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Spafford M, Lunn D, Graham P. Malignant inflammatory myofibroblastic tumor: a rare case presentation. J Surg Case Rep 2022; 2022:rjac403. [PMID: 36148141 PMCID: PMC9487198 DOI: 10.1093/jscr/rjac403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Malignant inflammatory myofibroblastic tumors (IMT) are extremely rare, aggressive tumors with variable presentation. This is a case of a 29-year-old female presented with severe anemia and a large abdominal mass presumed to be a gastrointestinal stromal tumor (GIST). Severe anemia, leukocytosis and thrombocytosis accompanied the presentation. Final pathological assessment yielded a diagnosis of malignant IMT. Given the rarity of these tumors, no established diagnostic criteria exist aside from histological analysis of the tissue, which may result in delays or inappropriate treatment. As these tumors are aggressive in nature, a high index of suspicion is critical to improve outcomes. Further reports on the presentation, diagnosis and treatment of such rare tumors are important to develop clinical diagnostic guidelines to improve diagnosis and treatment and improve outcomes.
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Affiliation(s)
- Megan Spafford
- Department of General Surgery, University of Saskatchewan , Saskatoon, SK , Canada
| | - Danley Lunn
- Department of General Surgery, University of Saskatchewan , Saskatoon, SK , Canada
| | - Peter Graham
- Department of General Surgery, University of Saskatchewan , Saskatoon, SK , Canada
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2
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A case report of inflammatory myofibroblastic tumor of cecum mimicking malignant wall thickening. Int J Surg Case Rep 2022; 94:107166. [PMID: 35658318 PMCID: PMC9097691 DOI: 10.1016/j.ijscr.2022.107166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Inflammatory myofibroblastic tumors (IMT) are an uncommon mesenchymal solid tumor commonly documented in children and young adults (Kim et al., 2012 [1]). Cecum is a rare location of this entity, may simulating a malignant tumor process. Presentation of case A 71 year old patient was admitted for pain in the right iliac fossa with chronic constipation evolving for two months associated with weight loss. As a diagnosic step, an abdominal computed tomography (CT) scan was performed showing a thickening of the cecal wall. There was no regional or distant metastasis. During a colonoscopy, many biopsies have been returned to a non-specific chronic colitis; as a result, the IMT of the cecum was confirmed pathologically after ilio-coecal resection. Discussion IMT is difined as a solid mesenchymal tumor basically affects the soft parts as well as the visceral organs. The litterature show that frequent localisations are pulmonary and intra-orbital (Krzysztof Siemion et al., 23 February 2022); therefore, the cecal location is very rare may mimic a malignant tumor (Mauricio Gonzalez-Urquijo et al., January 20, 2020), It is worth recalling that the imaging outcomes are polymorphic and inconclusive; in addition, Surgical excision is the treatment of choice for IMT (Alireza Mirshemirani et al., Dec 2011) and the histopathology is still required for the final diagnosis. Conclusion Radiologic features of IMT present a diagnostic challenge to the radiologist; also, mimic malignancy may lead to unnecessary investigations. Inflammatory myofibroblastic tumors (IMTs) are an unusual solid tumor derived from mesenchymal origin and grouped into a mix of fibroinflammatory disorders. Clinical manifestations are not specific, dependent on the location of the tumor, an inflammatory syndrome may be associated. Their radiological appearance is polymorphic and not conclusive. The final diagnostic is based on histopathology. Surgical treatment is the preferred treatment; complete excision with negative margin has a lower risk of recurrence.
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3
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Zulu S, Kruger C, Morare N, Montwedi D, Ngwenya S. Inflammatory pseudo-tumour of the colon mimicking acute appendicitis: A case report. Int J Surg Case Rep 2022; 90:106695. [PMID: 34999473 PMCID: PMC8749171 DOI: 10.1016/j.ijscr.2021.106695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Presentation of case Discussion Conclusion Inflammatory pseudotumours are often mistaken for malignant lesions This error can result in unnecessary resection being performed We investigated whether radiography can diagnose inflammatory pseudotumours Our findings reveal that radiography may not be effective in this context Further studies may be required to prevent unnecessarily extensive resection
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Affiliation(s)
- S Zulu
- Department of Surgery, University of Pretoria, South Africa.
| | - C Kruger
- Department of Surgery, University of Pretoria, South Africa
| | - N Morare
- Department of Surgery, University of Pretoria, South Africa
| | - D Montwedi
- Department of Surgery, University of Pretoria, South Africa
| | - S Ngwenya
- Department of Surgery, University of Pretoria, South Africa
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Flores R, De La Garza H, Santillan-Gomez AA. A Case of an Inflammatory Myofibroblastic Tumor Mimicking Appendicitis. Cureus 2021; 13:e14059. [PMID: 33898142 PMCID: PMC8059672 DOI: 10.7759/cureus.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare tumors that have been described only in a few cases in the literature. IMTs are mesenchymal neoplasms that typically affect children and young adults. The most common anatomical locations are the abdominopelvic region, lung, and retroperitoneum, but any site may be involved. Given that there are no clinical or radiographic characteristics specific to IMTs, the diagnosis is made by pathology. We report on a young woman presenting with an acute appendicitis-like clinical picture due to an IMT located in the ascending colon to raise awareness of this rare, but possible presentation.
