Exophytic inflammatory myofibroblastic tumor of the stomach in an adult woman: A rare cause of hemoperitoneum

Gastric inflammatory myofibroblastic tumor: a case report

BACKGROUND

Inflammatory myofibroblastic tumor (IMT) of the stomach is an uncommon mesenchymal neoplasm. We present a case of gastric submucosal tumor (SMT) where the final diagnosis was IMT.

CASE PRESENTATION

A 69-year-old man presented with a 24-mm SMT on the posterior wall of the middle third of the stomach that was detected by screening upper gastrointestinal endoscopy. Abdominal contrast-enhanced computed tomography showed that the tumor was well-enhanced. Although endoscopic ultrasonography-guided biopsy was performed, the histological diagnosis was not confirmed preoperatively. Since the tumor was clinically suspected to be a gastrointestinal stromal tumor, we performed gastric wedge resection by laparoscopic-endoscopic cooperative surgery. Pathologically, proliferative spindle cells with a positive reaction for smooth muscle actin, negativity for c-kit, desmin, s-100, CD34, STAT-6, β-catenin and anaplastic lymphoma kinase 1 were identified. Hence, the tumor was finally diagnosed as an IMT originating from the stomach.

CONCLUSIONS

When an SMT of the stomach is identified, the possibility of gastric IMT should be considered.

A Huge Abdominal Wall Inflammatory Myofibroblastic Tumor: A Report of a Rare Case and Literature Review

An inflammatory myofibroblastic tumor (IMT), frequently misdiagnosed as a malignant neoplasm, is a rare tumor characterized by the presence of myofibroblastic spindle cells and infiltration of inflammatory cells. In the current study, a 49-year-old female patient with a huge abdominal mass in the left abdominal wall was examined. Diagnostic procedures included blood tests, as well as ultrasound, Doppler, and computed tomography (CT) scans, which revealed the presence of a huge complex multiloculated cystic lesion measuring 30 x 37 x 20 cm. The patient underwent complete excision of the mass. Histopathological examination confirmed the benign nature of the tumor and revealed no evidence of malignancy. A comprehensive review of the available literature shows that the current case is one of the few documented cases. The report concluded by emphasizing the importance of surgical intervention as the primary therapeutic strategy and the crucial role of histopathology in the diagnostic process.

Gastric inflammatory myofibroblastic tumor presented with severe anemia and inflammation: a case report

BACKGROUND

Inflammatory myofibroblastic tumor (IMT) is a rare stromal tumor, often found in children and young adults, and most commonly occurs in the lungs. Surgical resection is considered the standard treatment for localized IMT, although only limited data exist. Gastric IMT in adults is extremely rare, and there are no established guidelines for its treatment.

CASE PRESENTATION

A 69-year-old male presented with persistent fatigue and weakness. Laboratory examination revealed severe anemia and inflammation. Upper gastrointestinal endoscopy at admission revealed a 40-mm type I softish tumor in the lesser curvature of the gastric body, without apparent hemorrhage. Repeated biopsies, including partial resection with snare, failed to give a definitive diagnosis. Computed tomography (CT) revealed a massive lesion at the gastric body, protruding into the gastric lumen, which was consistent with the gastric tumor. After admission, the patient developed anemia refractory to frequent blood transfusions despite the absence of apparent gastrointestinal bleeding. In addition, the patient had recurrent fevers of 38 °C or higher, and persistent high inflammatory levels. Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT 1 month after the first visit exhibited an increased FDG uptake in the gastric tumor. In addition, this CT scan revealed a rapid increase in tumor size to 75 mm. It was suspected that the undiagnosed gastric tumor caused these serious clinical symptoms, and he underwent distal gastrectomy and cholecystectomy. The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. The histopathological diagnosis was IMT. The postoperative course was uneventful, and the patient's symptoms subsided drastically, improving both anemia and systemic inflammation. The patient has shown no recurrence or relapse of the symptoms over one and a half years.

