1
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Wang QA, Chen HW, Wu RC, Wu CE. Update of Diagnosis and Targeted Therapy for ALK + Inflammation Myofibroblastic Tumor. Curr Treat Options Oncol 2023; 24:1683-1702. [PMID: 37938503 PMCID: PMC10781869 DOI: 10.1007/s11864-023-01144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
OPINION STATEMENT: Inflammatory myofibroblastic tumor (IMT), characterized by intermediate malignancy and a propensity for recurrence, has presented a formidable clinical challenge in diagnosis and treatment. Its pathological characteristics may resemble other neoplasms or reactive lesions, and the treatment was limited, taking chemotherapies as the only option for those inoperable. However, discovering anaplastic lymphoma kinase (ALK) protein expression in approximately 50% of IMT cases has shed light on a new diagnostic approach and application of targeted therapies. With the previous success of combating ALK+ non-small-cell lung cancers with ALK tyrosine kinase inhibitors (TKIs), crizotinib, a first-generation ALK-TKI, was officially approved by the U.S. Food and Drug Administration in 2020, to treat unresectable ALK+ IMT. After the approval of crizotinib, other ALK-TKIs, such as ceritinib, alectinib, brigatinib, and lorlatinib, have proven their efficacy on ALK+ IMT with sporadic case reports. The sequential treatments of targeted therapies in may provide the insight into the choice of ALK-TKIs in different lines of treatment for unresectable ALK+ IMT.
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Affiliation(s)
- Qi-An Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Chiao-En Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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2
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Zhang P, Wang C, Lv Z, Du M, Xu R. Crizotinib combined with bronchoscopic interventional treatment in ALK-positive inflammatory myofibroblastic tumor of left main stem bronchus: a case report. J Cardiothorac Surg 2023; 18:318. [PMID: 37950305 PMCID: PMC10638830 DOI: 10.1186/s13019-023-02427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT), also known as an inflammatory pseudotumor, is a unique type of intermediate soft tissue tumor that commonly occurred in the lung. Its unclear etiology and cellular activity brought about the confusion not only in naming of it, but also in diagnosis and treatment. CASE PRESENTATION We reported the case of an 18-year-old male student who suffered from shortness of breath, chest tightness and chest pain. Chest computed tomography scan showed a spherical neoplasm blocking left main stem bronchus. After fiberoptic bronchoscopy procedure, the results of histopathological and immunohistochemical analysis indicated an IMT. The targeted next generation sequencing based genomic profiling of the tumor using formalin-fixed and paraffin embedded tissue was performed and a EML4-ALK fusion was detected. The patient began to receive Crizotinib, a ALK tyrosine kinase inhibitor, at a dose of 250 mg twice daily orally. The patient has recovered well after the operation, and no recurrence or metastasis has been found after 12 months' follow-up. CONCLUSION By means of the diagnosis and treatment of this case, the characteristics and therapies of IMT are illustrated. In addition, it also provides a reference for the therapeutic strategy of IMT in the future.
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Affiliation(s)
- Peng Zhang
- Department of Cardiothoracic Surgery, The 961st Hospital of Joint Logistics Support Force of PLA, Qiqihar, 230200, China
| | - Chenchen Wang
- Department of Emergency and Critical Care Medicine, The 961st Hospital of Joint Logistics Support Force of PLA, Qiqihar, 230200, China
| | - Zechao Lv
- Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai, 200040, China
| | - Mingxiang Du
- Department of Cardiothoracic Surgery, The 961st Hospital of Joint Logistics Support Force of PLA, Qiqihar, 230200, China
| | - Ruixin Xu
- Department of Cardiothoracic Surgery, The 960th Hospital of Joint Logistics Support Force of PLA, No. 25 Shifan Road, Tianqiao District, Jinan, 250031, People's Republic of China.
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3
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Tong M, Zhang BC, Jia FY, Wang J, Liu JH. Hepatic inflammatory myofibroblastic tumor: A case report. World J Clin Cases 2023; 11:4318-4325. [PMID: 37449218 PMCID: PMC10336984 DOI: 10.12998/wjcc.v11.i18.4318] [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: 02/02/2023] [Revised: 04/15/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Hepatic inflammatory myofibroblastic tumor (HIMT) is a rare type of hepatic tumor. It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation, and its imaging findings are diverse.
CASE SUMMARY Here, we report a case of HIMT that was initially diagnosed as liver malignancy but was confirmed as HIMT by histopathology after hepatectomy. Mostly, HIMTs are infiltrated with plasma cells and stain positively for anaplastic lymphoma kinase on immunohistochemistry as well as for some other kinases.
CONCLUSION HIMT can be treated with single nonsteroidal anti-inflammatory drugs and without surgery when it is diagnosed accurately. Because the etiology of HIMT is unknown and the diagnosis is difficult, the pathogenesis and clinical process need to be further studied.
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Affiliation(s)
- Meng Tong
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Bo-Cheng Zhang
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Fei-Yu Jia
- Graduate Management Office, Education and Teaching Department, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Jing Wang
- Department of Radiology, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Jing-Hua Liu
- Department of Hepatobiliary Surgery and Minimally Invasive Institute of Digestive Surgery and Prof. Cai’s Laboratory, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
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4
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Uterine inflammatory myofibroblastic tumor. Pathol Res Pract 2023; 242:154335. [PMID: 36706588 DOI: 10.1016/j.prp.2023.154335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is recognized as a true neoplasm of unknown etiology, but its pathogenesis is related to abnormalities in the ALK gene. This is an uncommon tumor with a wide anatomic distribution and often constitutes a challenging diagnosis owing to its histological similarities with other tumors. Uterine IMTs are rare and their detailed characteristics should be described based on case reports and small case series. Thus, we performed a comprehensive review of the literature showing that uterine IMTs show a wide range of age at diagnosis (median, 39 years), and a symptomatology similar to that of common leiomyomas, only rarely presenting with inflammatory manifestations. IMTs represent 0.1% of "leiomyomas," an estimate that increases to 10% for pregnant women and to 14% for the smooth muscle tumors of uncertain malignant potential (STUMP) category of tumors, implying that tumors excised during pregnancy, STUMPs, and leiomyosarcomas should be systematically screened with ALK immunohistochemistry, as this is a targetable abnormality. Most reported cases are ALK-positive; the fusion partners vary, but in pregnancy-associated tumors, TIMP3 prevails. Almost 25% of the patients will show an aggressive course, and this is associated with older age, non-pregnancy-associated tumors, larger tumors, infiltrative tumor border, absence of abundant inflammation, atypia, important mitotic activity, and necrosis.
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Huang Y, Shu SN, Zhou H, Liu LL, Fang F. Infant biliary cirrhosis secondary to a biliary inflammatory myofibroblastic tumor: A case report and review of literature. World J Clin Cases 2022; 10:8375-8383. [PMID: 36159551 PMCID: PMC9403675 DOI: 10.12998/wjcc.v10.i23.8375] [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: 03/30/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A biliary inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymoma that, although it has a broad age spectrum, usually occurs in adults. Diagnosis is difficult because biliary IMTs often exhibit nonspecific clinical symptoms and imaging features, resulting in delayed or inappropriate treatment. Although most IMTs are benign, some show malignant properties such as infiltration, recurrence, and metastasis.
CASE SUMMARY Here, we retrospectively describe a 10-month-old infant who was admitted to our hospital due to stubborn jaundice. The patient responded poorly to routine medical treatment and his clinical manifestations and laboratory tests lacked specificity, so we turned to repeated ultrasound scans and other imaging examinations. As both hepatosplenic ultrasonography and diffusion-weighted magnetic resonance imaging demonstrated a space-occupying lesion, an exploratory laparotomy was performed. The final diagnosis made over two mo after the disease onset was infant biliary cirrhosis caused by a biliary IMT, which partially infiltrated into the liver. This infant is the youngest case of biliary IMTs that has been reported till now. The patient underwent an incomplete resection of the mass and Kasai Portoenterostomy. However, because of cirrhosis, he also received a paternal liver transplant. Since some IMTs show malignant properties, we proceeded with a three-year of follow-up; however, no recurrence or metastasis has been noted.
CONCLUSION Neoplastic disease such as IMTs should be considered when routine medical treatment of obstructive jaundice is not successful. Observation of dynamic imaging changes is helpful for diagnosis. Periodic follow-up is necessary for IMTs.
