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Billingsley BC, Chaudhary R, Morris MW, Cox JA, Camacho-Gomez SM, Varshney N. Inflammatory Myofibroblastic Tumor of the Esophagus and Stomach Successfully Treated With ALK Inhibitor in a Pediatric Patient: A Case Report and Concise Review of Literature. Int J Surg Pathol 2024:10668969241246470. [PMID: 38656257 DOI: 10.1177/10668969241246470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of borderline malignant potential. Nearly half of all IMTs have rearrangement of anaplastic lymphoma kinase (ALK) locus on chromosome 2p23 which can be treated with targeted therapy. Herein, we describe an unusual presentation of IMT involving an anatomical region rarely implicated in this disease process. A 15-year-old male patient came to the ER with dysphagia and coffee ground emesis. On esophagogastroscopy, a nodular luminal obstructing 30 × 50 mm mass in the lower esophagus was found, which was continuous with a large, partially circumferential gastric mass extending from the mid-body to the proximal antrum. Biopsies from esophageal and gastric masses revealed submucosal lesions composed of cytologically bland spindle and epithelioid cells, intermingled with inflammatory infiltrate, for which several immunohistochemical (IHC) stains were performed. The molecular study demonstrated ATIC::ALK fusion. Based on morphological, IHC, and molecular study findings, the diagnosis of ALK-positive IMT was rendered. Because surgical excision was deemed infeasible, the patient was started on ALK-inhibiting therapy with crizotinib. The patient responded well with no evidence of residual or recurrent disease on follow-up imaging or surveillance esophagogastroduodenoscopy. Crizotinib was ultimately discontinued after 10 months of therapy, and the patient continues to undergo surveillance imaging for monitoring of disease burden.
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Affiliation(s)
- Benjamin C Billingsley
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ritica Chaudhary
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael W Morris
- Division of Pediatric, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jennifer A Cox
- Division of Hematology and Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandra M Camacho-Gomez
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas at Austin, Austin, TX, USA
| | - Neha Varshney
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Cheng T, Liang S, Zhang J, Wang W. Indolent growth of low‑grade myofibroblastic sarcoma of the knee with the resemblance of a benign lesion: A case report. Oncol Lett 2024; 27:163. [PMID: 38426155 PMCID: PMC10902747 DOI: 10.3892/ol.2024.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/05/2024] [Indexed: 03/02/2024] Open
Abstract
Low-grade myofibroblastic sarcoma (LGMS) is a rare soft-tissue malignant neoplasm originating from the stromal cells that is predominantly comprised of atypical myofibroblasts. The present study reports the case of a patient with low-grade myofibroblastic sarcoma in the soft tissue of the knee. The patient exhibited a soft, painless mass on the medial side of the left knee. During surgery, a yellow-white mass above the posterior margin of the sartorius muscle was identified. This mass, which was irregular and adherent to surrounding tissues, had a blurry boundary, indicative of invasive growth. The morphology of the mass significantly differed from conventional lipomas and was lacking typical features. Immunohistochemical staining confirmed the diagnosis of a malignant LGMS. The patient experienced no recurrence over 1 year of follow-up and reported complete recovery of knee range of motion. The present study suggests that an incisional biopsy may be performed if LGMS is suspected based on patient symptoms and imaging results. In addition, long-term follow-up is crucial for the timely detection and management of any recurrence, playing a key role in the patient's ongoing care and treatment.
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Affiliation(s)
- Tao Cheng
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou 550000, P.R. China
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, P.R. China
| | - Shaohua Liang
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, P.R. China
| | - Jinli Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, P.R. China
| | - Wen Wang
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou 550000, P.R. China
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, P.R. China
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Huang Y, Zhang M, Li Q, Huang Q. Gastric and cardiac inflammatory myofibroblastic tumor: an extremely rare case. J Cardiothorac Surg 2024; 19:31. [PMID: 38287440 PMCID: PMC10823716 DOI: 10.1186/s13019-024-02481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a unique, rarely metastatic tumor composed of myofibroblasts and fibrous spindle cells with inflammatory cell infiltration that can affect any organ in the human body. By reviewing the relevant literature on PubMed, we found that this is the first case report of IMT with both gastric and cardiac involvement. CASE PRESENTATION A 57-year-old male patient was admitted to the hospital with complaints of malaise, poor appetite, and epigastric pain with black stools. We found a mass in the patient's stomach and left atrium by contrast-enhanced computed tomography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and other tests. The patient underwent laparoscopic Billroth II subtotal gastrectomy and Braun's gastrointestinal reconstruction under general anesthesia. On the 46th day following stomach surgery, the cardiac tumor was removed under general anesthesia. The patient has treated with doxorubicin 70 mg of D1 chemotherapy two months after cardiac surgery. Postoperative pathological immunohistochemistry of the mass confirmed the diagnosis of an IMT. His review three months after the cardiac surgery suggested the progression of the left atrial mass, but he declined further treatment and finally died one month after the review. CONCLUSIONS As a unique class of tumors that rarely metastasize, IMTs have an unknown etiology and pathogenesis, and distant metastasis is primarily observed in patients with negative activin receptor-like kinase (ALK) expression. The preferred treatment for IMT is complete surgical resection, and the effectiveness of adjuvant therapy for patients with distant metastases is still being determined. The clinical presentation of IMT lacks specificity and is often related to the location of tumor growth, which poses a diagnostic challenge. Pathological immunohistochemistry is the only way to confirm the diagnosis at present. Our case report reminds clinicians that a category of ALK-negative IMT with a tendency toward distant metastasis should not be ignored.
