Pulmonary Inflammatory Myofibroblastic Tumor in Children: A Case Report and Brief Review of Literature

Surgically challenging inflammatory myofibroblastic tumor: A rare neoplasm of lung

Inflammatory myofibroblastic tumor is considered one of the rarest benign tumors constituting 0.7% of all lung neoplasms. It was first described in 1939. We report a case of a 10-year-old child who presented with recurrent cough and fever. Chest radiography and computed tomography demonstrated complete involvement of right lung by the tumor. The tumor along with the affected lung was meticulously dissected from the surrounding structures and was delivered outside. The histopathology of the specimen revealed it to be inflammatory fibroblastoma.

Pulmonary Inflammatory Myofibroblastic Tumor: A Case Report

An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor that occurs predominantly in children and young adults. Etiology remains unclear. But based on the frequent detection of chromosomic alterations, especially near the anaplastic lymphoma kinase (ALK) gene, IMT is now considered to be a true neoplasm. In addition, the possible aggressive behavior, and the ability to metastasize suggest at least an intermediate malignant potential. Surgery remains the treatment of choice, but the use of chemotherapy, nonsteroidal anti-inflammatory drugs, immunotherapy, and targeted therapy are reported. We describe a case of a pulmonary IMT in a 6-year-old boy with an incidental finding of a lesion in the right upper lobe. A video-assisted thoracoscopic right upper lobectomy with lymph node resection was performed. Microscopic examination confirmed the diagnosis of IMT with the nodule showing spindle cells in a background of plasma cells. ALK immunohistochemical expression was negative.

Diagnosis of inflammatory myofibroblastic tumor in a pediatric patient initially suspected of tuberculosis

BACKGROUND

Symptoms of inflammatory myofibroblastic tumor (IMT) are atypical, and histopathological misdiagnosis of IMT is still inevitable. Here we present a pediatric case that an eight-year-old boy with recurrent fever for fifteen months, received anti-tuberculosis therapy for five months and was ultimately confirmed to be IMT.

CASE PRESENTATION

An eight-year-old boy experienced a recurrent fever for fifteen months, accompanied by cough, vomiting, meteorism, night sweating, and emaciation. Thoracoabdominal computer tomography revealed multiple enlarged lymph nodes in the thorax, abdomen, and axilla, as well as minimal bilateral pleural effusion. Histopathological examinations of the intestines and greater omentum implied fibrous tissue hyperplasia along with eosinophil and lymphocyte infiltration. The patient was initially misdiagnosed with tuberculosis, and symptoms were relieved partially following anti-tuberculosis treatment. However, after four months, the symptoms aggravated again and a subsequent histopathological analysis of a second sample from the greater omentum revealed the presence of IMT. Eventually, after surgical resection of the lesions and chemotherapy, the clinical symptoms in the child gradually alleviated.

CONCLUSIONS

The clinical course of IMT is variable, and pediatricians should pay attention to differentiating IMT from tuberculosis.

Cross-sectional imaging review of common to uncommon lung cancer mimickers in a tertiary care oncology center

Lung cancer is the most diagnosed cancer worldwide. Many non-malignant pulmonary lesions, such as tuberculosis, fungal infection, organizing pneumonia, inflammatory myofibroblastic tumor, and IgG4 disease, can mimic lung cancer due to their overlapping morphological appearance on imaging. These benign entities with minor differentiating imaging clues may go unnoticed in a high-volume cancer institution, leading to over-investigation that may result in repeated biopsies, pointless wedge resections, and related morbidities. However, with a thorough medical history, laboratory diagnostic work-up, and careful analysis of imaging findings, one can occasionally restrict the range of possible diagnoses or arrive at a definitive conclusion. When imaging features overlap, image-guided lung sampling is crucial since histopathological analysis is the gold standard.

Inflammatory myofibroblastic tumor presenting as ileocolic intussusception: A case report

Key Clinical Message

The report urges considering rare neoplastic tumor, like IMT, in intussusception cases and underscores the vital role of comprehensive and swift diagnosis in influencing treatment choices and patient results.