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Affiliation(s)
- Yuan Huang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hua Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ling-Ling Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Feng Fang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Gros L, Dei Tos AP, Jones RL, Digklia A. Inflammatory Myofibroblastic Tumour: State of the Art. Cancers (Basel) 2022; 14:cancers14153662. [PMID: 35954326 PMCID: PMC9367282 DOI: 10.3390/cancers14153662] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Among sarcomas, which are rare cancers, inflammatory myofibroblastic tumors are extremely rare. Unlike other subtypes, this is a largely oncogene-driven neoplasia, and early gene rearrangement identification is important for accurate advanced stage treatment. In this manuscript, we review the clinicopathologic characteristics of this ultra-rare entity, as well as the current treatment landscape, with a particular focus on opportunities provided by tyrosine kinase inhibitors (TKIs). Abstract An inflammatory myofibroblastic tumor (IMT) is a neoplasm composed of myofibroblastic and fibroblastic spindle cells accompanied by inflammatory cells, including lymphocytes and eosinophils. It is an ultra-rare tumor, the optimal management of which remains to be defined. Surgery is the treatment of choice for localized tumors. The treatment of advanced disease is not precisely defined. Chemotherapy regimens result in an overall response rate of approximately 50% based on retrospective data. The latest pathophysiological data highlight the role played by tyrosine kinase fusion genes in IMT proliferation. Anaplast lymphoma kinase (ALK) oncogenic activation mechanisms have been characterized in approximately 80% of IMTs. In this context, data regarding targeted therapies are most important. The aims of this article are to review the latest published data on the use of systematic therapy, particularly the use of molecular targeted therapy, and to publish an additional case of an IMT with Ran-binding protein 2 (RANPB2)-ALK fusion showing a long response to a tyrosine kinase inhibitor.
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Affiliation(s)
- Louis Gros
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, 35128 Padua, Italy;
- Department of Medicine, University of Padua School of Medicine, 35128 Padua, Italy
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK;
- Division of Clinical Sciences, Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ, UK
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
- Center of Sarcoma, Department of Oncology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence:
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Carrasco Rodríguez R, García Fontán EM, Blanco Ramos M, Magdalena Benavides LJ, Otero Lozano D, Moldes Rodriguez M, Cañizares Carretero MA. Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. Cir Esp 2022; 100:329-335. [PMID: 35577280 DOI: 10.1016/j.cireng.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.
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Affiliation(s)
| | | | | | | | - Daniel Otero Lozano
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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8
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Liu J, Bai Z, Li S, Zeng S, Li C, Liu Q. Case Report: Recurrence of Testicular Myofibroblastic Tumor After Surgery. Front Oncol 2022; 11:810708. [PMID: 35096616 PMCID: PMC8795764 DOI: 10.3389/fonc.2021.810708] [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: 11/07/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT), also known as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a distinctive, rarely metastasizing neoplasm composed of myofibroblastic and fibroblastic spindle cells accompanied by inflammatory infiltration of plasma cells, lymphocytes and/or eosinophils. IMT predominantly affects children and young adults, and the age at presentation ranges from 3 to 89 years. We present a very rare case of recurrent testicular IMT without ALK rearrangement. This case highlights the clinical characteristics and diagnostic factors associated with primary and recurrent foci of this rare tumour, along with key therapeutic approaches.
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Affiliation(s)
- Jiayi Liu
- The First Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Zhijie Bai
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Shuaiqi Li
- School of Medicine, Nankai University, Tianjin, China
| | - Sheng Zeng
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Chuang Li
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Qian Liu
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
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9
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Ruan H, Yan BD, Tao YM, Ran X, Li SS. Endoscopic therapy combined with photodynamic therapy for intratracheal inflammatory myofibroblastic tumor. Photodiagnosis Photodyn Ther 2022; 38:102784. [DOI: 10.1016/j.pdpdt.2022.102784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
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10
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Park JW, Han SH, Kim DK. [Inflammatory Myofibroblastic Tumor Misdiagnosed as Intrahepatic Cholangiocarcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 79:41-44. [PMID: 35086972 DOI: 10.4166/kjg.2021.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/28/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare tumor that is currently classified as an intermediate cancer according to the World Health Organization classification system. The pathophysiology of its occurrence is still unknown. Imaging tests, such as CT or MRI, can be helpful in diagnosis, but the final diagnosis is confirmed by a pathological examination through a biopsy and immunohistochemistry stain. The patient, in this case, presented an asymptomatic intrahepatic mass discovered incidentally on an imaging examination. Initially, intrahepatic cholangiocarcinoma was suspected, but she was finally diagnosed with IMT through a histological examination after a liver resection.
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Affiliation(s)
- Ji Weon Park
- Department of Gastroenterology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Song Hee Han
- Department of Pathology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Dong Kyun Kim
- Department of Gastroenterology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
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11
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Liu Z, Li G, Gou A, Xiao Z, Xu Y, Song S, Guo K, Ma G. Inflammatory myofibroblastic tumor in the pancreatic neck: a rare case report and literature review. Gland Surg 2021; 10:1832-1839. [PMID: 34164329 DOI: 10.21037/gs-21-303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare disease of unknown etiology. It usually occurs in abdominal soft tissues and lung, and is extremely rare in the pancreas. IMT can occur in any part of a person at any age, however, it mostly affects children and young people. Its clinical manifestations are atypical, imaging examinations are not specific, and the differential diagnosis of pancreatic malignancies is difficult, making it easily misdiagnosed. Surgical resection is the preferred method of treatment for IMT. In this case report, we report a rare case of IMT in the neck of the pancreas and reviewed the relevant literature. In our case, the patient was a 57-year-old woman with an IMT in the neck of the pancreas. Abdominal pain was the only clinical symptom, and imaging features were not specific. She underwent surgery to remove the pancreatic mass, and the final diagnosis of IMT was based on histopathology and immunohistochemistry. After 6 months of regular follow-up, the patient had no complications or further incidents. The purpose is to emphasize the difficulty of the preoperative diagnosis of pancreatic IMT and the difficulty of distinguishing it from pancreatic malignancies. It is hoped that clinicians can gain a deeper understanding of pancreatic IMT through this case report.
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Affiliation(s)
- Zhe Liu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Guichen Li
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Anjiang Gou
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Zhihuan Xiao
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Yuanhong Xu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Shaowei Song
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Kejian Guo
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Gang Ma
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
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Carrasco Rodríguez R, García Fontán EM, Blanco Ramos M, Juaneda Magdalena Benavides L, Otero Lozano D, Moldes Rodriguez M, Cañizares Carretero MA. Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. Cir Esp 2021; 100:S0009-739X(21)00112-3. [PMID: 33896608 DOI: 10.1016/j.ciresp.2021.03.009] [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: 02/04/2020] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didńt find any loco-regional or distant recurrence in the patients studied. CONCLUSION IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.
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Affiliation(s)
| | | | | | | | - Daniel Otero Lozano
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
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13
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Donmez YN, Aykan HH, Orhan D, Peker RO, Yilmaz M, Karagoz T. Intrapericardial inflammatory myofibroblastic tumour in a 3-month-old infant associated with Coronavirus OC43 presenting with pericardial tamponade. Paediatr Int Child Health 2020; 40:261-267. [PMID: 32662356 DOI: 10.1080/20469047.2020.1794360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Inflammatory myofibroblastic tumour usually has a benign course and is very rarely associated with the heart. It can have life-threatening consequences, depending on its position or the presence of aggressive and metastatic complications. A 3-month-old boy presented with pericardial tamponade and was diagnosed with intrapericardial inflammatory myofibroblastic tumour associated with Coronavirus OC43. A large tumour attached to the left ventricle was completely removed by surgical resection and he made a full recovery. ABBREVIATIONS ALK: anaplastic lymphoma kinase; CMV: cytomegalovirus; CRP: C-reactive protein; EB: Epstein-Barr virus; ESR: erythrocyte sedimentation rate; IM: inflammatory myofibroblastic tumour; NSAI: non-steroidal anti-inflammatory drugs; PTFE: polytetrafluoroethylene; SMA: smooth muscle actin.