CONCLUSIONS

In this case, the tumor resection finally enabled the diagnosis of IMT and resolved the clinical symptoms. Despite its predominantly benign morphological nature, some cases of IMT present clinically adverse courses. Surgical treatment may lead to its final diagnosis and improvement of clinical symptoms.

Gastric inflammatory myofibroblastic tumor, a rare mesenchymal neoplasm: A case report

BACKGROUND

The inflammatory myofibroblastic tumor (IMT) is a rare mesenquimal tumor of doubtful biological behaviour. It's characterised for affecting mainly children and young adults, although it can appear at any age, being the lungs the primary affected organ (in children it represents 20% of all primary pulmonary tumors).

CASE SUMMARY

We present the case of a 45 year old woman, with a computed tomography (CT) finding of injury on the anterior surface of the fundus/gastric body and a solid perigastric injury of 12 mm in the ecoendoscopy. The case is presented in the tumor committee deciding to perform a laparoscopic wedge resection. The histological diagnosis was a IMT. The diagnosis is based on imaging tests like the abdominal CT, abdominal ecography and the ecoendoscopy but to confirm the diagnosis a pathological study is necessary.

CONCLUSION

Due to the unpredictable nature of this tumor, surgical resection is the best therapeutic option.

A rare case of inflammatory myofibroblast tumor of the stomach successfully treated by inverted laparoscopic and endoscopic cooperative surgery

BACKGROUND

An Inflammatory myofibroblastic tumor (IMT) is a rare intermediate malignancy characterized by myofibroblast proliferation and inflammatory cell infiltration. Various organs are the primary sites of origin. However, primary tumors originating in the stomach tend to be extremely rare, making the diagnosis difficult. Herein, we present a case of IMT originating in the stomach that was effectively managed using inverted laparoscopic endoscopic cooperative surgery (LECS).

CASE PRESENTATION

A 47-year-old male who was admitted to the hospital because of a submucosal tumor that was discovered during upper gastrointestinal endoscopy. The diameter of the tumor was approximately 20 mm. A KIT-negative gastrointestinal stromal tumor was suspected based on the biopsy findings. Therefore, partial resection of the stomach was performed using inverted laparoscopic and endoscopic cooperative surgery. Histopathological examination revealed collagen fiber proliferation from the submucosal layer to the muscular layer, accompanied by infiltration of spindle-shaped cells, lymphocytes, and numerous inflammatory cells. Immunohistochemistry results were positive for SMA and negative for CD34, desmin, and c-kit. IgG4-positive cells were observed with an IgG4/IgG ratio > 50%, and specific nuclei were positive for ALK. Therefore, IMT was diagnosed. This condition may be difficult to diagnose both before and after surgery because of its rarity and submucosal tumor-like morphology.

CONCLUSION

When a submucosal tumor originating in the stomach is observed, IMT should be considered. Partial resection of the stomach with LECS and immunohistochemical diagnosis may be useful.

A Recurrent Inflammatory Myofibroblastic Tumor-like Lesion of the Splenic Capsule in a Kitten: Clinical, Microscopic and Ultrastructural Description

OBJECTIVE

To describe the findings of an unusual splenic tumor in a kitten.

METHODS

A grossly multinodular mass arising from the splenic capsule of a 7-month-old male Havana kitten was echographically detected and surgically removed by splenectomy, then analyzed microscopically and ultrastructurally.

RESULTS

The mass showed features of an inflammatory myofibroblastic tumor.

TREATMENT AND OUTCOME

Two months after surgical excision, the mass recurred in the same intra-abdominal area but disappeared after 2 months of anti-inflammatory therapy. Follow-up at 18 months after surgery revealed resolution of the disease.

CLINICAL RELEVANCE

Inflammatory myofibroblastic tumor in cats have been rarely reported and are usually in the orbital region. In the present report, an unusual multinodular gross presentation, a recurrence over time, and a favorable clinical course, are described.

