Inflammatory pseudotumor-like follicular dendritic cell sarcoma with first clinical manifestation of thrombocytopenia: A case report

BACKGROUND

Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is often associated with Epstein-Barr (EB) virus infection. The tumor is commonly found in the spleen and liver, and it has been reported in the literature that it can be associated with paraneoplastic pemphigus, myasthenia gravis, and other diseases. A case of IPT-like FDCS with clinical features of thrombocytopenia has not been reported.

PATIENT CONCERNS

A 59-year-old male patient visited our hospital in September 2020 due to bleeding gums and epistaxis.

DIAGNOSIS

Splenic lymphoma with marked thrombocytopenia was initially diagnosed. The patient underwent pathological examination after splenectomy. Microscopic examination showed spindle-shaped or oval cells arranged in loose bundles, a large number of lymphocytes and plasma cells infiltrating the interstitium, and fibrin-like changes in the blood vessel wall. Immunohistochemical detection of tumor cells was positive for CD21, CD35, and Epstein-Barr virus in situ hybridization, and the patient was diagnosed with IPT-like FDCS.

INTERVENTIONS

The patient underwent a splenectomy. The patient received platelet-raising therapy postoperatively.

OUTCOMES

No tumor recurrence or metastasis was found during the 17-month follow-up period, and the platelet count returned to normal.

CONCLUSION

IPT-like FDCS is an uncommon tumor, and its first presentation with marked thrombocytopenia is even rarer. The tumor was clinically and radiographically nonspecific. Definitive diagnosis relies on histopathological and immunohistochemical staining. IPT-like FDCS is biologically indolent and has a favorable prognosis.

Intratumor Abscess in a Posttraumatic Hepatic Inflammatory Pseudotumor Spreading Out of the Liver

A 45-year-old woman with abdominal pain after minor trauma was referred to our hospital. Computed tomography (CT) showed a hypovascular tumor in the left liver lobe. A tumor biopsy revealed granuloma, although no findings indicated malignancy or infection. A follow-up imaging study showed spread of the hepatic tumor. Her abdominal pain worsened after a second minor trauma. CT revealed an intratumor abscess, and pus overflowed from the patient's umbilicus. The abscess was improved by antibiotics and drainage therapy. In this case, unusual imaging findings and an atypical disease course of a hepatic inflammatory pseudotumor were observed.

Retro-odontoid Degenerative Pseudotumour Causing Spinal Cord Compression and Myelopathy: Current Evidence on the Role of Posterior C1-C2 Fixation in Treatment

BACKGROUND

A retro-odontoid pseudotumour compressing the spinal cord and causing myelopathy is often associated with an inflammatory condition such as rheumatoid arthritis. A degenerative non-inflammatory retro-odontoid pseudotumour responsible for clinically relevant spinal cord compression is a rare condition described in small clinical series and is likely associated with craniovertebral junction hypermobility or instability-like conditions. For several years, direct removal of the lesion through an anterior or lateral approach has been advocated as the best surgical option. However, in the last decade the posterior approach to the craniovertebral junction, to perform C1-C2 fixation and C1 laminectomy without removal of the retro-odontoid tissue, has demonstrated its efficacy in reducing retro-odontoid pannus as well as in obtaining improvement of myelopathy.

METHODS

In this paper we analyse the clinical and radiological outcomes of seven patients (five males and two females) treated with posterior C1-C2 fixation and C1 laminectomy for a degenerative non-inflammatory retro-odontoid pseudotumour responsible for spinal cord compression. C1 laminectomy provided immediate spinal cord decompression. We also review the relevant literature focusing on associated cervical degenerative conditions that may contribute to triggering or acceleration of atlantoaxial hypermobility or 'instability', causing formation of the retro-odontoid tissue.