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Affiliation(s)
- Yasemin Nuran Donmez
- Departments of Pediatric Cardiology, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Hayrettin Hakan Aykan
- Departments of Pediatric Cardiology, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Diclehan Orhan
- Pediatric and Perinatal Pathology, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Recep Oktay Peker
- Cardiovascular Surgery, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Mustafa Yilmaz
- Cardiovascular Surgery, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Tevfik Karagoz
- Departments of Pediatric Cardiology, Hacettepe University Faculty of Medicine , Ankara, Turkey
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Smaily H, Cherfane P, Matar N. Pediatric laryngeal inflammatory myofibroblastic tumour: Case report and systematic review of the literature. Auris Nasus Larynx 2020; 48:1047-1053. [PMID: 32878712 DOI: 10.1016/j.anl.2020.08.018] [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: 12/02/2019] [Revised: 07/12/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumours (IMT) are rare benign neoplasms in the pediatric population, found most frequently in the lungs with rare reports of laryngeal involvement. The aim of this paper is to present a clinical case of laryngeal IMT followed by a systematic review on pediatric laryngeal IMT. CASE REPORT We present the case and the management of a 13-year-old boy with a laryngeal IMT MATERIAL AND METHODS: A comprehensive review of literature was conducted in September 2019 using Pubmed and Scopus. Included articles were reviewed for mean age at presentation, gender, main symptoms, treatment modality, histopathological features and follow-up RESULTS: Sixteen cases of pediatric laryngeal IMT were reported in the literature. The mean age of presentation was 7 years; endoscopic surgical resection was used in 87% of procedures, and the mean number of interventions needed to achieve remission was 1.6. CONCLUSIONS Pediatric laryngeal IMT are rare benign proliferations with only 16 reported case in the medical literature. The diagnosis of this entity remains a challenge and the standard of care is surgery with clear margins.
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Affiliation(s)
- Hussein Smaily
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
| | - Patrick Cherfane
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Nayla Matar
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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15
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Okazaki M, Sano Y, Mori Y, Sakao N, Yukumi S, Shigematsu H, Izutani H. Two cases of granuloma mimicking local recurrence after pulmonary segmentectomy. J Cardiothorac Surg 2020; 15:7. [PMID: 31915034 PMCID: PMC6950876 DOI: 10.1186/s13019-020-1055-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT is the most sensitive non-invasive imaging method for the detection of tumor metastasis and recurrence, but sometimes reveals false-positive results. Herein, we report two cases of false-positive results on PET/CT scans along with elevated serum carcinoembryonic antigen (CEA) levels, mimicking local recurrence after pulmonary segmentectomy. Case presentation Case 1; A 75-year-old woman underwent thoracoscopic left basal segmentectomy for primary lung cancer. Follow-up at 6 months after the surgery revealed serum CEA level elevation and chest CT showed a nodule measuring 25 × 22 mm in the residual left lower lobe. PET/CT revealed FDG uptake in the nodule diagnosed as local recurrence of lung cancer, and the patient underwent partial resection of the nodule. Microscopic examination of the resected specimen revealed granuloma caused by polyglycolic acid (PGA) sheet. Case 2; A 58-year-old man underwent VATS right S1 segmentectomy for lung metastasis from rectal carcinoma. Serum CEA levels gradually increased after surgery, and PET/CT revealed FDG uptake in the stump diagnosed as local recurrence of the lung metastasis. The patient underwent completion lobectomy 6 months after the segmentectomy, and the pathology of the resected specimen revealed an inflammatory granuloma caused by PGA suture. Conclusions Although suture and stapler granulomas have been reported, granuloma caused by PGA sheets has never been reported. Postoperative recurrence of lung cancer should be diagnosed with not only PET/CT scans and serum tumor markers but also pathological findings, to avoid unnecessary treatment such as chemotherapy, radiation, and difficult reoperation.
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Affiliation(s)
- Mikio Okazaki
- Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, Toon City, Japan.
| | - Yoshifumi Sano
- Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, Toon City, Japan
| | - Yu Mori
- Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, Toon City, Japan
| | - Nobuhiko Sakao
- Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, Toon City, Japan
| | - Syungo Yukumi
- Department of Surgery, National Hospital Organization Ehime Medical Center, Toon City, Japan
| | - Hisayuki Shigematsu
- Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, Toon City, Japan
| | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Medical School, Toon City, Japan
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16
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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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17
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Bisceglia M, Minenna E, Altobella A, Sanguedolce F, Panniello G, Bisceglia S, Ben-Dor DJ. Anaplastic Kaposi's Sarcoma of the Adrenal in an HIV-negative Patient With Literature Review. Adv Anat Pathol 2019; 26:133-149. [PMID: 30212382 DOI: 10.1097/pap.0000000000000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kaposi's sarcoma (KS) is a peculiar tumor of viral etiology, with the HHV8 rhadinovirus playing a fundamental role in its development. Several epidemiological categories of KS have been identified, of which the sporadic, endemic, iatrogenic, and the epidemic are the main ones. Several histologic disease morphologies have been described, such as inflammatory, angiomatous, spindle cell, mixed, and the anaplastic (sarcomatous) subtypes. The skin of the limbs is most commonly affected, but any other organ or site may be involved. Microscopically KS may enter the differential diagnosis with several different entities, and for this purpose the immunohistochemical detection of the viral latent nuclear antigen-1 (LNA-1) may be crucial. Sporadic KS is usually benign, but rarely it may be aggressive. Anaplastic histology heralds an ominous course in any clinical context. We report a case of anaplastic retroperitoneal KS, occurring in an HIV-negative adult man. This patient presented with a huge left suprarenal mass, which was totally resected, and initially diagnosed as inflammatory leiomyosarcoma, because of the monomorphic spindle cell tumor morphology. After 12 years the tumor recurred locally as an unresectable mass, which was biopsied and examined. At the time of recurrence, the histologic slides of the primary tumor were reviewed, and the previous diagnosis was changed to that of atypical KS. Histologically the recurrent tumor showed both spindle cell and epithelioid appearances. Strongly diffuse HHV8/LAN-1 immunopositivity was documented in both tumors. The final diagnosis for the entire case was anaplastic KS. Then, the patient died in a few months.
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Affiliation(s)
- Michele Bisceglia
- Department of Anatomic Pathology, School of Biomedical Sciences, Etromapmax Pole, Lesina (FG)
| | - Elena Minenna
- Department of Medical and Surgical Sciences, School of Allergology and Clinical Immunology, University of Foggia
| | | | | | | | - Stefano Bisceglia
- Department of Emergency Medicine, Polyclinic of Modena, Modena, Italy
| | - David J Ben-Dor
- Department of Pathology, The Barzilai Medical Center, Ashkelon, Israel
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18
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Honda K, Kadowaki S, Kato K, Hanai N, Hasegawa Y, Yatabe Y, Muro K. Durable response to the ALK inhibitor alectinib in inflammatory myofibroblastic tumor of the head and neck with a novel SQSTM1-ALK fusion: a case report. Invest New Drugs 2019; 37:791-795. [PMID: 30790150 DOI: 10.1007/s10637-019-00742-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/04/2019] [Indexed: 12/12/2022]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm that typically develops in the lungs and seldom in the head and neck region. It is often related to the anaplastic lymphoma kinase (ALK) fusion gene. Crizotinib, a first-generation ALK inhibitor, has been shown to have a notable response in patients with ALK-positive IMT. Here, we report the first case of a 46-year-old man with IMT harboring a novel SQSTM1-ALK fusion gene who demonstrated marked response to alectinib. The patient presented a right neck mass (5-cm diameter) that progressively enlarged and expanded to the upper mediastinum. ALK-rearranged IMT was diagnosed after complete tumor resection. Spindle cells displayed diffuse cytoplasmic staining for ALK on immunohistochemistry. A fluorescence in situ hybridization analysis revealed the translocation of a part of the ALK gene locus at chromosome 2p23. FoundationOne CDx™ assay identified an SQSTM1-ALK gene fusion. After a year, right cervical, subclavian, and mediastinal lymph node metastases, considered unresectable, developed. Notably, the patient exhibited a marked response to alectinib treatment and has sustained for 17 months following systemic therapy initiation without significant adverse events. This report highlights the possibility of alectinib being a reasonable option for advanced IMT with the SQSTM1-ALK fusion.