Colonic inflammatory myofibroblastic tumour presenting as 'pyrexia of unknown origin': report of a rare disease and its unique presentation

An intra-abdominal inflammatory myofibroblastic tumour (IMT) belongs to a rare group of diseases initially described as an inflammatory pseudotumour. Even though it is seen more often in children, its incidence in adults is even rarer. Clinical presentations can vary depending on its site and inherent tumour properties. The colon is an uncommon site for IMT and pyrexia of unknown origin (PUO) as its dominant clinical presentation is even rarer. A 27-year-old woman presented with PUO. She was evaluated under the department of internal medicine before undergoing an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan. This showed an intensely enhancing descending colon mass. An image-guided biopsy of this lesion was reported as IMT. She underwent a left hemicolectomy and complete excision of the tumour, following which her symptoms resolved completely. The patient has been disease-free at a 6-month follow-up and is asymptomatic at 1 year.

Primary gastric inflammatory myofibroblastic tumor: A case report

RATIONALE

Primary gastric inflammatory myofibroblastic tumor is extremely rare. Only a few cases were reported in the domestic and foreign medical literature with corresponding imaging findings of this disease even more rarely reported.

PATIENT CONCERNS

We present one case of a 52-year-old female patient with upper abdominal pain, acid reflux, and belching for 2 months.

DIAGNOSES AND INTERVENTIONS

Electron ultrasound gastroscopy (EUS) revealed elevation of gastric antrum mucosa. A whole abdominal and pelvic multi-slice spiral computed tomography (CT) detected a round nodule in the gastric antrum with considerably delayed enhancement, with initial suspicion of gastrointestinal stromal tumors (GISTS). Then a laparoscopic assisted distal gastrectomy was performed. Finally, the postoperative pathology confirmed the diagnosis of primary gastric IMT.

OUTCOMES

After 6 months of follow-up, the patient was still alive without any evidence of metastasis or recurrence.

LESSONS

Familiarizing with the CT features of this rare tumor may raise radiologists' awareness of the disease and potentially could avoid misdiagnosis.

Gastric inflammatory myofibroblastic tumor treated with combined laparoscopic and endoscopic gastric wedge resection: a case report

Background

Inflammatory myofibroblastic tumor is an uncommon soft tissue neoplasm rarely reported in the stomach.

Case presentation

We identified a tumor highly suggestive of poorly differentiated gastric adenocarcinoma in the lesser curvature of the stomach of a 53-year-old female during screening endoscopy. Although the patient’s gastric biopsy did not reveal cancer, the tumor configuration was strongly suspicious for malignancy, and we performed a gastric wedge resection using a combined laparoscopic and endoscopic method. The lesion was diagnosed as inflammatory myofibroblastic tumor based on its morphological and immunohistological features.

Conclusions

Inflammatory myofibroblastic tumor should be considered in the differential diagnosis of soft tissue tumors in the stomach. We present a case of inflammatory myofibroblastic tumor safely treated with combined laparoscopic and endoscopic gastric wedge resection.

Inflammatory Myofibroblastic Tumor of the Stomach in an Adult Woman: A Rare Intermittent Cause of Gastric Outlet Obstruction

Background

Inflammatory myofibroblastic tumor is a neoplasm of intermediate biological potential that frequently recurs and rarely metastasizes.

Case report

We report a rare case of intermittent gastric outlet obstruction by an inflammatory myofibroblastic tumor of the cardia.

Results

A 56-year-old woman presented at the gastroenterology department with a two-day history of hematemesis and melena. She had intermittent nausea and vomiting complaints, which had manifested periodically for about five months. Upper gastrointestinal endoscopy demonstrated a mass of 6 cm in diameter, which was resected. Histological examination revealed ulcerated mucosal granulation-like tissue with myofibroblastic spindle cell proliferation in a storiform pattern.

Conclusions

In order to avoid unnecessary aggressive therapy, gastric IMT should be taken into account when a gastric mass accompanied by the various clinical manifestations of IMT is found in an adult.

