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Shen Q, Liu X, Zhang L, Li T, Zhou J. Inflammatory myofibroblastic tumor of the liver after adrenal neuroblastoma surgery: a case report. Discov Oncol 2024; 15:174. [PMID: 38761221 PMCID: PMC11102410 DOI: 10.1007/s12672-024-01039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
A boy aged 55 months was diagnosed with stage IV Neuroblastoma (NB) of the right adrenal gland 2 years ago. Preoperative chemotherapy was given and he was then treated with retroperitoneal tumor resection and lymph node dissection. After surgery, the children were transferred to the Hemato-Oncology Department for chemotherapy according to the high-risk group NB, with outpatient follow-up every 6 months. In the second postoperative year, abdominal computed tomography (CT) scan revealed a rounded hypodense area in the upper part of the right posterior lobe of the liver, with marked inhomogeneous enhancement in the venous phase after enhancement, which was surgically resected, and postoperative pathology confirmed inflammatory myofibroblastic tumor (IMT) of liver. The patient was not given any special treatment after surgery. In this study, whole transcriptome sequencing was performed on the postoperative specimen of adrenal NB and the specimen of IMT of liver. This unusual case emphasizes the need for close monitoring of second tumor development in NB survivors even in the absence of known predisposing factors.
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Affiliation(s)
- Qiyang Shen
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingyu Liu
- Department of Pediatric Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Lijie Zhang
- Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tao Li
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Jianfeng Zhou
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Park BU, Lee HE, Zhang L. Mimickers of immunoglobulin G4-related hepatobiliary disease on biopsy. Semin Diagn Pathol 2024; 41:95-107. [PMID: 38238218 DOI: 10.1053/j.semdp.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 03/24/2024]
Abstract
With the growing recognition of IgG4-related hepatobiliary disease, establishing a definitive diagnosis relies mainly on a combination of clinical findings, serological markers, and imaging modalities. However, the role of histopathological evaluation remains indispensable, particularly in cases necessitating differential diagnosis or malignancy exclusion. While diagnosing IgG4-related hepatobiliary disease through surgical resection specimens is often straightforward, pathologists encounter substantial challenges when evaluating biopsies. The increasing rarity of surgical interventions exacerbates this due to improved disease recognition and suspicion. Numerous confounding factors, including the absence of the characteristic histologic features, limited tissue sample size, biopsy artifacts, and the limited value of IgG4 counts, further complicate the diagnostic process. Additionally, many other disorders exhibit clinical and histological features that overlap with IgG4-related disease, intensifying the complexity of interpreting biopsy specimens. This article explores the clinical and histomorphologic features of IgG4-related hepatobiliary disease and its potential mimickers. It offers valuable insights for pathologists and clinicians when confronted with biopsy specimens from hepatobiliary organs.
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Affiliation(s)
- Byoung Uk Park
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Hee Eun Lee
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lizhi Zhang
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, United States.
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3
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Tong M, Zhang BC, Jia FY, Wang J, Liu JH. Hepatic inflammatory myofibroblastic tumor: A case report. World J Clin Cases 2023; 11:4318-4325. [PMID: 37449218 PMCID: PMC10336984 DOI: 10.12998/wjcc.v11.i18.4318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/15/2023] [Accepted: 05/23/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Hepatic inflammatory myofibroblastic tumor (HIMT) is a rare type of hepatic tumor. It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation, and its imaging findings are diverse.
CASE SUMMARY Here, we report a case of HIMT that was initially diagnosed as liver malignancy but was confirmed as HIMT by histopathology after hepatectomy. Mostly, HIMTs are infiltrated with plasma cells and stain positively for anaplastic lymphoma kinase on immunohistochemistry as well as for some other kinases.
CONCLUSION HIMT can be treated with single nonsteroidal anti-inflammatory drugs and without surgery when it is diagnosed accurately. Because the etiology of HIMT is unknown and the diagnosis is difficult, the pathogenesis and clinical process need to be further studied.
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Affiliation(s)
- Meng Tong
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Bo-Cheng Zhang
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Fei-Yu Jia
- Graduate Management Office, Education and Teaching Department, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Jing Wang
- Department of Radiology, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
| | - Jing-Hua Liu
- Department of Hepatobiliary Surgery and Minimally Invasive Institute of Digestive Surgery and Prof. Cai’s Laboratory, Linyi People’s Hospital, Linyi 276000, Shandong Province, China
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Hinojosa Arco LC, Roldán de la Rúa JF, Arranz Salas I, Gómez Pérez R, Suárez Muñoz MÁ. Inflammatory myofibroblastic tumor of the liver mimicking Klatskin tumor. Cir Esp 2023; 101:303-307. [PMID: 35568329 DOI: 10.1016/j.cireng.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/14/2022] [Indexed: 04/21/2023]
Affiliation(s)
- Luis Carlos Hinojosa Arco
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
| | | | - Isabel Arranz Salas
- Servicio de Anatomía Patológica, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Rocío Gómez Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Miguel Ángel Suárez Muñoz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Costa CM, Neto JS, Benavidez MR, Vincenzi R, Roda K, Oliveira CMV, Travassos NPR, de Lima LGCA, Pereira FP, Fonseca EA. Liver transplantation for hilar inflammatory myofibroblastic tumor: Case report and review of the literature. Pediatr Transplant 2022; 27:e14445. [PMID: 36435975 DOI: 10.1111/petr.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/15/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) of the liver are rare neoplasms. These tumors are difficult to distinguish from other neoplasms by radiological examination, have uncertain evolution, and there is no consensus on the treatment of these lesions. Hilar tumors can involve the portal vein, hepatic artery, bile duct, and spread to the branches of the portal triad, causing obstructive symptoms, occlusive phlebitis, and portal hypertension. Thus, liver transplantation (LT) is an excellent alternative for locally advanced hilar tumors, since it ensures complete tumor resection with free margins. METHODS/RESULTS We present a literature review and a case report showing a 3-year-old boy with liver IMT invading the hepatic hilum and inferior vena cava, who underwent a successful living donor liver transplantation that required portal vein and vena cava replacement. CONCLUSION The incidence of hilar IMTs is low and there is no well-established standard treatment. Liver transplantation for a hilar tumor with vascular invasion was acceptable in this case because the radically of the surgery was the key for the cure, and because the tumor was benign in nature.