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Affiliation(s)
- Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Shigenori Kadowaki
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Kyoko Kato
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
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19
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Qian J, Zhu K, Ye J. Ultrasonic Manifestations of Mesenteric Inflammatory Myofibroblastic Tumors in Children. Front Pediatr 2019; 7:39. [PMID: 30891434 PMCID: PMC6411639 DOI: 10.3389/fped.2019.00039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/30/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: To explore the ultrasonic manifestations of mesenteric inflammatory myofibroblastic tumors (IMTs) in children. Methods: Seven patients with mesenteric IMTs were retrospectively analyzed. The ultrasonic manifestations, such as the locations, sizes, morphology, borders, internal echo, blood flow, and metastasis, of the tumors were detected. Results: In all the seven pediatric patients, a solitary lesion was found for the mesenteric IMTs, including five cases in the ileocecal mesentery and two cases in the mesentery of ascending colon. All the single tumors were revealed as irregular hypoechoic masses with uneven internal echoes and enhanced echoes in the surrounding intestine and omentum. Internal blood flow signals were enriched in the tumors. The borders were clear in five cases and unclear in two cases. In addition, two cases had peritoneal effusion and one case had calcified plaques. In the follow-up studies, one of the seven IMT patients had malignant transformation, and one case was transferred to the pelvic cavity. Conclusion: Ultrasonic examination can clearly demonstrate the locations, sizes, morphology, borders, internal echo, blood flow as well as metastasis of the pediatric IMT of the mesentery, having an important clinical application value as an adjunct to computed tomography (CT).
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Affiliation(s)
- Jingjing Qian
- Department of Ultrasound, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Zhu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Ye
- Department of Ultrasound, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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20
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Moran CA, Suster S. Reprint of: Unusual non-neoplastic lesions of the lung. Semin Diagn Pathol 2018; 35:339-346. [PMID: 30249369 DOI: 10.1053/j.semdp.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many nonneoplastic conditions that may affect the lung are in reality rare or unusual manifestations of metabolic processes, inflammatory conditions, or unknown etiology. Because of their rarity, they can often be confused with malignant neoplasms. Familiarity with these conditions not only will expedite further treatment for these patients but also will avoid the process of more tests or unnecessary surgical procedures. The nomenclature for some of those conditions is still controversial. The clinical outcome of these conditions can be quite variable, with some patients surviving a long number of years and others eventually succumbing to the disease. We will limit our discussion in this review to four of these conditions, including inflammatory pseudotumor (inflammatory myofibroblastic tumor), placental transmogrification of lung, alveolar microlithiasis, and metastatic calcification. Although these lesions are not part of the gamut of neoplastic conditions affecting the lung, they are nonetheless important to recognize, as their outcome may not necessarily be an innocuous one.
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Affiliation(s)
- Cesar A Moran
- Department of Pathology, M.D. Anderson Cancer Center, Houston, Texas.
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
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21
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Patel A, Kocoglu MH, Kaul A. Therapeutic strategies for durable response in plasma cell granulomas in the central nervous system. Ann Hematol 2018; 98:1027-1029. [PMID: 30178192 DOI: 10.1007/s00277-018-3490-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/27/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Ameet Patel
- Department of Medicine, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA.
| | - Mehmet H Kocoglu
- Division of Hematology/Oncology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Akash Kaul
- American University Integrative Sciences, Tucker, GA, USA
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22
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Boylan KE, Larsen BT, Young BA, Downs-Kelly E, Panchabhai TS, Collum ES, Jensen L, Emerson LL. Pulmonary Mycobacterial Spindle Cell Pseudotumor: A Report of 3 Cases Including a Practical Approach to Histopathologic Recognition of This Unusual Entity. Int J Surg Pathol 2018; 26:629-634. [PMID: 29720005 DOI: 10.1177/1066896918770010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mycobacterial spindle cell pseudotumor (MSP) is a rare benign spindle cell lesion containing acid-fact mycobacteria. These lesions are most commonly identified in the lymph nodes, skin, spleen, or bone marrow of immunocompromised patients and only rarely involve the lungs. We report 3 cases of pulmonary MSP, which include 2 patients who are known to be HIV-positive. The histopathological diagnosis of MSP in the lung lends itself to many challenges due to its rare incidence and its spindled tumor-like appearance. The differential diagnosis is broad and includes both benign and malignant entities. We highlight the importance of the clinical context in which these lesions typically present and the morphologic spectrum of features seen, and we offer a practical approach to the workup of pulmonary mycobacterial pseudotumor. Appropriate recognition of this entity should lead to an accurate diagnosis of a treatable benign condition despite the clinical presentation often favoring malignancy.
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Affiliation(s)
- Katherine E Boylan
- 1 Department of Pathology, University of Utah School of Medicine and Associated Regional and University Pathologists Laboratories, Salt Lake City, UT, USA
| | - Brandon T Larsen
- 2 Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Brittany A Young
- 1 Department of Pathology, University of Utah School of Medicine and Associated Regional and University Pathologists Laboratories, Salt Lake City, UT, USA
| | - Erinn Downs-Kelly
- 1 Department of Pathology, University of Utah School of Medicine and Associated Regional and University Pathologists Laboratories, Salt Lake City, UT, USA
| | - Tanmay S Panchabhai
- 3 John and Doris Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Earle S Collum
- 4 Department of Pathology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Leif Jensen
- 5 Department of Radiology, Division of Chest Imaging, University of Utah, Salt Lake City, UT, USA
| | - Lyska L Emerson
- 1 Department of Pathology, University of Utah School of Medicine and Associated Regional and University Pathologists Laboratories, Salt Lake City, UT, USA
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23
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Liu HK, Lin YC, Yeh ML, Chen YS, Su YT, Tsai CC. Inflammatory myofibroblastic tumors of the pancreas in children: A case report and literature review. Medicine (Baltimore) 2017; 96:e5870. [PMID: 28079824 PMCID: PMC5266186 DOI: 10.1097/md.0000000000005870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumors are an uncommon neoplasm, which are very rarely located in the pancreas. Clinically and radiologically, this rare pancreatic tumor presents as an abdominal mass lesion that mimics other pancreatic tumors, and should therefore be considered in the differential diagnosis of pancreatic tumors. CLINICAL FINDINGS AND DIAGNOSIS The 15-year-old boy complained of abdominal pain over the left upper quadrant with intermittent fever for 7 days. Abdominal sonography revealed one cystic lesion with a hyperechoic component in the left upper quadrant of the abdomen. Surgical excision was performed and postoperative findings indicated a pancreatic tail tumor. The pathology indicated inflammatory myofibroblastic tumors. To our knowledge, this patient is a unique case as the tumor was located in the pancreatic tail only, sparing the body. INTERVENTIONS AND OUTCOMES The patient underwent tumor resection and segmental resection of the transverse colon with simple closure. The patient had no evidence of disease recurrence at 3 years follow-up. CONCLUSION Inflammatory myofibroblastic tumors of the pancreas in children are extremely rare. Surgical excision is the standard treatment, and corticosteroids use in children need more large-scale studies.
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Affiliation(s)
| | | | | | - Yaw-Sen Chen
- Department of Surgery, E-Da Hospital, I-Shou University, Yanchao District, Kaohsiung, Taiwan
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24
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Wang X, Zhao X, Chin J, Zhu L, Wang Z, Zhong Z. Recurrent retroperitoneal inflammatory myofibroblastic tumor: A case report. Oncol Lett 2016; 12:1535-1538. [PMID: 27446466 DOI: 10.3892/ol.2016.4767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 06/07/2016] [Indexed: 01/25/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT), which was previously known as inflammatory pseudotumor, is characterized by myofibroblastic spindle cells accompanied by inflammatory infiltrates. IMT is a rare lesion of unclear etiology, which induces non-specific clinical symptoms. The present case report describes a 74-year-old female patient with recurrent IMT, which was successfully re-resected 30 months subsequent to initial surgical removal. The patient presented with left hydroureteronephrosis and a 10-cm paravertebral mass which, upon surgery, was found to involve the descending colon. Successful, complete en bloc re-resection was achieved, and at 24 months follow-up, the patient remained clinically free of disease. Complete surgical extirpation, where feasible, is the recommended treatment for primary and recurrent IMT lesions.
