Inflammatory pseudotumour of lymph nodes

Inflammatory myophibroblastic tumor of the proximal ileon in a patient with complicated umbilical hernia: A case report and literature review

Introduction

Inflammatory myofibroblastic tumors are neoplasms that occur infrequently, mainly affects children and young adults. It is an intermediate grade fibrotic multinodular neoplasm.

Description of the case

We present the case of a 47-year-old female patient, who underwent emergency umbilical hernioplasty, later developed intestinal obstruction secondary to an inflammatory myofibroblastic tumor.

Discussion

In 1939 Brunn described it for the first time, later in 1954 Umiker named it “Inflammatory Myofibroblastic Tumor”. The symptoms are nonspecific. In 15 to 40% of patients they are asymptomatic. Cells positive for actin, smooth muscle, vimentin and desmin, in 3367% of cases the cells are positive for ALK, which is present in some malignant lesions. The recommended treatment is radical resection.

Conclusion

The diagnosis is established by histopathological study, surgery is the cornerstone of treatment.

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Rare case of intestinal myofibroblastic tumor

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Inflammatory myofibroblastic tumors are infrequent tumors with benign behavior most of the time.

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Myofibroblastic tumor of unusual presentation

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Complete resection as the treatment of choice in myofibroblastic tumors

Differences between left and right suboccipital and intracranial vertebral artery dimensions: an influence on blood flow to the hindbrain?

BACKGROUND AND PURPOSE

Although vertebral artery (VA) blood flow is adequate in normal circumstances, reduction in the dimensions of the vessel because of atherosclerosis, or compression or stretching, may lead to hindbrain hypoxia with serious clinical manifestations. Such effects may be more pronounced in VAs that are naturally smaller than the norm. Because normative data for the suboccipital (VA3) and intracranial (VA4) vertebral artery are not readily available, it was the aim of the present study to measure the dimensions of these distal parts of the VA, to inform professional practice of the possible influence of different vessel dimensions on blood flow to the hindbrain.

METHOD

The study was a laboratory-based observational or descriptive study. A total of 40 and 54 left and right, suboccipital and intracranial parts of the VA (n = 188 vessels), obtained from cadavers of females and males aged 20-80 years, was processed for light microscopic study and measurement of the dimensions of the vessels. The left and right inner and outer diameters, cross-sectional areas and the tunica media thicknesses were calculated in each part of the vessel and compared by use of t-tests.

RESULTS

The histological structure of the VA was typical of a muscular or distributing artery. Although, in the total number of specimens, no statistically significant differences were found between left and right sides in either part of the vessel, a larger left than right VA4 was demonstrated in the females. The VA3 was significantly larger than VA4 in males and females, and all dimensions in both parts of the vessel were greatest in the older age group.

CONCLUSIONS

Reduced VA blood flow, whether because of atherosclerosis or compression or stretching of the vessel, is more likely to occur in arteries that are smaller than normal. This information is of value to clinicians in avoiding further compromising the VA and its blood flow during professional practice.

[Inflammatory pseudotumor of lymph node]

INTRODUCTION

Inflammatory pseudotumor of lymph node is a rare case in the etiology of fever of unknown origin.

OBSERVATION

We report the observation of a woman, aged 40, hospitalized with intermittent fever revealing under-diaphragm adenopathy related to inflammatory pseudotumor of lymph node.

CONCLUSION

Inflammatory pseudotumor of lymph node is a rare pathology whose nosological definition is unclear. It should probably be considered as belonging to a category different from the inflammatory pseudotumor of other organs. The diagnosis presents itself in case of isolated adenopathy or prolonged fever and is based on an anatomopathology that essentially calls to mind a lymphoma. The evolution of the condition is shown to be favorable : it can lead to a spontaneous remission, or call for a non-steroid anti-inflammatory treatment, or a steroid therapy.

Clinical and histological coexistence of inflammatory pseudotumour of the lymph nodes and rheumatoid arthritis

Inflammatory pseudotumour (IPT) of the lymph nodes is an uncommon, self-limiting, non-neoplastic proliferation of spindle cells, associated with a polymorphous inflammatory cell infiltrate embedded in a collagen-rich stroma and a variable degree of fibrosis, arising in the nodal parenchyma. Its clinical picture is characterised by site-specific signs and the presence, in most cases, of constitutional symptoms. The pathogenesis of IPT is unknown, but it has been interpreted as an aberrant reactive condition of the nodal connective framework, possibly related to viral infections or chronic inflammatory conditions. Its prognosis is usually favourable. We here report the simultaneous onset of seronegative rheumatoid arthritis (RA) and nodal IPT in a 31-year-old woman. Notably, in the nodal biopsy the coexistence of rheumatoid nodules, as well as histological and immunohistochemical features of IPT, was observed. To our knowledge, such an association has not been previously reported and the hypothesis that IPT could represent an unusual epiphenomenon of an RA-related chronic inflammatory response is suggested.