Abstract

We present a case of a 36-year-old male who presented with abdominal pain and vomiting. Inflammatory markers were elevated in routine investigations, while other laboratory parameters were within normal limits. Ultrasound imaging revealed a target lesion, which required further evaluation with a CT scan and confirmed ileocolic intussusception. An exploratory laparotomy showed a solid lesion measuring 5 by 6 cm in the cecum, along with evidence of ileocolic intussusception. A standard right hemicolectomy was performed, and the postoperative course was uneventful. Histopathological examination showed an inflammatory myofibroblastic tumor with nodular hyperplasia. The report highlighted the importance of assessing rare neoplastic causes in patients with intussusception.

Giant lung tumor in hereditary spherocytosis: inflammatory myofibroblastic tumor

Inflammatory myofibroblastic tumors are a rare subset of lung lesions in the adult age group. They pose a diagnostic challenge as they present with non-specific findings. We report a 27-year-old female with an inflammatory myofibroblastic tumor on a background of hereditary spherocytosis.

A 17-Month-Old Male Infant With a Cystic Lesion of the Left Lung

CASE PRESENTATION

A 17-month-old male infant with history of an abnormal chest shadow in the left lung lower lobe was admitted to our hospital for the resection of the malformation. At 9 months of age, he was admitted to his local hospital because of a persistent cough. The chest CT scan in his local hospital indicated a cystic lesion in the left lung lower lobe associated with inflammation. However, no thoracic abnormalities were seen in antenatal ultrasonography, and no clinical symptoms were observed at birth. After anti-inflammatory treatments given to this infant, he achieved remission and was discharged from his local hospital.

Inflammatory myofibroblastic tumor of colon and duodenum: Metachronous, metastatic or local recurrence? An unusual presentation

ABSTRACT

Inflammatory myofibroblastic tumor (IMT) is a tumefactive proliferation of spindled myofibroblastic cells admixed with inflammatory infiltrate. This tumor has a predilection for the involvement of visceral soft tissues and has a tendency for local recurrence. Occurrence of metastatic or metachronous IMTs is a rare presentation. We report a rare case of a 50-year-old man with metastatic IMTs in the colon and duodenum.

Pulmonary inflammatory myofibroblastic tumor in a male child: A case report

Pulmonary inflammatory myofibroblastic tumor (IMT) is a rare condition in the normal population and specifically in the pediatric population. We reported a 9-year-old male child who presented with cough and intermittent fever and weight loss that was most suggestive of the infectious process. We reviewed the consideration of diagnosis and treatment.

Inflammatory Myofibroblastic Tumor: A Multi-Institutional Study from the Pediatric Surgical Oncology Research Collaborative

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate malignancy. We describe the largest cohort of IMT patients to date, aiming to further characterize this rare, poorly understood tumor. This is a multi-institutional review of IMT patients ≤39 years, from 2000-2018, at 18 hospitals in the Pediatric Surgical Oncology Research Collaborative. 182 patients were identified with median age of 11 years. 33% of tumors were thoracic in origin. Presenting signs/symptoms included pain (29%), respiratory symptoms (25%), and constitutional symptoms (20%). Median tumor size was 3.9 cm. Anaplastic lymphoma kinase (ALK) overexpression was identified in 53% of patients. 7% of patients had distant disease at diagnosis. 91% of patients underwent resection: 14% received neoadjuvant treatment and 22% adjuvant treatment. 12% of patients received an ALK inhibitor. 66% of surgical patients had complete resection, with 20% positive microscopic margins, and 14% gross residual disease. Approximately 40% had en bloc resection of involved organs. Median follow-up time was 36 months. Overall 5-year survival (OS) was 95% and 5-year event-free survival (EFS) was 80%. Predictors of recurrence included respiratory symptoms, tumor size, and distant disease. Gross or microscopic margins were not associated with recurrence, suggesting that aggressive attempts at resection may not be warranted. This article is protected by copyright. All rights reserved.

Thoracic Multidetector Computed Tomography Evaluation of Inflammatory Myofibroblastic Tumor of the Lung in Pediatric Patients in the Era of Modern Diagnosis

PURPOSE

The purpose of this study was to investigate the characteristic thoracic multidetector computed tomography (MDCT) findings of pathologically proven inflammatory myofibroblastic tumor (IMT) of the lung in children in the era of modern understanding based on refined pathologic diagnosis.

