavizadeh SA, Mohan S. Chapter 6 Non-Squamous Cell Causes of Cervical Lymphadenopathy. Semin Ultrasound CT MR 2017; 38:516-530. [PMID: 29031368 DOI: 10.1053/j.sult.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cervical lymphadenopathy is a common indication for imaging evaluation of the neck. Besides metastatic squamous cell carcinoma of the head and neck, cervical lymphadenopathy can be due to many causes, with simple reactive lymphadenopathy on one end of the spectrum and malignant lymphadenopathy due to a distant infraclavicular primary, on the other end. A systematic approach to the cause of cervical lymphadenopathy, which includes pattern of lymph node enlargement, lymph node characteristics, systemic symptoms, and extranodal abnormalities, can be very useful in arriving at the correct diagnosis. In this article, various patterns of cervical lymphadenopathy due to non-squamous cell causes are discussed.
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Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
| | - Seyed Ali Nabavizadeh
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Suyash Mohan
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Telugu RB, Prabhu AJ, Kalappurayil NB, Mathai J, Gnanamuthu BR, Manipadam MT. Clinicopathological Study of 18 Cases of Inflammatory Myofibroblastic Tumors with Reference to ALK-1 Expression: 5-Year Experience in a Tertiary Care Center. J Pathol Transl Med 2017; 51:255-263. [PMID: 28415158 PMCID: PMC5445201 DOI: 10.4132/jptm.2017.01.12] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 12/25/2022] Open
Abstract
Background Inflammatory myofibroblastic tumor is a histopathologically distinctive neoplasm of children and young adults. According to World Health Organization (WHO) classification, inflammatory myofibroblastic tumor is an intermediate-grade tumor, with potential for recurrence and rare metastasis. There are no definite histopathologic, molecular, or cytogenetic features to predict malignant transformation, recurrence, or metastasis. Methods A 5-year retrospective study of histopathologically diagnosed inflammatory myofibroblastic tumors of various anatomic sites was conducted to correlate anaplastic lymphoma kinase-1 (ALK-1) expression with histological atypia, multicentric origin of tumor, recurrence, and metastasis. Clinical details of all the cases were noted from the clinical work station. Immunohistochemical stains for ALK-1 and other antibodies were performed. Statistical analysis was done using Fisher exact test. Results A total of 18 cases of inflammatory myofibroblastic tumors were found during the study period, of which 14 were classical. The female-male ratio was 1:1 and the mean age was 23.8 years. Histologically atypical (four cases) and multifocal tumors (three cases, multicentric in origin) were noted. Recurrence was noted in 30% of ALK-1 positive and 37.5% of ALK-1 negative cases, whereas metastasis to the lung, liver, and pelvic bone was noted in the ALK-1 positive group only. Conclusions Overall, ALK-1 protein was expressed in 55.6% of inflammatory myofibroblastic tumors. There was no statistically significant correlation between ALK-1 expression, tumor type, recurrence and metastasis. However, ALK-1 immunohistochemistry is a useful diagnostic aid in the appropriate clinical and histomorphologic context.
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Affiliation(s)
- Ramesh Babu Telugu
- Department of General Pathology, Christian Medical College and Hospital, Vellore, India
| | - Anne Jennifer Prabhu
- Department of General Pathology, Christian Medical College and Hospital, Vellore, India
| | | | - John Mathai
- Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, India
| | - Birla Roy Gnanamuthu
- Department of Thoracic Surgery, Christian Medical College and Hospital, Vellore, India
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