ALK-positive gastric inflammatory myofibroblastic tumor in an adult with familial adenomatous polyposis and diffuse fundic polyposis

BACKGROUND

Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare in adults and exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Here we report a case of gastric IMT with lymph node metastasis in an adult who had undergone total colectomy for familial adenomatous polyposis (FAP).

CASE PRESENTATION

A 37-year-old man presented gradual-onset epigastric discomfort; he had undergone total colectomy for FAP 6 years before. The upper endoscopy revealed diffuse polyposis in the body of stomach and a submucosal protruding tumor of approximately 4.5 × 3.5 cm in the gastric angular incisure, appearing like gastrointestinal stromal tumor. Histology after surgery verified the diagnosis of fundic gland polyposis (FGPs) and gastric IMT with lymph node metastasis. Both the primary IMT tissue and its metastatic lesion but not the FGP or FAP tissue were positive for anaplastic lymphoma kinase (ALK) on immunohistochemical staining. Fluorescent in situ hybridization confirmed the existence of ALK rearrangement in IMT tissues. However, the patient exhibited no abnormalities in microsatellite instability or mismatch repair-system components, including MSH6, MSH2, MLH1 and PMS2, in IMT, FGP or FAP tissue.

CONCLUSIONS

This case allowed for exploring the relationship among IMT, FGP and FAP and indicates that gastric IMT should be considered in the diagnosis of a gastric mass in patients with FAP. ALK may be a useful biomarker in the diagnosis of IMT and its metastatic lesions.

Fever,Weight Loss and Early Satiety due to Gastric Inflammatory Myofibroblastic Tumor; Case Report and Literature Review

Gastric inflammatory myofibroblastic tumor (IMT) is a rare tumor with and unpredictable prognosis usually find in young adults. We present an 18-yearold man with gastric IMT. He complained of epigastric pain, intermittent fever and night sweating associated with weight loss since two years ago. Physical examination showed anemic and cachestic features with mild abdominal tenderness in palpitation as well as an abdominal mass in epigastrium. Abdominal CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy revealed a submucosal lesion in fundus of stomach of approximately 8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous fundal mass with areas of calcification. The patient underwent laparoscopic partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed an IMT.

Inflammatory myofibroblastic tumor treated with laparoscopic proximal gastrectomy and double-tract anastomosis

Inflammatory myofibroblastic tumors (IMTs) of the stomach are extremely rare in adults, and their oncologic prognosis is not well understood. We present a 28-year-old man with a proximal gastric IMT. The patient visited the emergency department of Yeouido St. Mary's Hospital with syncope and hematemesis. Hemoglobin levels were <5.5 g/dl. Gastric fibroscopy showed a protruding mass 4×4 cm in size, with central ulceration on the posterior wall of the fundus and diffuse wall thickening throughout the cardia and anterior wall of the upper body. Endoscopic biopsy revealed indeterminate spindle cells, along with inflammation. Given the risk of rebleeding, an operation was performed despite the uncertain diagnosis. Because the mass was circumferential, laparoscopic proximal gastrectomy and double-tract anastomosis were performed to ensure a safe resection margin. The pathological diagnosis was consistent with an IMT originating from the stomach, although the tumor was negative for anaplastic lymphoma kinase gene mutation.

Inflammatory myofibroblastic tumor of the thigh: presentation of a rare case and review of the literature

Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. We present a case of a 47-year-old male with fever, fatigue, and a slow-growing thigh mass. The inflammatory markers were elevated and the MR images showed a well-defined intermuscular lesion with mild heterogeneous enhancement. The lesion was excised and histologic examination was consistent with an inflammatory myofibroblastic tumor. No adjuvant therapy was needed and the patient remained asymptomatic with no evidence of tumor recurrence during the 2 years of follow-up.