MATERIALS AND METHODS

All pediatric patients (age 18 y and above) with a known pathologic diagnosis of IMT of the lung who underwent thoracic MDCT studies from May 2008 to December 2020 were included. Two pediatric radiologists independently evaluated thoracic MDCT studies for the presence of abnormalities in the lung (nodule, mass, cyst, ground-glass opacity, consolidation), pleura (pleural effusion, pneumothorax), and mediastinum and hilum (lymphadenopathy). When a lung abnormality was present, the number, size, composition (solid, cystic, or combination of both), location (laterality, lobar distribution, and intraparenchymal vs. pleural-based), borders (well-circumscribed vs. ill-defined), the presence and type of associated calcification (punctate, dense, curvilinear, or flocculent), the presence of associated cavitation, contrast enhancement pattern (homogeneous, heterogenous, central, or peripheral), and other associated findings (neural foramen involvement, anomalous vessels, mass effect, and invasion of adjacent thoracic structures) were also evaluated. Interobserver agreement between 2 independent reviewers was evaluated with κ statistics.

RESULTS

In all, 12 thoracic MDCT studies from 12 individual pediatric patients (5 males [42%] and 7 females [58%]; mean age: 9.9 y; SD: 4.4 y; range: 2 to 16 y) comprised the final study population. All 12 thoracic MDCT studies (100%) were performed with intravenous contrast. The most frequent MDCT finding of IMT of the lung in children is a solitary (92%), pleural-based (83%), well-circumscribed (100%), solid (92%) mass with heterogenous contrast enhancement (100%), often with dense calcification (50%), which occurred in both lungs and all lobes with similar frequency. No pleural abnormality (pleural effusion, pneumothorax) or mediastinal abnormality (lymphadenopathy) was detected. In addition, although mass effect on adjacent thoracic structures was frequently seen (42%), no invasion, neural foramen involvement, or associated anomalous vessels was identified. There was excellent interobserver κ agreement between 2 independent reviewers for detecting abnormalities on thoracic MDCT studies (κ>0.95).

CONCLUSIONS

IMT of the lung in children typically presents as a solitary, pleural-based, well-circumscribed, solid mass with heterogenous contrast enhancement, often with dense calcification, without significant laterality or lobar preference. In addition, pleural or mediastinal abnormalities are characteristically absent. These notable MDCT attributes of IMT of the lung are an important and novel finding, with great potential to help differentiate pediatric IMT of the lung from other thoracic masses in children.

Clinical characteristics and prognosis of pulmonary inflammatory myofibroblastic tumor: An over 10-year retrospective analysis

Importance

Pulmonary inflammatory myofibroblastic tumors (PIMTs) are primary lung tumors in children. Misdiagnosis easily occurs because of the nonspecific clinical manifestations, laboratory examination results, and imaging findings in affected patients.

Objective

To summarize the clinical characteristics, diagnosis, and prognosis of children with PIMTs.

Methods

This retrospective analysis included 23 children with PIMTs who received treatment in our hospital from January 2008 to January 2019. The clinical manifestations, laboratory examination results, and computed tomography findings were retrospectively analyzed.

Results

The population included 13 boys and 10 girls, with a median age at onset of 78 months (range, 10–126 months). Fourteen patients had PIMT lesions in the right lung and nine patients had PIMT lesions in the left lung. The surgical procedures included pulmonary wedge resection, pulmonary lobectomy, and total pneumonectomy. The median operation time was 115 min (range, 45–235 min); the median intraoperative blood loss volume was 30 mL (range, 3–500 mL). During the operation, one patient each had pulmonary hemorrhage, vena cava hemorrhage, and thoracic duct injury. Postoperative complications included pulmonary embolism in one patient and tumor recurrence in two patients; neither of these complications recurred after reoperation. The median follow‐up period was 49 months (range, 2–127 months).

Interpretation

Children with PIMTs exhibited good prognoses and primarily underwent surgical resection as treatment. Complete preoperative evaluation should be performed in affected patients.

Inflammatory myofibroblastic tumours of the thorax: Radiologic and clinicopathological correlation

CONTEXT AND AIMS

Inflammatory myofibroblastic tumour (IMT) is a rare mesenchymal neoplasm with intermediate malignant potential. The aim of this study is to describe and compare the clinical presentation, computed tomography (CT) findings and anaplastic lymphoma kinase -1 (ALK-1) expression of IMT of the thorax in children and adults. We also sought to study the tumour behaviour after treatment on the follow-up imaging.

MATERIALS AND METHOD

This is a retrospective observational study of 22 histopathologically proven cases of IMT in the thorax. The clinical parameters, CT findings, biopsy results, treatment received and follow-up were recorded. Statistical analysis was performed using Fisher's exact test.