RESULTS

The mean follow-up period (of six followed-up patients) was 55.8 months (range 10-96 months). In all cases the Nurick score at the latest follow-up visit demonstrated clinical improvement; magnetic resonance imaging during follow-up demonstrated progressive reduction of the retro-odontoid pseudotumour in all but one patient, who died of surgery-unrelated disease in the early postoperative period. No vascular or neural damage secondary to C1-C2 fixation was observed.

CONCLUSION

C1-C2 fixation associated with C1 laminectomy is an effective surgical option to treat myelopathy secondary to a degenerative retro-odontoid pseudotumour. In these cases, direct removal of intracanalar tissue compressing the spinal cord is not required, as C1-C2 fixation is sufficient to cause its disappearance.

[Inflammatory Pseudotumor in the Cecum-A Case Report and Review of Literature]

A 42-year-old woman with complaints of fever and abdominal pain, was diagnosed to have perforative appendicitis, for which emergency surgery was performed. Marked thickening and edema around the cecum, ileum, and the mesentery was observed. Ileocecal resection was performed, as malignant disease could not be excluded. Histopathological examination revealed abscess formation in the lining membrane of the intestine, inflammatory granulation and proliferation of the spindleshaped cells in the serosal membrane extensively, and an inflammatory pseudotumor(IPT)was diagnosed. It is generally difficult to clearly distinguish IPT from a malignant tumor before surgery. We thus report this case, along with a review of literature.

Primary Pleural Inflammatory Pseudotumor in a Child

BACKGROUND

Inflammatory pseudo tumor, a rare non-neoplastic lesion, commonly presents as slow growing solid lesion in the lung, but many extra-pulmonary locations have been described.

CASE CHARACTERISTICS

A 4-year-old girl who presented with respiratory distress due to massive pleural effusion. Computed tomography revealed large hypodense non-enhancing lesion in the left hemi thorax. Surgical exploration revealed large semisolid pleural collection filled with gelatinous material with normal underlying lung.

OUTCOME

Histopathology revealed spindle shaped cells with abundant myxoid stroma. Child recovered after surgery and was asymptomatic at 5 years follow-up.

MESSAGE

Primary pleural inflammatory pseudotumor may be a rare cause of pleural effusion in a child.

Head and neck inflammatory pseudotumor: Case series and review of the literature

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement

BACKGROUND AND PURPOSE

There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors.

PATIENTS AND METHODS

263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles.

RESULTS

The prevalence of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that "preoperative diagnosis other than osteoarthrosis" was the strongest predictor of the presence of fatty atrophy.

INTERPRETATION

Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach.

Hemoperitoneum secondary to perforated inflammatory myofibroblastic tumor: A case report of an unusual complication

INTRODUCTION

Inflammatory myofibroblastic tumors (IMT) are rare neoplasms characterized by a proliferation of spindle-shaped cells with a stroma infiltrated by macrophages, lymphocytes and plasma cells.

CASE REPORT

We report a case of 59 years old male who presented an acute abdomen due to a mass of the mesentery of the terminal ileum, which was perforated with active bleeding. Histopathology reported a low-grade TMI with clear margins.

DISCUSSION

Inflammatory myofibroblastic tumors of the mesentery are rare entities whose etio-pathogenia remains unclear. It requires a histopathological diagnosis and inmunohistochemical evaluation and its treatment is based on complete resection of the tumor. These type of neoplasms require close monitoring due to local recurrence.

Inflammatory Pseudotumor of the Brain Parenchyma with IgG4 Hypergammaglobulinemia