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Affiliation(s)
- Xinjun Wang
- Department of Urology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Joseph Chin
- Department of Surgery, Division of Urology, London Health Sciences Centre, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Liang Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zijian Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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Hassan M, Pujani M, Jairajpuri ZS, Rana S, Goel A, Jetley S. Inflammatory Pseudotumor of the Spleen Masquerading as Splenic Malignancy. Oman Med J 2016; 31:154-7. [PMID: 27168929 DOI: 10.5001/omj.2016.30] [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] [Indexed: 11/03/2022] Open
Abstract
Inflammatory pseudotumors (IPTs) of the spleen are extremely rare, benign tumors of unknown etiology, and are most frequently detected incidentally. We report a case of IPT of the spleen in a 19-year-old male, who presented to the Hamdard Institute of Medical Sciences and Research, New Delhi, with a history of pain and heaviness in the left hypochondrium. On clinical examination, splenomegaly was detected. Ultrasonography and contrast-enhanced computed tomography of the abdomen revealed an enlarged spleen with a mass lesion completely occupying the lower pole of the spleen. Therefore, a diagnosis of splenomegaly with a malignant splenic lesion was suggested. Open splenectomy was performed. On gross examination, a well-circumscribed nodular growth measuring 9 × 8 × 5 cm in diameter was seen on the lower pole of the spleen, which on cut section appeared tan white with foci of yellowish discoloration. Microscopic examination of the nodular growth revealed spindle cells in a hyalinized stroma with inflammatory infiltration of predominantly plasma cells and lymphocytes. On immunohistochemistry, the spindle cells were positive for smooth muscle actin. A diagnosis of IPT of the spleen was rendered following histopathology testing. Splenectomy is both diagnostic and curative for this rare entity, and prognosis is usually favorable following the procedure.
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Affiliation(s)
- Mohammad Hassan
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Mukta Pujani
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Zeeba Shamim Jairajpuri
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Safia Rana
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Amit Goel
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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26
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Adachi M, Kiho K, Sekine G, Ohta T, Matsubara M, Yoshida T, Katsumata A, Tanuma JI, Sumitomo S. Inflammatory Myofibroblastic Tumor Mimicking Apical Periodontitis. J Endod 2015; 41:2079-82. [DOI: 10.1016/j.joen.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/01/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022]
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27
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Werner RL, Castle JT. Inflammatory Myofibroblastic Tumor of the Nasal Cavity. Head Neck Pathol 2015; 10:336-9. [PMID: 26483083 PMCID: PMC4972743 DOI: 10.1007/s12105-015-0662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel L. Werner
- Department of Head and Neck and Endocrine Pathology, The Joint Pathology Center, Silver Spring, MD 20910 USA
| | - James T. Castle
- Department of Oral and Maxillofacial Pathology, Naval Postgraduate Dental School, 8955 Wood Road, Bethesda, MD 20889-5628 USA
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Panda D, Mukhopadhyay D, Datta C, Chattopadhyay BK, Chatterjee U, Shinde R. Inflammatory Myofibroblastic Tumor Arising in the Pancreatic Head: a Rare Case Report. Indian J Surg 2015; 77:538-40. [PMID: 26884665 DOI: 10.1007/s12262-015-1322-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/18/2015] [Indexed: 12/31/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. It is primarily a visceral and soft tissue tumor; however, involvement of pancreas is extremely unusual. A localization in the pancreas needs differentiation from other tumors and chronic pancreatitis. We report a case of inflammatory myofibroblastic tumor arising in pancreatic head in a 32-year-old female who underwent Whipple's procedure.
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Affiliation(s)
- Devasis Panda
- Department of Pathology, I.P.G.M.E & R., Kolkata, 700020 India
| | | | - Chhanda Datta
- Department of Pathology, I.P.G.M.E & R., Kolkata, 700020 India
| | | | | | - Raunak Shinde
- Department of General Surgery, I.P.G.M.E & R., Kolkata, India
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Inflammatory myofibroblastic tumor of the pancreatic head - a case report of a 6 months old child and review of the literature. Radiol Oncol 2015; 49:265-70. [PMID: 26401132 PMCID: PMC4577223 DOI: 10.2478/raon-2014-0017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/22/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumors are rare in the pediatric population. Most common localizations were reported in the lungs. A localization in the pancreas needs differentiation from other tumors and chronic pancreatitis. Treatment is surgical resection, although there are reports of treatment with oral steroids and radiation therapy. CASE REPORT A 6-month-old child was treated due to a tumor in the head of the pancreas. On admission he was jaundiced with pruritus. US and MRI confirmed pancreatic tumor. Preoperative biopsy wasn't conclusive regarding the nature of the tumor. Duodenopancreatectomy was performed. Postoperative course was uneventful. Histologic examination confirmed the diagnosis of inflammatory myofibroblastic tumor. On follow up, he remained with no evidence of recurrence. CONCLUSIONS A literature review revealed 10 cases of pancreatic inflammatory myofibroblastic tumors in the pediatric age group. Our patient is the youngest reported. Despite major resection, there were no complications. However, management of this child might be possible with steroids, but conservative treatment might be insufficient, especially in aggressive forms of tumors.
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Abstract
We describe and analyze the clinical course and imaging findings of a case of a renal inflammatory myofibroblastic tumor (IMT) that is similar to cystic renal cell carcinoma. "Solitary cysts" on the left kidney were found during a health examination of a 60-year-old female. The patient also had hypertension. She had undergone surgeries twice for limb trauma fracture and had no definite record of hepatitis. There was no tenderness with percussion of the kidney area or edema in the lower extremity. The renal function results, including serum creatinine, blood urea nitrogen, and blood urea, were within the normal range. No gross hematuria or microscopic hematuria was found. An 8.7 cm × 9.2 cm mixed echogenic mass at the upper pole of the left kidney was observed with ultrasound, the majority of which was an anechoic mass that was slightly protruding from the renal capsule and had well-circumscribed borders. After a bolus injection of an ultrasound contrast agent, the mass had rapid enhancement with fast fading. An approximately 9.4 cm × 10.1 cm round-like cyst lesion at the upper pole of the left kidney was revealed by computed tomography (CT) examination of the abdomen; it had edge finishing with well-circumscribed borders. The upper inner wall of the lesion was thick with crescentic soft tissue. The solid content had gradual enhancement on enhanced CT scans. A kidney tumor was considered based on the CT findings. Based on the preoperative examination, the left renal cystic masses were resected. Intraoperative frozen sections were used to further clarify the nature of the lesion, and no significant malignant cells were observed; therefore, the kidney was not removed. The pathological diagnosis was renal IMT. After surgery, the patient recovered and did not have recurrence or metastasis over the course of long-term follow-up. CT images of our patient with renal cystic disease are categorized as Fuhrman grade IV and typically indicate the presence of malignant lesions. However, gradual enhancement of the solid content in our case is different from typical cystic renal cell carcinoma. The nature of the lesion was further identified using intraoperative frozen sections, which helped avoid unnecessary nephrectomy.
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Affiliation(s)
- Wenjie Liang
- From the Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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31
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Ugalde P, García Bernardo C, Granero P, Miyar A, González C, González-Pinto I, Barneo L, Vazquez L. Inflammatory pseudotumor of spleen: a case report. Int J Surg Case Rep 2015; 7C:145-8. [PMID: 25648471 PMCID: PMC4336391 DOI: 10.1016/j.ijscr.2015.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
We present a case of nflammatory pseudotumor of spleen. It is an extremely rare condition of unknown etiology. It is considered as a benign lesion with multiple differential diagnoses. Splenectomy is indicated to confirm diagnosis.
Introduction Inflammatory pseudotumor of spleen is an extremely rare benign condition of uncertain etiology that presents with nonspecific symptoms or as an incidental finding in patients studied by other processes. Since the first description in 1984 by Cotelingam and Jaffe, only 114 cases have been reported. Presentation of case We present a case of a fifty-six years old woman with a splenic injury in ultrasound and computed tomography. The patient undergoes laparoscopic splenectomy and the histologic study of the specimen revealed findings consistent with inflammatory pseudotumor of spleen. Discussion This rare entity whose pathogenesis is still unknown, can present with nonspecific symptoms. Radiologic studies may lead the diagnosis being useful CT and MRI. The definitive diagnosis is established with the histological findings, characterized by the presence of inflammatory cells with areas of necrosis and fibrosis. There are multiple differentials diagnoses: metastasis, lymphoma, splenic infarction, hemangiomas, vascular malformations, lymphangioma, plasmacytoma, reactive lymphoid hyperplasia, abscess and infectious granulomatous processes; therefore suspicion of malignant neoplasm must be considered, being indicated splenectomy to confirm the diagnosis. Conclusion Inflammatory pseudotumor of spleen is a benign disease, in which diagnostic approach must bear in mind the possibility of a malignant lesion. For this reason, the surgical approach is appropriate to confirm the diagnosis and rule out malignancy with histology.
