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Taiymi A, Meryem N, Bouziane M, Zazour A, Kharrasse G, Khannoussi W, Ismaili Z. Abdominal Inflammatory Myofibroblastic Tumour Presenting as a Pancreatic Mass: A Case Report. Cureus 2023; 15:e41213. [PMID: 37525776 PMCID: PMC10387333 DOI: 10.7759/cureus.41213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
An abdominal inflammatory myofibroblastic tumor (AIMT), is a rare benign tumor composed of inflammatory and other mesenchymal cells. It can affect the entire body, predominantly in children and young adults. The diagnosis is challenging considering the wide clinical presentation and can often be mistaken for malignant tumors. We report a rare case of a 46-year-old female patient, who presented with intermittent abdominal pain weight loss, and an abdominal palpable mass. Abdominal ultrasound found a well-defined 18 cm, rounded mass, with solid and cystic components. Abdominal CT demonstrated a well-defined, hypodense, retro gastric mass of 20 cm, with thickened wall and heterogenous enhancement. The mass had contact with the pancreatic tail, transverse colon, spleen, left kidney pedicles, abdominal aorta, superior mesenteric vein, and mesaraic trunk with no invasion signs. The mass was initially thought to be pancreatic cancer, but given the large size, other diagnoses like sarcoma, lymphoma, or abdominal hydatid cyst were suggested. Endoscopic ultrasound found a rounded retro gastric mass of 18/12 cm, with a thickened wall and well-limited calcifications. The content was both cystic and solid with mobile vegetations, with no visible Doppler flow. The mass had contact with the body and tail of the pancreas, spleen hilum, the upper pole of the spleen, and the hepatic pedicle behind, with no invasion sign. After a multidisciplinary team meeting, a decision was taken to perform surgical resection with mass resection, distal splenopancreatectomy, and transverse and sigmoid colectomy. Pathological and immunostaining results were consistent with inflammatory pseudotumor. The postoperative recovery was uncomplicated. The patient remains asymptomatic with no obvious signs of metastasis or recurrence. AIMT represents a reel diagnostic challenge. Clinical symptoms are unspecific. Radiological and endoscopic features can often be mistaken for malignant tumors. Surgical management remains to be the best therapeutic option. We report a rare case of AIMT treated by surgery with complete resection. We suggested a long-term follow-up given the local recurrence risk.
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Affiliation(s)
- Afafe Taiymi
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Mohammed First University, Oujda, MAR
| | - Nasiri Meryem
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
| | | | - Abdelkrim Zazour
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
| | - Ghizlane Kharrasse
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Mohammed First University, Oujda, MAR
| | - Wafaa Khannoussi
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Mohammed First University, Oujda, MAR
| | - Zahi Ismaili
- Gastroenterology and Hepatology, Mohammed VI University Hospital, Oujda, MAR
- Gastroenterology and Hepatology, Digestive Disease Research Laboratory, Oujda, MAR
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Liu JB, Gu QB, Liu P. Inflammatory myofibroblastic tumor of the pancreatic neck misdiagnosed as neuroendocrine tumor: A case report. World J Gastroenterol 2023; 29:3216-3221. [PMID: 37346157 PMCID: PMC10280791 DOI: 10.3748/wjg.v29.i20.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a relatively rare tumor. The global incidence of IMT is less than 1%. There is no specific clinical manifestation. It usually occurs in the lungs, but the pancreas is not the predilection site.
CASE SUMMARY We present a case of a male patient, 51 years old, who was diagnosed with a pancreatic neck small mass on ultrasound one year ago during a physical examination. As he had no clinical symptoms and the mass was relatively small, he did not undergo treatment. However, the mass was found to be larger on review, and he was referred to our hospital. Since the primal clinical diagnosis was pancreatic neuroendocrine tumor, the patient underwent surgical treatment. However, the case was confirmed as pancreatic IMT by postoperative pathology.
CONCLUSION Pancreatic IMT is relatively rare and easily misdiagnosed. We can better under-stand and correctly diagnose this disease by this case report.
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Affiliation(s)
- Jia-Bei Liu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha 410005, Hunan Province, China
| | - Qian-Biao Gu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
| | - Peng Liu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
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Patterson KN, Trout AT, Shenoy A, Abu-El-Haija M, Nathan JD. Solid pancreatic masses in children: A review of current evidence and clinical challenges. Front Pediatr 2022; 10:966943. [PMID: 36507125 PMCID: PMC9732489 DOI: 10.3389/fped.2022.966943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022] Open
Abstract
Pancreatic tumors in children are infrequently encountered in clinical practice. Their non-specific clinical presentation and overlapping imaging characteristics often make an accurate preoperative diagnosis difficult. Tumors are categorized as epithelial or non-epithelial, with epithelial tumors further classified as tumors of the exocrine or endocrine pancreas. Although both are tumors of the exocrine pancreas, solid pseudopapillary neoplasm is the most prevalent solid pancreatic tumor in children, while pancreatoblastoma is the most common malignant tumor. Insulinoma is the most common pediatric pancreatic tumor of the endocrine pancreas. Malignant tumors require a complete, often radical, surgical resection. However, pancreatic parenchyma-sparing surgical procedures are utilized for benign tumors and low-grade malignancy to preserve gland function. This review will discuss the epidemiology, pathophysiology, clinical and diagnostic characteristics, and management options associated with both common and rare solid pancreatic masses in children. We will also discuss current challenges encountered in their evaluation and treatment.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Archana Shenoy
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Maisam Abu-El-Haija
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jaimie D Nathan
- Department of Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children's Hospital, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, United States
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