High fever as an initial symptom of primary gastric inflammatory myofibroblastic tumor in an adult woman

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor, plasma cell granuloma or inflammatory myofibroblastoma, is characterized histopathologically by myofibroblastic spindle cells with inflammatory cell infiltrates composed of plasma cells, lymphocytes and eosinophils. Inflammatory myofibroblastic tumor is typically seen in children or young adults and is most commonly localized to the lungs, but it can occur anywhere in the body. To date, however, only a few cases involving the stomach have been reported. Herein, we present a case of gastric inflammatory myofibroblastic tumor in an adult woman with an initial symptom of high fever.

Primary gastric inflammatory myofibroblastic tumor in an adult-case report with brief review

The term inflammatory myofibroblastic tumor more commonly referred to as "pseudostumor ", denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 45-year-old diabetic man with a gastric Inflammatory myofibroblastic tumor. The histopathological and immunohistochemical analysis was the key to reach diagnosis.

Primary inflammatory myofibroblastic tumor of the stomach in an adult woman: a case report and review of the literature

Inflammatory myofibroblastic tumor has been defined as a histologically distinctive lesion with uncertain behaviour. The term inflammatory myofibroblastic tumor more commonly referred to as "pseudostumor ", denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor mostly occurs in the soft tissue of children and young adults, and the lungs are the most commonly affected site, but it has been recognized that any anatomic localization can be involved. Inflammatory myofibroblastic tumors in adults are very rare, especially in the stomach. We present a case of a 43-year old woman with primary inflammatory myofibiroblastic tumor in the stomach and a review of the literature.

Rare gastric inflammatory myofibroblastic tumor in an adult woman: a case report with review of the literature

Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 37-year-old woman with a gastric IMT. She presented epigastric pain since 2 months, anemia and weight loss associated. Physical examination showed cutaneous pallor and mild abdominal tenderness in the epigastrium. Abdominal ultrasonography showed a tumor near the pancreas and the CT scan revealed that the lesion was arising from the stomach. Upper endoscopy showed a submucosal lesion of approximately 7.5 cm located in the posterior wall of the gastric body such as a gastrointestinal stromal tumor (GIST). The patient underwent a subtotal gastrectomy and Billroth I reconstruction. The histopathological and immunohistochemical analysis revealed an IMT that originated from the gastric wall.

Synchronous gastric inflammatory myofibroblastic tumour with gastrointestinal stromal tumour of the stomach and hepatic syringious haemangioma

Inflammatory myofibroblastic tumour of the stomach is a very rare lesion. A case of a gastric inflammatory myofibroblastic tumour associated with gastrointestinal stromal tumour of the stomach and hepatic syringious haemangioma is described. We report an 80-year-old male who had an exophytic mass in the area of the pylorus and the duodenum, where hepatic cysts were found in the magnetic resonance (MRI) scan on examination of hypochromic microcytic anaemia, and prolapsus and torsion of the bulb of the stomach found during gastroscopy. During surgical excision of the exophytic mass, a gastrointestinal stromal tumour from the gastric fundus and a syringious haemangioma from the superior hepatic surface were resected. All tumours were treated successfully by surgical excision. The patient had an uneventful recovery. Neither recurrence nor metastasis was found after a 12-month follow-up. To our knowledge, this is the first time that such an association is reported in the literature.

Inflammatory myofibroblastic tumor of the small bowel: a case report

Inflammatory Myofibroblastic Tumor (IMT) is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. The tumor most commonly occurs in the pulmonary system of children and young adult, although it may rarely develop in older patients and other organs. Symptoms are non-specific and depend on the location of the tumor. The gastrointestinal tract is rarely the primary site of origin for this lesion. We report an unusual presentation of this rare lesion in a 58 year old woman with intussusception and partial intestinal obstruction.

Anterograde jejunojejunal intussusception resulted in acute efferent loop syndrome after subtotal gastrectomy

Postoperative intussusception is an unusual clinical entity in adults, and is rarely encountered as a complication following gastric surgery. The most common type after gastric surgery is retrograde jejunogastric intussusception, and jejunojejunal intussusception has been rarely reported. We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth II anastomosis in a 38-year-old Korean woman with early gastric cancer, and include a review of the literature on this unusual complication.