Inflammatory pseudotumor of lymph node and spleen: an entity biologically distinct from inflammatory myofibroblastic tumor

Inflammatory pseudotumors (IPTs) of the lymph node and spleen are an uncommon, benign cause of lymphadenopathy and/or splenomegaly that often bear striking clinicopathologic similarities to the inflammatory myofibroblastic tumors (IMTs) found in soft tissues. These tumors have classically been grouped together under the umbrella category of "inflammatory pseudotumor." Recent evidence shows that IMTs are in fact neoplastic processes that often harbor balanced chromosomal translocations involving the ALK kinase gene. These translocations result in expression of ALK kinase in IMTs as assessed by immunohistochemical studies. However, the relationship between IMT and IPT of the lymph node and spleen is uncertain. To determine if ALK tyrosine kinase expression is also present in IPT, 13 cases of IPT (9 involving lymph nodes, 4 splenic lesions) were examined for the presence of ALK tyrosine kinase by immunohistochemical staining on paraffin-embedded tissue. In addition, in situ hybridization studies for Epstein-Barr virus--encoded RNAs (EBER) and immunoperoxidase studies for human herpesvirus-8 (HHV8)--specific proteins were performed. All cases had clinical, morphologic, and immunophenotypic findings typical of IPT and had varying proportions of fibroblastic and inflammatory components. Age ranged from 11 to 75 (median, 40) years; 8 subjects were male, and 5 were female. None of the cases (0 of 13) had positive staining for ALK kinase or HHV8, and in 1 a lymph node (1 of 13) was focally positive for EBV (EBER) by in situ hybridization. The absence of ALK kinase as detected by immunohistochemical studies in IPT of the lymph node and spleen suggests that this entity is biologically distinct from the histologically similar IMT.

Inflammatory pseudotumor of lymph nodes: clinicopathologic and immunohistological study of 11 Japanese cases

We report 11 Japanese cases of inflammatory pseudotumor (IPT) of the lymph node. There were 7 males and 4 females with ages ranging from 5 to 68 years (median; 48). Only 2 patients had systemic lymphadenopathy, and all others had involvement of only 1 lymph node group. Constitutional symptoms such as fever were present in 8 patients and laboratory abnormalities were detected in 5. All patients recovered and were alive and well after 2 to 180 months (median; 32 months). Histologically, the process mainly involved the connective tissue framework of the lymph node, secondarily spreading into the lymph node parenchyma and the perinodal tissue. It was characterized by a storiform growth pattern of myofibroblasts, marked vascularity with associated vascular lesions, and a polymorphous reactive cellular infiltrate in a collagen-rich stroma. An immunohistochemical study revealed numerous myofibroblasts, histiocytes, and vascular endothelial cells expressing vascular endothelial growth factor (VEGF) in 6 cases. It was suggested that VEGF may be involved, in part, in the induction of the angiogenesis of IPT. Moreover, the present study indicates that follicular dendritic cell sarcoma, nasal T/natural killer cell lymphoma, and anaplastic large cell lymphoma should be added to the differential diagnosis from IPT of the lymph node. Int J Surg Pathol 9(3):207-214, 2001

Lymphadenopathy

Lymphadenopathy can occur in any age group, in symptomatic or asymptomatic patients, and in a single site or at multiple sites. Lymphadenopathy is associated with numerous disorders. An abnormal lymph node may be observed or palpated by the patient, found by a health care worker, or discovered through radiologic evaluation. Lymphadenopathy may be a part of a complex case presentation, or the clinical cause may be straightforward. Patients with potentially curable malignant disorders may have lymphadenopathy as the first sign of their disease. This review of lymphadenopathy summarizes general considerations, discusses which patients might be considered for biopsy, reviews which nodes are most likely to be diagnostic, outlines initial diagnostic considerations on a region-by-region basis, and reviews a broad differential diagnosis for adenopathy.