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Affiliation(s)
- Rene Flores
- Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.,Surgical Oncology, Methodist Health System, San Antonio, USA
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5
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Sabbah M, Gharbi G, Jouini R, Haddad D, Bibani N, Chamakhi C, Gargouri D. A pseudotumoral form of Crohn's disease: A case report and review of the literature. Clin Case Rep 2021; 9:1677-1682. [PMID: 33768913 PMCID: PMC7981728 DOI: 10.1002/ccr3.3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/16/2020] [Accepted: 01/14/2021] [Indexed: 11/09/2022] Open
Abstract
In front of a colonic tumor, the diagnosis of a pseudotumoral form of Crohn's disease must be considered. However, it is a rare form, especially when inaugural and a neoplasia must be eliminated before retaining the diagnosis.
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Affiliation(s)
- Meriem Sabbah
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Ghada Gharbi
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Raja Jouini
- Department of PathologyHabib Thameur HospitalTunisTunisia
| | - Dhafer Haddad
- Department of SurgeryHabib Thameur HospitalTunisTunisia
| | - Norsaf Bibani
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Chiraz Chamakhi
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RadiologyHabib Thameur HospitalTunisTunisia
| | - Dalila Gargouri
- Department of GastroenterologyHabib Thameur HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
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Coelho VV, Surendran S, Roopavathana B, Chase S. Colonic inflammatory myofibroblastic tumour presenting as 'pyrexia of unknown origin': report of a rare disease and its unique presentation. BMJ Case Rep 2020; 13:13/12/e236056. [PMID: 33298475 DOI: 10.1136/bcr-2020-236056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Victor Vijay Coelho
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suraj Surendran
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Beulah Roopavathana
- General Surgery Unit IV, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suchita Chase
- General Surgery Unit IV, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Chinnakkulam Kandhasamy S, Sundaramurthi S, Vijayakumar C, Goneppanavar M, Nelamangala Ramakrishnaiah VP. Inflammatory Myofibroblastic Tumor of Sigmoid Colon: Unusual Cause of Intestinal Obstruction. Cureus 2020; 12:e11809. [PMID: 33409054 PMCID: PMC7779172 DOI: 10.7759/cureus.11809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMFTs) are rare solid mesenchymal tumors frequently noted in children and young adults. It is characterized by variable clinicopathological and etiopathogenetic features. They are commonly reported in the lungs and occurrence in the colon is extremely rare. Here, we report a case of IMFT in the sigmoid colon confirmed histopathologically after surgical resection. A 40-year-old lady presented with abdominal pain, vomiting, and constipation for four days. On abdominal examination, there was tenderness in the left iliac fossa region with localized guarding. Contrast-enhanced computed tomography (CECT) showed a sigmoid colonic mass lesion with few enlarged perilesional lymph nodes. Colonoscopy demonstrated circumferential ulceration with irregular margin associated with luminal narrowing noted 55 cm from the anal verge and scope could not negotiate beyond, biopsies were taken. Later, the biopsy came as descriptive in nature. Hence, we proceeded for surgery and intra-operatively we have found there was circumferential thickening in the sigmoid colon for about size 8 cm of which was abutting the left lateral parietal wall. We have done sigmoid colon resection with adequate margins and postoperatively patient did well. Finally, the histopathology report suggested an IMFT sigmoid colon.
