Oral inflammatory myofibroblastic tumor: case report and review of literature

Inflammatory myofibroblastic tumor of anterior maxillary gingiva: An unusual clinical presentation

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm with variable clinical presentation. We hereby present a case of a 27-year-old female who presented to us with an unsuspecting gingival overgrowth in her anterior gingiva. This article aims to describe IMT as a rare intraoral entity which may involve the anterior maxillary gingiva, involving or sparing the underlying bone, as only a handful of such cases have been reported so far. Surgical excision is the mainstay of treatment. Biopsy and histopathological examination of even the smallest lesions is a must. Timely diagnosis and intervention can prevent severe morbidity that can arise if these lesions are left undiagnosed as aggressive management of lesions that become extensive is mandatory.

Inflammatory myofibroblastic tumor in the retromolar region of an 8-year-old child: A rare finding

Inflammatory myofibroblastic tumor (IMT) of the oral cavity is an extremely rare finding. The etiology and pathogenesis of IMT is controversial and unclear. The tumor requires complete surgical excision and continuous monitoring of clinical consequences. The present article describes the clinical, histological, operative and immunohistochemical features of a case of IMT in the mandibular retromolar region of an 8-year-old male. Histologically, the lesion shows myofibroblastic spindle cell proliferations with infiltrative margins in an inflammatory background. Immunohistochemically, the myofibroblastic spindle cells in the present case were positive for α-smooth muscle actin and CD68 due to which the diagnosis of IMT was confirmed.

Inflammatory myofibroblastic tumor manifesting as recurrent generalized gingival enlargement: Report of a rare case

Oral inflammatory myofibroblastic tumor (IMT) is extremely rare and its manifestation as generalized gingival enlargement (GGE) has never been reported. We are reporting the case of 50-year-old female patient presenting with recurrent GGE for 4 years. Panoramic radiograph revealed severe bone loss in posterior sextants and root resorption in some teeth. Initial incisional biopsy was suggestive of chronic inflammatory infiltrate with fibrocollagenous tissue. Definitive treatment comprised of surgical excision of the enlarged gingiva with a tapering dose of steroid therapy. Histopathological and immunohistochemical examination from a repeat biopsy of deeper tissues was suggestive IMT. No recurrence was found at 2 years follow up. Recurrent GGE with advanced bone loss and external root resorption should raise the suspicion of a locally aggressive lesion. Dentists should be aware of oral IMT and include it in differential diagnosis of gingival enlargements for comprehensive management to avoid recurrence of the lesion.

Seek the Spindle Tumor in Submandibular Space

INTRODUCTION

Submandibular region is surgically significant in the head and neck field and a mass in this region may have multiple differential diagnoses.

CASE REPORT

An elderly man came with a single 4×2.5 cm swelling in the neck on the right side, just below the lower jaw, since one month. Ultrasound showed an irregular heterogeneous hypoechoic lesion in the right submandibular space measuring 37×23 mm with mild internal vascularity. The submandibular gland appeared separate but compressed. Fine needle aspiration was suggestive of spindle cell neoplasm. The swelling was excised under general anesthesia. By histopathological examination, the lesion was diagnosed as anaplastic lymphoma kinase-negative inflammatory myofibroblastic tumor (IMT) based on focal immunoreactivity with cyclin D1. The patient then received radiotherapy 60 Gray divided into 30 fractions over 6 weeks. The case had no evidence of recurrence or residual disease six months post-surgery.

CONCLUSION

Tumefactive spindle-cell lesion in the head and neck can comprise inflammatory conditions, benign and malignant neoplasms or borderline neoplasms, such as nodular fasciitis and IMT. The definitive histologic diagnosis of IMT helps in tailoring the treatment modality based on its locally aggressive biologic potential.

Inflammatory myofibroblastic tumour of the jaw: A rare presentation

Inflammatory Myofibroblastic Tumour (IMT) is a rare entity of unknown aetiology and pathogenesis. It was initially described in the lung, although there have been reported cases affecting extra-pulmonary sites. The aetiology of IMT remains unclear, with current evidence suggesting that IMTs are neoplastic processes resulting from chromosomal translocations that often cause an overexpression of ALK tyrosine kinase. Histologically, a variably cellular myxoid morphology is common in these tumours, with the presence of inflammatory cell infiltrate. Clinically, symptoms are non-specific, although the presence of a swelling is frequently reported. Imaging studies are not very useful in the diagnosis, as they only describe the presence of a mass, and do not provide a definitive diagnosis. This article presents a case, of Inflammatory Myofibroblastic Tumour of the jaw, in a male patient aged 16 years.