RESULTS

IMT of the thorax had diverse imaging appearances, presenting either as large invasive lung masses with or without calcifications or as smaller endobronchial lesions. Children commonly presented with long duration fever (P = 0.02) and large invasive lung masses (P = 0.026), whereas adults presented with long duration haemoptysis (P = 0.001) and endobronchial lesions or smaller lung parenchymal lesions. Calcifications were more common in children (P = 0.007). ALK-1 was positive in 40% of children and 18.2% of adults (P = 0.547). Endobronchial lesions showed a trend for ALK-1 negativity. Patients with bronchoscopic excision had local recurrence and patients with surgical wedge resection had metastatic brain lesions as compared to those with lobectomy and pneumonectomy (P = 0.0152). A patient with unresectable lung mass had malignant transformation to spindle cell sarcoma after 9.5 years.

CONCLUSIONS

Thoracic IMT presents with some distinct clinical and CT findings in adults and children. The CT findings and management options have implications for prognosis. If resectable, lobectomy is a better option than wedge resection or bronchoscopic excision for preventing local recurrence and metastasis. IMT can undergo malignant transformation.

Solitary round pulmonary lesions in the pediatric population: a pictorial review

The purpose of this current pictorial review is to define the solitary round pulmonary lesion (SRPL), to familiarize with its prevalence in the pediatric population, and, moreover, to educate radiologists on its vast differential diagnosis and imaging manifestations. Furthermore, by highlighting valuable clues, it intends to assist radiologists efficiently partake in its diagnosis, work-up, and follow-up in order to narrow down the differential diagnosis by working alongside the clinician and combining clinical information, lab results, and radiological findings.

A Rare Presentation of Inflammatory Myofibroblastic Tumor in the Nasolabial Fold

Inflammatory myofibroblastic tumor (IMT) is a benign lesion that occurs most frequently in the soft tissues and viscera. In the head and neck region, the tumor has been reported to occur in the orbit, tongue, nasopharynx, larynx, and paranasal sinuses and the central nervous system. Despite being a benign lesion, it exhibits infiltrative and destructive behaviours, making histopathological examination necessary to confirm the diagnosis. We report the case of a 38-year-old female presented with a right nasolabial fold mass, which was confirmed histologically to be an IMT. Surgical excision of the mass was achieved through a sublabial approach with an uneventful postoperative period. To the best of our knowledge, this is the first reported case of an IMT in the nasolabial fold.

Ureteral inflammatory myofibroblastic tumor: A case report and literature review

RATIONALE

Inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue neoplasm which has been described in a variety of locations. In the urogenital system, IMT predominantly occurs in the bladder and the kidney. IMT arising from the ureter is exceedingly rare and has been sporadically reported before.

PATIENT CONCERNS

We reported an extremely exceptional case of IMT arising from the ureteral submucosa in a 54-year-old man. The patient was hospitalized with the main complaint of intermittent and moderate left abdominal pain for 2 months.

DIAGNOSES AND INTERVENTIONS

Computed tomography scan revealed a nearly circular mass in the left upper ureter. Ureteroscopy showed that the ureteral lumen mucosa was smooth. However, the upper ureter was compressed and narrow. Renal dynamic imaging was performed and the measured glomerular filtration rate was 46.98 mL/min (right renal) and 9.77 mL/min (left renal), respectively. A retroperitoneoscopic radical nephroureterectomy was performed. The histopathologic examination revealed that the soft-tissue neoplasm was mainly composed of myofibroblastic spindle cells proliferation with mixed inflammatory infiltrate, containing lymphocytes, neutrophils, and eosinophils. On immunohistochemical staining, the tumor was positive for smooth muscle actin and Ki-67 (<1%+), indicating a confirmed diagnosis of ureteral IMT.

OUTCOMES

The patient recovered well with no occurrence of complications. At 3-year follow-up, there was no radiologic evidence of tumor recurrence or metastasis and the man was well.

LESSONS

Ureteral IMT is extremely rare and often asymptomatic, resulting in delayed diagnosis. Radiologic evidences may be suggestive of the diagnosis of IMT. However, it is necessary to make an accurate diagnosis in terms of histopathologic assessment. Complete lesion excision is the best therapeutic approach with rare recurrences and excellent survival.