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Affiliation(s)
| | | | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Mangala Goneppanavar
- Pathology, Mahatma Gandhi Medical College and Research Institute, Puducherry, IND
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8
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Ajani MA, Fatunla EO, Onakpoma FA, Salami AA. Inflammatory Pseudotumor: A 20-Year Single Institutional Experience. Adv Biomed Res 2020; 9:68. [PMID: 33816387 PMCID: PMC8012865 DOI: 10.4103/abr.abr_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/26/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Inflammatory pseudotumor (IPT) is a relatively rare benign disease. The aim of the study was to demonstrate the demographic distribution, clinical presentation, and histomorphological characteristics of IPT while highlighting its associated diagnostic challenges. Materials and Methods: A retrospective cross-sectional review of all the IPT diagnosed in our institution between January 1999 and December 2018 was conducted. The samples were received from within and outside the hospital facility. The demographic data, clinical history, and histologic reports were reviewed. Results: A total of 25 cases of histologically confirmed IPT were seen. Patients' age ranges from 7 to 74 years with a mean age of 38.96 years and standard deviation ± 17.94 years. There was a bimodal peak occurrence in the third and fifth decades. Most of the patients were adults (23, 92%), whereas only 2 (8%) were children. There was a female preponderance with a male-to-female ratio of 1:2.6. The head and neck had the highest number of cases (44%), followed by the gastrointestinal tract (GIT) (40%). Eight (73%) of head and neck cases occurred in the orbit. The presenting complaints depended on the site of the lesion with pain and swelling being the commonest symptoms irrespective of the site of the lesions. Two cases of bilateral IPT were observed. Immunohistochemistry was used in a certain condition of diagnostic dilemma. Conclusion: This study showed a female preponderance of IPT with the head and neck and GIT being the most common location. It is important to rule out other differentials in the diagnosis of IPT.
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Affiliation(s)
- Mustapha Akanji Ajani
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria.,Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ebenezer O Fatunla
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Francis A Onakpoma
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Ayodeji A Salami
- Department of Pathology, University College Hospital, Ibadan, Oyo State, Nigeria.,Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Karaisli S, Kamer E, Ekinci N, Cengiz F, Er A, Peskersoy M. Inflammatory myofibroblastic tumour of the colon: 2 case reports and a comprehensive review of the literature. Int J Colorectal Dis 2020; 35:947-958. [PMID: 32100112 DOI: 10.1007/s00384-020-03522-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Inflammatory myofibroblastic tumour (IMT), which is also named as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a rare tumour which rarely develops in the colorectal region. We aimed to review all reported cases to draw attention about this rare tumour. METHODS We present two new cases of colonic IMT with no recurrence during the follow-up period. We also reviewed previously reported colorectal IMT/IPT/PCG patients to investigate demographics, diagnosis and treatment modalities. RESULTS A total of 60 patients which including our 2 patients and 58 patients from 42 published articles were analysed. Male/female ratio was 34/26. Mean age was found to be 31.84 ± 22.26 years (9 months-82 years). Abdominal pain (56.7%) and fever (23.3%) were the most common complaints in the first admission. Fifty-nine (98.3%) out of 60 patients underwent surgery. During follow-up, 7 (14.3%) patients developed a local recurrence. CONCLUSION IMT may occur at any age. IMT is considered to be a borderline tumour with the potential for recurrence or distant metastasis. Complete resection of the tumour is recommended for treatment. Long-time follow-up is necessary due to recurrence potential of the tumour even many years after complete surgical resection. TRIAL REGISTRATION The study follows the regulation of the Institutional Review Board for human research at Izmir Katip Celebi University Ataturk Training and Research Hospital. Written informed consents were obtained from the patients who participated in this study.
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Affiliation(s)
- Serkan Karaisli
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Erdinc Kamer
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nese Ekinci
- Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fevzi Cengiz
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ahmet Er
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Mustafa Peskersoy
- Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Pandit N, Yadav TN, Shrestha D, Adhikari P, Awale L. IMFT of the sigmoid colon: a case report. J Surg Case Rep 2019; 2019:rjz334. [PMID: 31768246 PMCID: PMC6865348 DOI: 10.1093/jscr/rjz334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 08/23/2019] [Accepted: 10/17/2019] [Indexed: 12/23/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMFT) of the colon is a very rare entity, characterized by proliferation of myofibroblast cells admixed with inflammatory infiltrates. The entity was first described in the late 1990s, and since then less than 30 cases have been described. It frequently mimics other neoplasm of the colon, such as adenocarcinoma, lymphoma and stromal tumor, and is very difficult to clinch the diagnosis preoperatively based on the clinical and radiological findings. Here, we discuss an uncommon case of sigmoid IMFT in a 35-year old male, presenting with bleeding per rectum and managed successfully by colectomy.
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Affiliation(s)
- Narendra Pandit
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Tek Narayan Yadav
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Deepa Shrestha
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Purbesh Adhikari
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.,Department of Pathology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Laligen Awale
- Division of Surgical Gastroenterology, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Spyrou I, Davakis S, Moris D, Lakiotaki E, Dimitrokallis N, Papalampros A, Schizas D, Pikoulis E, Felekouras E. Inflammatory pseudotumour of the colon. Ann R Coll Surg Engl 2017; 99:e151-e153. [PMID: 28462661 DOI: 10.1308/rcsann.2017.0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction A colorectal inflammatory myofibroblastic tumour (IMT) is a rare but benign entity masquerading as a malignant tumour. Although the lung is considered the most common site of occurrence, IMTs may arise in diverse extrapulmonary locations. We describe a case of a colonic IMT in a patient who presented in the emergency setting. Case History A 77-year-old man was admitted at our emergency department with acute abdominal pain. Physical examination revealed vague tenderness of the lower abdomen and non-palpable masses. Preoperative evaluation revealed a mass in the right lower quadrant of the abdomen, possibly originating from the terminal ileum, 1-2cm from the caecum. Owing to the clinical impression of a potentially malignant lesion, the patient underwent subtotal colectomy and omentectomy. The pathology report suggested the morphological and immunohistochemical features were more compatible with a colonic IMT. Conclusions A colorectal IMT is a rare clinical entity that can easily mimic a highly malignant tumour and cannot be distinguished clinically or radiologically. An accurate diagnosis is based on histological examination and surgical resection is therefore usually required.