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Affiliation(s)
- Yueqi Huang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Mingqi Zhang
- Department of General Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Qingchun Li
- Department of Image, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Qiulin Huang
- Department of General Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China.
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Zabeirou A, Efared B, Souiki T, James Didier L, Majdoub KI, Toughrai I, Chbani L, Mazaz K. An inflammatory myofibroblastic tumor of the ampulla of Vater, an exceptional location: a case report. Ann Med Surg (Lond) 2023; 85:6237-6242. [PMID: 38098604 PMCID: PMC10718341 DOI: 10.1097/ms9.0000000000001416] [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: 08/23/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance Inflammatory myofibroblastic tumors constitute a group of mesenchymal tumors associated with inflammatory infiltration. They occur mainly in young patients. It is classified by the World Health Organization as a borderline neoplasm. They are observed in many organs, particularly the lungs. Digestive localization is rare, and localization into the ampulla of Vater has been reported once. Case presentation We report the case of a 39-year-old patient who was admitted for cholestatic jaundice with right hypochondrium pain. Computed tomography and magnetic resonance imaging revealed a tumor at the biliopancreatic junction. A cephalic duodenopancreatectomy was performed, and a histological examination of the surgical specimen revealed an inflammatory myofibroblastic tumor of the ampulla of Vater. The postoperative evolution was without any complications. Clinical discussion This is the second case of localization of an inflammatory myofibroblastic tumor in Vater's ampulla. The therapeutic approach is the complete excision of these inflammatory tumors, thus reducing the risk of local recurrence. In the literature, all cases of incomplete excision have resulted in recurrences. Conclusion Inflammatory myofibroblastic tumors are rare. The diagnosis was based on histopathological findings and confirmed using immunohistochemical techniques.
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Affiliation(s)
- Aliou Zabeirou
- Department of General and Visceral Surgery, Hôpital Général de Référence
| | - Boubacar Efared
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Tarek Souiki
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Lassey James Didier
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Karim I. Majdoub
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Imane Toughrai
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Laila Chbani
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Khalid Mazaz
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
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Kimura N, Hiraki M, Akashi M, Miyahara K, Imamura M, Furukawa S, Samejima R. A rare case of inflammatory myofibroblast tumor of the stomach successfully treated by inverted laparoscopic and endoscopic cooperative surgery. Surg Case Rep 2023; 9:189. [PMID: 37902858 PMCID: PMC10616023 DOI: 10.1186/s40792-023-01767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
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.
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Affiliation(s)
- Naoya Kimura
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Masatsugu Hiraki
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan.
| | - Michiaki Akashi
- Department of Pathology, Japan Red Cross Society Karatsu Red Cross Hospital, Karatsu, Saga, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Japan Red Cross Society Karatsu Red Cross Hospital, Karatsu, Saga, Japan
| | - Minori Imamura
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Shunsuke Furukawa
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Ryuichiro Samejima
- Department of Surgery, Japan Red Cross Society Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
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Liu J, Bai Z, Li S, Zeng S, Li C, Liu Q. Case Report: Recurrence of Testicular Myofibroblastic Tumor After Surgery. Front Oncol 2022; 11:810708. [PMID: 35096616 PMCID: PMC8795764 DOI: 10.3389/fonc.2021.810708] [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: 11/07/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Inflammatory myofibroblastic tumour (IMT), also known as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a distinctive, rarely metastasizing neoplasm composed of myofibroblastic and fibroblastic spindle cells accompanied by inflammatory infiltration of plasma cells, lymphocytes and/or eosinophils. IMT predominantly affects children and young adults, and the age at presentation ranges from 3 to 89 years. We present a very rare case of recurrent testicular IMT without ALK rearrangement. This case highlights the clinical characteristics and diagnostic factors associated with primary and recurrent foci of this rare tumour, along with key therapeutic approaches.
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Affiliation(s)
- Jiayi Liu
- The First Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Zhijie Bai
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Shuaiqi Li
- School of Medicine, Nankai University, Tianjin, China
| | - Sheng Zeng
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Chuang Li
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
| | - Qian Liu
- Department of Urology, Tianjin First Central Hospital, School of Medicine, NanKai University, Tianjin, China
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