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Affiliation(s)
- Paúl Ugalde
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Carmen García Bernardo
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Granero
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alberto Miyar
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen González
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio González-Pinto
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Barneo
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lino Vazquez
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
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Eilers AL, Nazarullah AN, Shipper ES, Jagirdar JS, Calhoon JH, Husain SA. Cardiac Inflammatory Myofibroblastic Tumor. World J Pediatr Congenit Heart Surg 2014; 5:556-64. [DOI: 10.1177/2150135114546203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although inflammatory myofibroblastic tumors (IMTs) can be found in virtually every major organ, cardiac origin is rare. After recently providing care to a child who presented with a significant myocardial infarction, interest in this rare tumor was piqued. We describe a comprehensive review of cardiac IMT, including information on nomenclature, epidemiology, clinical features, pathogenesis, gross/histological features, immunohistochemical profile, diagnosis, treatment, and prognosis. Fifty-seven cases were identified in the literature. Interestingly, our case represents the seventh case of coronary artery involvement reported. Moreover, it was found that an initial presentation of sudden death most commonly involves the coronary arteries.
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Affiliation(s)
- Amanda L. Eilers
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alia N. Nazarullah
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Edward S. Shipper
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jaishree S. Jagirdar
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John H. Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S. Adil Husain
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Inflammatory myofibroblastic tumors of the nasal cavity and paranasal sinus: a clinicopathologic study of 25 cases and review of the literature. Eur Arch Otorhinolaryngol 2014; 272:789-797. [PMID: 24756612 DOI: 10.1007/s00405-014-3026-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/24/2014] [Indexed: 12/17/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is rare in nasal cavity and paranasal sinus. The aim of this study was to describe the clinicopathological features of sinonasal IMT and analyze the relationship between the clinicopathological features and the prognosis. A retrospective study of 25 IMT patients between 2001 and 2012 was performed. Data on clinical features, treatment, and follow-up were recorded. The histological characters were observed. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan-Meier method. Clinically, the most common symptoms were nasal obstruction, facial pain, and toothache. Twenty patients received follow-ups 6-120 months after initial diagnosis. Fifteen (75 %) developed recurrence 1 or more times. One patient had left cervical lymph node metastasis (5 %). Five patients died of the tumor (25 %). Histologically, the IMTs composed of bland spindle cells admixed with a prominent infiltrate of plasma cells and lymphocytes and showed obvious atypia in recurrent cases. Histology with necrosis, mitosis (≥1/10 HPF), ganglion-like cells, histological pattern I or II and relapse (≥4 times) was significantly associated with poor OS and EFS. IMT of the nasal cavity and paranasal sinuses exhibits relatively bland histologic appearances, but can shows strongly aggressive behavior and relatively poor outcomes. Multiple relapse, necrosis, frequent mitosis, the presence of ganglion-like cells, and histological pattern might be associated with poor clinical outcomes.
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Navale P, Menon S, Bakshi G, Pruthy R, Desai S. Inflammatory myofibroblastic tumor of kidney with heterotopic bone formation: An unusual case mimicking a renal malignancy. Indian J Med Paediatr Oncol 2014; 34:320-2. [PMID: 24604966 PMCID: PMC3932604 DOI: 10.4103/0971-5851.125257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMFT) or pseudotumor is a rare tumor that can be seen in various organs. It is an enigmatic tumor of unknown etiology and difficult to differentiate from malignancy, clinically as well as radiologically. Histologically, it is composed of variable proportions of proliferating spindle myofibroblasts, fibroblasts, extracellular collagen, lymphocytes and plasma cells. This mainly affects the urinary bladder or prostate. Renal involvement is extremely rare and may pose diagnostic difficulty to the clinician. We describe a renal IMFT, mimicking renal malignancy, having unusual histological features.
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Affiliation(s)
- Pooja Navale
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ganesh Bakshi
- Department of Urologic Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Ritesh Pruthy
- Department of Urologic Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sangeeta Desai
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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He CY, Dong GH, Liu HG. Recurrent laryngeal inflammatory myofibroblastic tumor with positive anaplastic lymphoma kinase mimicking recurrent respiratory papillomatosis: a case report. World J Surg Oncol 2014; 12:54. [PMID: 24602144 PMCID: PMC3996035 DOI: 10.1186/1477-7819-12-54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/19/2014] [Indexed: 12/24/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) of the larynx is an unusual lesion, particularly in the pediatric age group. Laryngeal IMTs in children follow a benign clinical course with reports of only rare recurrences and no metastases. Although anaplastic lymphoma kinase (ALK) has been associated with IMTs, there is only one pediatric laryngeal IMT reported to be ALK-positive with immunohistochemical staining. Here, we present a case of a 10-year-old boy with a laryngeal IMT that recurred four times and was misdiagnosed as recurrent respiratory papillomatosis after the initial three operations. ALK positivity was demonstrated by both immunohistochemical staining and fluorescence in situ hybridization. To the best of our knowledge, this case report is the first to describe a laryngeal IMT that recurred multiple times and was confirmed to be ALK-positive at the molecular level.
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Affiliation(s)
| | | | - Hong-gang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, No,1 Dongjiaominxiang Street, Dongcheng District, Beijing 100730, China.
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36
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Rajabi P, Noorollahi H, Hani M, Bagheri M. Inflammatory pseudotumor of spleen. Adv Biomed Res 2014; 3:29. [PMID: 24592376 PMCID: PMC3928915 DOI: 10.4103/2277-9175.124679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 03/03/2013] [Indexed: 01/13/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is an uncommon tumor and its occurrence in spleen is rare. This tumor is composed of proliferation of spindle cells of unknown origin and etiology that mimic other tumors at clinical and histological evaluation. The most surmising etiology is Epstein Barr virus (EBV) and the most suspected origin is myofibroblasts, hence its synonym is "inflammatory myofibroblastic tumor." The clinical appearance of tumor is related to its location but the most ones are abdominal pain, fever and weight loss. Surgical removal for this lesion is treatment of choice and there is few reported case with recurrence and metastasis. Herein we report a 63-year-old female patient with and abdominal discomfort that primary paraclinical investigations had been showed splenic mass and therefore surgical treatment was performed for her. Microscopic examination suggest some different diagnosis such as IPT, thus immunohistochemical staining was perform to confirm the diagnosis and rule out the others.
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Affiliation(s)
- Parvin Rajabi
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Noorollahi
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Hani
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Bagheri
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
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Palaskar S, Koshti S, Maralingannavar M, Bartake A. Inflammatory myofibroblastic tumor. Contemp Clin Dent 2012; 2:274-7. [PMID: 22346151 PMCID: PMC3276851 DOI: 10.4103/0976-237x.91787] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Inflammatory myofibroblastic tumor is an uncommon lesion of unknown cause. It encompasses a spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. A number of terms have been applied to the lesion, namely, inflammatory pseudotumor, fibrous xanthoma, plasma cell granuloma, pseudosarcoma, lymphoid hamartoma, myxoid hamartoma, inflammatory myofibrohistiocytic proliferation, benign myofibroblatoma, and most recently, inflammatory myofibroblastic tumor. The diverse nomenclature is mostly descriptive and reflects the uncertainty regarding true biologic nature of these lesions. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case of inflammatory pseudotumor and review its inflammatory versus neoplastic behavior.