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Affiliation(s)
- I Spyrou
- National and Kapodistrian University of Athens , Greece
| | - S Davakis
- National and Kapodistrian University of Athens , Greece
| | - D Moris
- National and Kapodistrian University of Athens , Greece
| | - E Lakiotaki
- National and Kapodistrian University of Athens , Greece
| | | | - A Papalampros
- National and Kapodistrian University of Athens , Greece
| | - D Schizas
- National and Kapodistrian University of Athens , Greece
| | - E Pikoulis
- National and Kapodistrian University of Athens , Greece
| | - E Felekouras
- National and Kapodistrian University of Athens , Greece
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Rafailidis V, Phillips C, Yusuf G, Sidhu P. A case of adult intussusception with greyscale, contrast-enhanced ultrasound and computerised tomography correlation. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 25:120-125. [PMID: 28567107 DOI: 10.1177/1742271x16678646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/20/2016] [Indexed: 12/24/2022]
Abstract
Intussusception is often misdiagnosed as a cause of bowel ischemia and obstruction among adults due to its relatively rare presentation outside of the paediatric population. Ultrasound is often the first-line investigation for non-specific abdominal pain and can identify the presence of intussusception. In the adult population, it is essential to evaluate for causes and consequences of intussusception; as a result, computerised tomography is often deemed necessary. However, contrast-enhanced ultrasound allows for evaluation of potential causes and complications, including a neoplastic lead point and ischaemia of the bowel, whilst avoiding ionising radiation or nephrotoxic iodinated contrast. We report a case of adult intussusception with a polyp lead point with ultrasound, contrast-enhanced ultrasound and computerised tomography correlation.
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Affiliation(s)
| | | | - Gibran Yusuf
- Department of Radiology, King's College Hospital, London, UK
| | - Paul Sidhu
- Department of Radiology, King's College Hospital, London, UK
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Muturi A, Kotecha V, Ojee C, Mang'oka D, Muthuri J. A caecal pseoudotumour with an incidental adenomatoid testicular tumour in a man with right undescended testis: a case report. World J Surg Oncol 2016; 14:236. [PMID: 27585539 PMCID: PMC5009702 DOI: 10.1186/s12957-016-0995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumour refers to a non-malignant tumour-like mass resulting from an inflammatory reaction that is composed of granulation tissue with leukocyte infiltration that commonly occurs in the paediatric or young adult population. These tumours occur more commonly in the lungs and the orbit but rarely does it affect the gastrointestinal tract. It poses a clinical diagnostic challenge since it is a benign condition than can mimic the malignant counterpart. Our case is a rare presentation of the caecal pseudotumour in the presence of a right undescended abdominal testis evaluated as a caecal tumour with a differential diagnosis of a testicular malignancy. CASE PRESENTATION We report a 53-year-old male who presented with clinical signs suggestive of right colon tumour and undescended right testis. Intra-operatively, a caecal mass was found with no clearly discernable appendix and extensive adhesion of the right colon to the retroperitoneum, to the liver and gall bladder. A testis was found adherent to the posterior aspect of the caecum and terminal ileum. A right hemicolectomy was performed. Histopathology findings revealed an inflammatory mass with abundant fibroblast proliferation and chronic inflammatory cells infiltrate, involving bowel wall and periceacal adipose tissue; no malignant cells were identified. The testis had within it an adenomatoid tumour nodule. He had uneventful recovery and was discharged home 7 days post-operatively. At the moment, he is symptoms free. CONCLUSIONS The occurrence of right colonic inflammatory pseudotumour and co-existent adenomatoid testicular tumour arising from a cryptorchid testis is very unusual. This would make one incline towards a malignant testicular lesion in the presence of cryptorchidism. Testicular adenomatoid tumour is a rare benign neoplasm, mostly affecting fully descended testis and usually does not warrant orchidectomy for purposes of preserving testicular function. On the other hand, surgical resection remains the only safe and curative treatment option available for inflammatory pseudotumours.
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