Inflammatory Myofibroblastic Tumor: Rare Manifestation in Face

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth.

Inflammatory myofibroblastic tumour: A case report and a clinical update

The Inflammatory myofibroblastic tumor (IMT) is a heterogeneous group of rare lesions consisting predominantly of inflammatory cells and myofibroblastic spindle cells. Head and neck IMTs account for 14 to 18% of extra-pulmonary IMTs [lungs being the most commonly affected regions]. On account of its ambiguous clinical presentation, an IMT needs to be differentiated from other infectious, granulomatous, autoimmune and neoplastic lesions on the basis of histopathologic findings and immunohistochemical analysis. In this article, we report a case of IMT that presented in the anterior mandible that was treated by peripheral resection. Follow-up at 1 year showed satisfactory healing and no signs of recurrence. A special emphasis has been placed on the disputed nosology of this lesion and the latest therapeutic modalities.

Myofibroblasts: Master of disguise

Myofibroblasts are the unique population of smooth muscle-like fibroblasts. These cells have a role in growth factors secretion, matrix deposition and degradation. Thereby, myofibroblast contributes in both human physiology and pathology. This review explains the myofibroblastic lesions, imperative role of myofibroblasts in organogenesis, repair, regeneration, inflammation and tumorigenesis.

A rare case of inflammatory myofibroblastic tumor of the mandible mimicking a malignant tumor

Inflammatory myofibroblastic tumor (IMT) of the head and neck is a rare benign proliferative lesion of unknown etiology that mimics malignant lesions clinically and radiographically. I report the case of a 27-year-old woman who presented with a mass in her left mandible associated with restricted mouth opening that had developed over the preceding 7 months. The mass was resected completely with 5 mm margin under general anesthesia. The mass was extending to the floor of the mouth and impinging on the masseter and temporalis muscles. Given its characteristics of being localized and aggressive, complete surgical resection is the best treatment modality for IMT.

Inflammatory myofibroblastic tumor of the upper alveolus: A rare entity presenting as a jaw swelling

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of borderline nature that can clinically present as a malignant neoplasm. It commonly occurs in the lungs, and a very few oral IMTs have been reported in the literature. IMT consists of inflammatory cells and myofibroblastic spindle cells. The diagnosis of IMT requires histopathological examination with immunohistochemical staining to look for the expression of smooth-muscle actin for confirmation of the diagnosis. The objective of this paper is to report an IMT on the upper alveolus with clinic-a pathological similarity with a malignant lesion and its management. Though oral IMTs are rare, it should be considered in the differential diagnosis of tumors of the upper jaw. Complete surgical excision of alveolar IMT is the treatment of choice because of its unpredictable clinical behavior. The patients with oral IMTs require periodic post-surgical follow-up for recurrence.

Inflammatory myofibroblastic tumor of maxilla showing sarcomatous change in an edentulous site with a history of tooth extraction following periodontitis: A case report with discussion

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of uncertain origin with variable biological behavior ranging from reactive lesions to highly aggressive malignancy. Oral IMTs are extremely rare and only 25 cases had been reported so far. A case of IMT with sarcomatous transformation in an extraction site with a history of tooth extraction following tooth mobility of an upper left molar tooth is presented here. The tooth was extracted following a complaint of gingival swelling and mobility of tooth. Though malignant transformation in IMTs had been documented in the extra oral sites, wide search of associated literature suggests, this is the first case of oral IMT showing malignant change associated with gingiva. The case report attempts to highlight the variant possibilities of tooth mobility other than periodontitis and the importance of assessing the primary cause of such conditions.