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Affiliation(s)
- Sangeeta Palaskar
- Department of Oral Pathology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
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Multiple inflammatory myofibroblastic tumor of the duodenum: case report and literature review. J Gastrointest Surg 2012; 16:1442-5. [PMID: 22528570 DOI: 10.1007/s11605-012-1883-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/22/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) is a rare low-grade malignant mesenchymal tumor, which can occur at any location, although the lung is the most commonly affected organ. It is extremely rare in the duodenum and only two cases have been reported previously. We report, to our knowledge, the first case of multiple neoplastic lesions. CASE REPORT A 20-year-old male presented with the chief complaints of intermittent right epigastric pain, nausea and vomiting. Imaging examination, electronic gastroscopy and preoperative biopsy revealed undefined lesions in the duodenum. Pancreaticoduodenectomy was performed and diagnosis of multiple IMT was confirmed by pathological biopsy of the excised tumor. A satisfactory outcome was proved by the follow-up 1 year after curative operation. CONCLUSION IMT can be diagnosed by histological examination and immunohistochemical test after surgical resection. Patients can benefit from radical resection with favorable prognosis.
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Siminovich M, Galluzzo L, López J, Lubieniecki F, de Dávila MTG. Inflammatory myofibroblastic tumor of the lung in children: anaplastic lymphoma kinase (ALK) expression and clinico-pathological correlation. Pediatr Dev Pathol 2012; 15:179-86. [PMID: 22280150 DOI: 10.2350/11-10-1105-oa.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare neoplastic lesion with a high incidence in children and young people, and may arise in lungs, soft tissue, or viscera. It is recognized as a borderline tumor with the possibility to recur, undergo malignant transformation, and metastasize. IMT is composed of fascicles of bland myofibroblastic cells admixed with an inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils. We reviewed pulmonary IMT diagnosed at Garrahan Hospital in Buenos Aires, Argentina, during 12 years and examined the clinical, laboratory, and pathological features as well as molecular genetics. Eight pediatric cases were evaluated with a male-to-female ratio of 5:3 and a median age of 6 years at diagnosis. The most common lung localization was the upper lobe. All cases underwent surgical excision and no local recurrences were found. Five out of eight patients, including two cases with metastatic/multifocal lesions in the central nervous system (CNS), are alive and disease free after a median follow-up of 30 months. Anaplastic lymphoma kinase (ALK) expression was negative in all pulmonary samples by immunohistochemistry (IHC), however, rearrangement for ALK locus by fluorescence in situ hybridization was found in one lung and in two CNS samples. These findings may reflect higher sensitivity of the molecular biologic procedure compare to traditional IHC practice. In our pediatric experience, 25% of patients with lung IMT developed CNS lesions; therefore we consider that CNS screening in these patients should be considered, at diagnosis and later during follow up.
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Affiliation(s)
- Mónica Siminovich
- Department of Pathology, Hospital Nacional de Pediatría J. P Garrahan, Buenos Aires, Argentina.
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Ohsaki E, Ueda K. Kaposi's Sarcoma-Associated Herpesvirus Genome Replication, Partitioning, and Maintenance in Latency. Front Microbiol 2012; 3:7. [PMID: 22291692 PMCID: PMC3264903 DOI: 10.3389/fmicb.2012.00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 01/05/2012] [Indexed: 02/03/2023] Open
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) is thought to be an oncogenic member of the γ-herpesvirus subfamily. The virus usually establishes latency upon infection as a default infection pattern. The viral genome replicates according to the host cell cycle by recruiting the host cellular replication machinery. Among the latently expressing viral factors, LANA plays pivotal roles in viral genome replication, partitioning, and maintenance. LANA binds with two LANA-binding sites (LBS1/2) within a terminal repeat (TR) sequence and is indispensable for viral genome replication in latency. The nuclear matrix region seems to be important as a replication site, since LANA as well as cellular replication factors accumulate there and recruit the viral replication origin in latency (ori-P) by its binding activity to LBS. KSHV ori-P consists of LBS followed by a 32-bp GC-rich segment (32GC). Although it has been reported that LANA recruits cellular pre-replication complexes (pre-RC) such as origin recognition complexes (ORCs) to the ori-P through its interaction with ORCs, this mechanism does not account completely for the requirement of the 32GC. On the other hand, there are few reports about the partitioning and maintenance of the viral genome. LANA interacts with many kinds of chromosomal proteins, including Brd2/RING3, core histones, such as H2A/H2B and histone H1, and so on. The detailed molecular mechanisms by which LANA enables KSHV genome partitioning and maintenance still remain obscure. By integrating the findings reported thus far on KSHV genome replication, partitioning, and maintenance in latency, we will summarize what we know now, discuss what questions remain to be answered, and determine what needs to be done next to understand the mechanisms underlying viral replication, partitioning, and maintenance strategy.
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Affiliation(s)
- Eriko Ohsaki
- Division of Virology, Department of Microbiology and Immunology, Osaka University Graduate School of Medicine Suita, Osaka, Japan
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Garcia BA, Tinsley S, Schellenberger T, Bobustuc GC. Recurrent inflammatory pseudotumor of the jaw with perineural intracranial invasion demonstrating sustained response to Rituximab. Med Oncol 2011; 29:2452-5. [PMID: 22161155 DOI: 10.1007/s12032-011-0128-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/28/2011] [Indexed: 12/12/2022]
Abstract
Corticosteroids are the mainstay of treatment of inflammatory pseudotumor (IPT) of the head and neck; however, involvement of the skull base and mandible can be unresponsive to steroids and require surgical resection. IPT is known to usually contain a CD20+ lymphocyte subgroup. Rituximab, a chimeric anti-CD20 antibody, has been successfully utilized in the treatment of other CD20+ diseases, including the similar idiopathic orbital inflammatory disease. This is the first report to describe successful treatment with Rituximab of a recurrent IPT of the mandible with trigeminal spread and leptomeningeal involvement with clinical and radiologic evidence demonstrating a sustained response to therapy.
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Affiliation(s)
- Bryan A Garcia
- Florida State University College of Medicine-Orlando Campus, 250 East Colonial Drive Suite 200, Orlando, FL 32801, USA.
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Gutiérrez-Jodas J, Ruiz-Molina I, Jurado-Ramos A, Navarro JCP, Ramirez-Ponferrada R, Solis-Garcia E, Baños EC. Inflammatory myofibroblastic tumor of the subglottis in children—Report of a single case with positive anaplastic lymphoma kinase. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pedex.2010.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Zhou X, Luo C, Lv S, Gan M. Inflammatory myofibroblastic tumor of the rectum in a 13-month-old girl: a case report. J Pediatr Surg 2011; 46:E1-4. [PMID: 21763818 DOI: 10.1016/j.jpedsurg.2011.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/05/2011] [Accepted: 03/11/2011] [Indexed: 12/17/2022]
Abstract
Inflammatory myofibroblastic tumor is a rare benign neoplasm. It is common in children and has been reported in various locations throughout the body but rarely in the rectum. A 13-month-old girl presented with a short history of a painless anal mass and no hematochezia. The mass was completely excised, and histologic examination of the initial biopsy showed fascicles of spindle cells in a mixed inflammatory background with predominance of plasma cells, typical of an inflammatory pseudotumor. The spindle cells were positive for smooth muscle actin and anaplastic lymphoma kinase staining. There is no evidence of recurrence or metastasis after a follow-up of 4.5 years.
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Affiliation(s)
- Xuewu Zhou
- Department of Pediatric Surgery, Taizhou Hospital, Zhejiang Province, China.
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44
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Shlopov BV, French SW. Inflammatory myofibroblastic tumor of the lung with unique histological pattern and association with Sjögren's disease and systemic lupus erythematosus. Exp Mol Pathol 2011; 91:509-14. [PMID: 21669196 DOI: 10.1016/j.yexmp.2011.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) of the lung is a rare condition. Radiological properties and clinical presentation of this disease can mimic malignant process. We present a case of IMT of the lung in a 58 year old female patient with a single lung nodule. Tumor was unencapsulated, firm, and well circumscribed. Microscopically tumor had multinodular structure with single or multiple small blood vessels in the center of each nodule surrounded in circular pattern by connective tissue containing spindle cells embedded into the thick layers of extracellular matrix. Extracellular matrix was identified as type I and type III collagen fibrils embedded into type IV collagen and laminin. The tumor was surrounded by T-, B-lymphocytes and polyclonal plasma cells. Histological organization of this lesion's stromal component was unique, but cell composition was similar to inflammatory pseudotumor of the lung. In addition, tumor tissue sections exhibited strong positivity for IgG, weak positivity for IgA, 1Cq, but were negative for IgM, and C3. Mutational analysis of the EGFR, KRAS genes and ALK locus rearrangement were performed and did not reveal any mutations. This is the first report of an IMT associated with Sjögren's disease, systemic lupus erythematosus and Non-Hodgkin lymphoma developing in the lungs. Patient was clinically followed up for 18 months and no recurrence of the tumor observed.