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Affiliation(s)
- Carolina Magalhães Costa
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcel R Benavidez
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Karina Roda
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Caio Márcio V Oliveira
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Nathália Porto R Travassos
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.,Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
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Shen L, Yang Z, Ding R, Wei W, Xu Y. Hepatic inflammatory myofibroblastic tumor: One case report. Front Surg 2022; 9:902753. [PMID: 35990088 PMCID: PMC9386116 DOI: 10.3389/fsurg.2022.902753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Hepatic inflammatory myofibroblastic tumor (HIMT) is a junctional neoplastic lesion of mesenchymal tissue origin that can sometimes become locally invasive and even metastasize or recur. Therefore, the diagnosis and treatment of HIMT is particularly important. However, hepatic inflammatory myofibroblastic tumor lacks a specific clinical presentation and typical imaging manifestations, thus posing a difficulty for us to diagnose and treat this disease. Case Presentation We report here a very rare surgical case of hepatic inflammatory myofibroblastic tumor (HIMT) in a 41-year-old female who was admitted to the hospital for more than half a month for a liver-occupying lesion with fever found on physical examination.After discussion with the hepatobiliary and pancreatic surgery team, we decided to perform surgical treatment. The final postoperative pathology confirmed hepatitis myofibroblastoma. Conclusion Our review of the domestic and international literature revealed no significant progress in the diagnosis and treatment of this disease, so we report here a case of surgical treatment. One of our aims in this case report is to highlight the efficacy of surgical treatment in HIMT. HIMT is extremely rare and difficult to diagnose. Due to their intermediate biological behavior, surgical resection should be performed whenever feasible and patients should be followed-up in order to detect recurrence and metastasis as early as possible.
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Hinojosa Arco LC, Roldán de la Rúa JF, Arranz Salas I, Gómez Pérez R, Suárez Muñoz MÁ. Tumor miofibroblástico inflamatorio hepático que mimetiza un tumor de Klatskin. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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What do we know about inflammatory myofibroblastic tumors? - A systematic review. Adv Med Sci 2022; 67:129-138. [PMID: 35219201 DOI: 10.1016/j.advms.2022.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/24/2021] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are rare intermediate-grade neoplasms that have a high recurrence rate after excision and exhibit low metastatic potential. These tumors contain proliferating neoplastic, fibroblastic and myofibroblastic cells, and are also characterized by chronic inflammatory infiltration by lymphocytes, plasma cells, eosinophils, and histiocytes. They belong to the group of inflammatory spindle cell lesions. Some reactive lesions, such as inflammatory pseudotumors, may appear to be IMTs, which makes their differential diagnosis extremely difficult. The aim of this article is to compile the recent information on IMTs to aid in their diagnosis and treatment. METHODS We reviewed articles published between 2017 and 2021, which were selected from online medical databases. In addition, some earlier articles and latest scientific monographies were analyzed. RESULTS The terminology used for inflammatory spindle cell lesions seems to be confusing. The terms "inflammatory myofibroblastic tumors" and "inflammatory pseudotumors" are interchangeably used by many scientists. However, a detailed analysis of the development of terminology suggests that the term "inflammatory myofibroblastic tumors" should be used to refer to a neoplastic lesion. CONCLUSIONS IMTs are rare neoplasms, which have not been investigated in detail due to the difficulty in collecting a large number of cases. Thus, our knowledge about this disease remains unsatisfactory. Recently developed techniques such as next-generation sequencing and computer-aided histopathological diagnosis may be useful in understanding the etiopathology of IMTs, which will help in the selection of the most appropriate therapy for patients.
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El-Diasty MT, Wazzan MA, Abduljabbar AH. Inflammatory Myofibroblastic Tumor of the Porta Hepatis: A Case Report. J Clin Imaging Sci 2021; 11:28. [PMID: 34221637 PMCID: PMC8247711 DOI: 10.25259/jcis_91_2021] [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: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old man presented with painless jaundice. Imaging revealed a porta hepatis mass compressing the common bile duct. Endoscopic biopsy was negative for malignancy. Complete surgical resection was performed. Pathological assessment showed IGg4 negative inflammatory myofibroblastic tumor.
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