An Unusual Case of Systemic Inflammatory Myofibroblastic Tumor with Successful Treatment with ALK-Inhibitor

Systemic inflammatory myofibroblastic tumor is an exceedingly rare entity. A 45-year-old Hispanic female presented with a 6-month history of left-sided thigh pain, low back pain, and generalized weakness. PET/CT scan revealed abnormal activity in the liver, adrenal gland, and pancreas. MRI of the abdomen demonstrated two 6-7 cm masses in the liver. MRI of the lumbar spine demonstrated lesions in the L2 to L4 spinous processes, paraspinal muscles, and subcutaneous tissues, as well as an 8 mm enhancing intradural lesion at T11, all thought to be metastatic disease. A biopsy of the liver showed portal tract expansion by a spindle cell proliferation rich in inflammation. Tumor cells showed immunoreactivity for smooth muscle actin and anaplastic lymphoma kinase 1 (ALK1). Tissue from the L5 vertebra showed a process histologically identical to that seen in the liver. FISH analysis of these lesions demonstrated an ALK (2p23) gene rearrangement. The patient was successfully treated with an ALK-inhibitor, Crizotinib, and is now in complete remission. We present the first reported case, to our knowledge, of inflammatory myofibroblastic tumor with systemic manifestations and ALK translocation. This case is a prime example of how personalized medicine has vastly improved patient care through the use of molecular-targeted therapy.

Inflammatory myofibroblastic tumor of salpinx: a very rare case treated with a less aggressive method

Inflammatory pseudotumour describes as a wide range of neoplastic and reactive lesions. One of the rare presentations of these tumors is found in the salpinx. This case report characterizes a thirty six year old woman with a history of left sided abdominal pain for a few months. Further examinations revealed that she had a complex cyst in her left salpinx. The patient had normal levels of tumor markers such as CA125, Alfa Fetoprotein (AFP), and Human Chorionic Gonadotropin (hCG), while other paraclinical test were in normal values Additionaly The patient underwent left salpingectomy by a gynecologist. The pathological diagnosis of the lesion was inflammatory myofibroblastic tumor (IMT). In immunohistochemistry the tumor stains was moderately positive in anaplastic lymphoma kinase (ALK) and also actin positive. Total resection of tumor was performed with no complications and remained disease free during follow up for 40 months. Although Inflammatory Myofibroblastic Tumor (IMT) is benign in nature, but in order to improve the prognosis, this tumor requires low intensity surgical treatment.

Benign fibroushistiocytoma of the gingiva

Benign fibroushistiocytoma is a benign connective tissue tumor rarely seen affecting the head and neck region. These tumors were believed to be of histiocytic origin as they are comprised of cells, which showed spindled morphology and cells with a round histiocytic appearance. The current concept consents that the lesional cells rather represent a fibroblastic differentiation. Diagnosis of these tumors proves to be challenging even with the use of immunohistochemistry due to lack of any specific markers. Here, we describe a case which presented in the gingiva mimicking a reactive lesion, which in fact was a tumor.

Unusual case of inflammatory myofibroblastic tumor in maxilla

Inflammatory myofibroblastic tumor (IMT) is a rare lesion found mostly in children and young adults and originates from the lung, abdominopelvic region, and retroperitoneum. Clinical manifestations of IMT or imaging are nonspecific and diagnosis is based on histopathological and immunohistochemical findings. Minority of all IMTs will metastasize. IMT in the oral cavity is an extreme rarity and this is a first case report of IMT in maxilla causing delayed tooth eruption and multiple cervical root resorption with an 11-year-old child. The IMT reported here was positive for smooth muscle actin, vimentin, and anaplastic lymphoma kinase (ALK1) with immunohistochemistry. Only three IMTs of the jaws have been reported so far and none of them had delayed root eruption and tooth resorption. This unusual case of IMT in a child was also ALK1- positive supporting neoplastic origin of her tumor. The case presented here underscores the importance of histopathological examination of the tissue found in any root resorption especially in the case of multiple resorptions.

Etiology analysis and computed tomography imaging of a tonsillar inflammatory myofibroblastic tumor: report of an immunocompetent patient and brief review

Objectives

The etiology of Inflammatory myofibroblastic tumor(IMT) is contentious. In this study, we used computed tomography (CT) to examine tonsillar IMT and further analyzed the etiology of this entity.

Methodology

We presented CT features of left tonsillar IMT and reviewed the English-language literature published between 1984 and 2011.

Results

To our knowledge, there are only six published cases of tonsillar IMT including the present case. Two patients were asymptomatic at initial presentation. Two patients were taking immunosuppressants, and one was pregnant and in an immunomodulated state. CT of our patient revealed a 2.6 × 1.8 cm irregular soft tissue mass between the left tonsil and the base of the tongue. It did not invade surrounding structures and was not enhanced on contrast-enhanced imaging.

Conclusions

Tonsillar IMT may be a benign tumor. We suggest that preoperative recognition of tonsillar IMT by CT may be important to avoid unnecessary expanded surgery.