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Affiliation(s)
- Boris V Shlopov
- Department of Pathology and Laboratory Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA
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Pfeifer L, Agaimy A, Janka R, Boxberger F, Wein A, Neurath MF, Siebler J. Complete Long-Term Remission of an Inflammatory Pseudotumor under Corticosteroid Therapy. Case Rep Oncol 2011; 4:304-10. [PMID: 21734886 PMCID: PMC3124465 DOI: 10.1159/000329415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Inflammatory pseudotumors (IPT) form a group of etiologically, histologically, and biologically heterogeneous tumefactive lesions that are histologically characterized by prominent inflammatory infiltrates. IPT has been described in various organs including the lungs, bladder, liver, spleen, heart, and others. It may mimic a malignant tumor clinically and radiologically. We report a case of a 26-year-old woman with an ALK1-negative IPT (7 cm in maximal diameter) mainly located in the 12th right back muscles, surrounding a fractured rib. Histologically, the tumor consisted of an inflammatory infiltrate composed predominantly of diffusely distributed lymphoplasmacytic cells and stromal fibroblasts associated with focal obliterative phlebitis. Conservative steroid treatment resulted in complete remission and the patient remained disease-free for more than 1 year later. To our knowledge this is the first report of IPT involving the skeletal back muscle and complete resolution under corticosteroid treatment.
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Affiliation(s)
- Lukas Pfeifer
- Department of Internal Medicine 1, University of Erlangen, Erlangen, Germany
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Sasagawa Y, Akai T, Itou S, Iizuka H. Multiple Intraosseous Inflammatory Myofibroblastic Tumors Presenting With an Aggressive Clinical Course: Case Report. Neurosurgery 2011; 69:E1010-5; discussion E1015-6. [DOI: 10.1227/neu.0b013e318223b651] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
The authors report a rare case of multiple intraosseous inflammatory myofibroblastic tumors presenting with an aggressive clinical course.
CLINICAL PRESENTATION:
A 60-year-old man presented with a 3-month history of headache and 2 weeks of jaw pain. Magnetic resonance imaging showed a homogeneously enhancing mass in the right parietal bone with subcutaneous and intracranial invasion. Bone scintigraphy revealed 4 intraosseous lesions involving the cranium, mandible, ischium, and calcaneum. After admission, the patient showed left hemiparesis and seizures caused by rapid intracranial tumor extension. The cranial and mandible tumors were resected. Histopathological examinations of both specimens revealed myofibroblastic spindle cell proliferation with inflammatory cell infiltration, and a diagnosis of inflammatory myofibroblastic tumor was made. Two days postoperatively, the patient presented with a high fever and disturbance of consciousness with swelling of the subcutaneous tissues of the head and mandibular lesions. Magnetic resonance imaging revealed a massive intracranial extension of the tumor. Corticosteroid therapy induced remarkable shrinkage of all lesions, and relief from symptoms was obtained. Radiotherapy was then performed for residual tumors.
CONCLUSION:
Multiple intraosseous inflammatory myofibroblastic tumors of the bone are very uncommon and may mimic malignant tumors. It is important to recognize that this entity can occur in the cranium and as multiple bony lesions. The recommended treatment is complete surgical resection with adjuvant steroid treatment. Considering the aggressive nature of this entity, additional chemo- and/or radiotherapy may be warranted.
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Affiliation(s)
- Yasuo Sasagawa
- Department of Neurosurgery, Kanazawa Medical University, Ishikawa, Japan
| | - Takuya Akai
- Department of Neurosurgery, Kanazawa Medical University, Ishikawa, Japan
| | - Shoutarou Itou
- Department of Neurosurgery, Tonami General Hospital, Toyama, Japan
| | - Hideaki Iizuka
- Department of Neurosurgery, Kanazawa Medical University, Ishikawa, Japan
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Mondello B, Lentini S, Barone M, Barresi P, Monaco F, Familiari D, La Rocca A, Sibilio M, Acri IE, David A, Monaco M. Surgical management of pulmonary inflammatory pseudotumors: a single center experience. J Cardiothorac Surg 2011; 6:18. [PMID: 21345228 PMCID: PMC3049133 DOI: 10.1186/1749-8090-6-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/23/2011] [Indexed: 11/29/2022] Open
Abstract
Background The pulmonary inflammatory pseudotumor (PIP) is a rare disease. It is still debated whether it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. PIP is characterized by a cellular polymorphism. Methods We retrospectively analyzed 8 patients with PIP treated by surgery between 2001 and 2009. Preoperative thoracic computed tomography (CT) scan was performed in all cases. All patients underwent preoperative bronchoscopy with washing and brushing and/or transbronchial biopsy and preoperative cytology examination Results There were 5 men and 3 women, aged between 38 and 69 years (mean of 58 years). 3 patients (37%) were asymptomatic. The others had symptoms characterized by chest pain, shortness of breath and persistent cough or hemoptysis. 5 patients had neutrophilic leucocytosis. CT scan demonstrated solitary nodules (maximum diameter <3 cm) in 5 patients (62%) and lung masses (maximum diameter >3 cm) in 3 patients (37%). In 2 patients there were signs of pleural infiltration. Distant lesions were excluded in all cases. A preoperative histology examination failed to reach a definitive diagnosis in all patients. At surgery, we performed two lobectomies, one segmentectomy and five wedge resections, these being performed with videothoracoscopy (VATS), except for one patient where open surgery was used. Complete tumor resection was obtained in all patients. According to the Matsubara classification, there were 2 cases of organizing pneumonia, 5 cases of fibrous histiocytoma and one case of lymphoplasmacytoma. All patients were discharged alive from hospital between 4 and 7 days after surgery. At follow-up CT scan performed annually (range 11 to 112 months) (mean 58 months), there were no residual lesions, neither local nor distant recurrences. Conclusions PIP is a rare disease. Many synonyms have been used for this disease, usually in relation to the most represented cell type. The true incidence is unclear. Preoperative diagnosis is difficult to reach, despite performing a bronchoscopy or a transparietal needle aspiration. Different classifications have been proposed for PIP. Either medical, radiation or surgical therapy has been used for PIP. Whenever possible, surgery should be considered the standard treatment. Complete surgical resection is advocated to prevent recurrence.
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Affiliation(s)
- Baldassare Mondello
- Thoracic Surgery Unit, Cardiovascular and Thoracic Department, Policlinic University Hospital, University of Messina, Italy
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Pannain VL, Passos JV, Filho ADR, Villela-Nogueira C, Caroli-Bottino A. Agressive inflammatory myofibroblastic tumor of the liver with underlying schistosomiasis: A case report. World J Gastroenterol 2010; 16:4233-6. [PMID: 20806444 PMCID: PMC2932931 DOI: 10.3748/wjg.v16.i33.4233] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) occurs infrequently in the liver. It is controversial whether it represents a low grade mesenchymal neoplasm or a reactive inflammatory lesion. Local recurrence and metastasis are rare and some tumors are associated with infectious agents. We report on a case of a large and partially resected IMT with local recurrence and diaphragm and kidney infiltration detected on routine surveillance two years later. Histologically, the tumor showed spindle cells without atypia, mitosis or necrotic areas in a myxoid and collagenized background with inflammatory cells. In the liver portal tracts, granulomatous lesions with viable eggs of Schistosoma mansoni were identified. Immunohistochemistry demonstrated spindle cells which were smooth-muscle actin and vimentin positive. In conclusion, this case points out that these histological patterns do not predict the aggressive biological behavior of the lesion. A reason for the recurrence and the infiltration may be incomplete tumor resection. Further investigation is necessary in order to better clarify an infectious cause in some IMTs.
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Chow SP, Nastri A, Hardy T. Infratemporal inflammatory myofibroblastic tumour with orbital extension. Clin Exp Ophthalmol 2010; 38:727-30. [DOI: 10.1111/j.1442-9071.2010.02329.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Obikane H, Ariizumi K, Yutani C, Mitsumata M. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) of the mitral valve of the heart. Pathol Int 2010; 60:533-7. [DOI: 10.1111/j.1440-1827.2010.02556.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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