A 58-year-old woman with a 1-month history of right hand clumsiness and speaking difficulty was admitted to our hospital. A neurological examination revealed sensory aphasia and right hemiparesis. Her laboratory tests showed elevated serum levels of IgG and IgG4, pancytopenia, and liver dysfunction. The results of the imaging studies of her abdomen were compatible with sclerosing cholangitis. Brain MRI showed extensive signal abnormalities in the left hemisphere on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images, extending from left internal capsule to the cerebral peduncle with an irregularly enhancing lesion in the left parietal lobe. A brain biopsy revealed lymphocyte and plasma cell infiltration and reactive gliosis. Most of the plasma cells were IgG positive; however, IgG4-positive plasma cells were sparsely observed. After the initiation of betamethasone treatment, her symptoms and the brain MRI abnormalities showed significant improvement. The brain biopsy results did not meet the current criteria of IgG4-related disease. This is the first reported case of a tumefactive lesion of the brain parenchyma with serum IgG4 elevation, which was responsive to steroid treatment. The accumulation of a greater number of reports on the pathological investigation of cases of possible IgG4-related disease may help to elucidate the exact role of IgG4 in IgG4-related disorders.

Melena as presentation of primary small intestine inflammatory myofibroblastic tumor in an adult woman. A case report

INTRODUCTION

Inflammatory myofibroblastic tumor (IMT), also known as inflammatory pseudotumor, plasma cell granuloma or inflammatory myofibroblastoma, is characterized histopathologically by myofibroblastic spindle cells with inflammatory cell infiltrates ( plasma cell, lymphocytes and eosinophils). Inflammatory myofibroblastic tumor is tipically seen in children or young adults and is most commonly localized in the lung, but it can occur anywhere in the body.

CASE REPORT

We present a case in a young woman with severe acute G.I. bleeding, an uncommon presentation of IMT in adults. The patient was admitted to the emergency department for melena. MRI showed a distal jejunum hypervascular mass. Other exams were negative. Surgical excision was recommended, so the patient underwent surgery with complete removal of the tumoral mass. No adjuvant therapy was employed and the patient is asymptomatic after 6 months of follow-up.

DISCUSSION

IMT is an rare lesion that mimics malignancy and is accompanied by various clinical manifestations. The treatment of choice is believed to be complete surgical excision and long term follow up.

KEY WORDS

Anemia, Inflammatory myofibroblastic tumor (IMT), Small intestine, Surgery.

Inflammatory pseudotumor of the colon causing intussusception: A case report and literature review

Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception from clinically suspected malignancy of the right colon where the patient underwent right hemicolectomy. Histopathology of the resected specimen confirmed IPT of the colon. This patient was observed to have abnormally elevated total leukocyte count and platelets before and after surgery. In an adult with intussusception associated with an abdominal mass, the possibility of IPT of the colon should be considered. Considering the abnormally high total leukocyte and platelet counts and colonic IPT, it is necessary to prevent postoperative adverse effects due to these changes. Although IPT of the colon is usually a benign process, controversy regarding its management still exists. We consider hemicolectomy as a safe treatment approach for colonic IPT and review the existing literature.

Inflammatory pseudotumour of the maxillary sinus mimicking malignancy

Inflammatory pseudotumours of the paranasal sinuses are rare entities and can be easily confused with aggressive malignant tumours. In this report we describe the characteristic behavior of inflammatory pseudotumours in the maxillary sinus. We present a case of a 47-year-old Caucasian woman, who presented in our ENT department because of progressive nasal obstruction, epistaxis, and epiphora. The clinical as well as the radiological findings suggested a maxillary sinus neoplasm, most probably of malignant nature. The histopathological examination showed an inflammatory pseudotumour of the maxillary sinus with polypoid structure and no signs of malignancy.

[Bilateral pleural thickening]

The authors report the case of a 20-year-old man in whom pulmonary and bone tuberculosis presented as bilateral pleural thickening without effusion.

Pseudotumours and IgG4-related disease: a case report

We report a case of a patient presenting with abdominal pain, weight loss and CT imaging showing mass lesions in the chest and abdomen associated with lymphadenopathy. He was diagnosed as having IgG4-related disease and responded well to steroid treatment.

Clinicopathologic characteristics of inflammatory pseudotumor-like follicular dendritic cell sarcoma

Inflammatory pseudotumor (IPT)-like follicular dendritic cell (FDC) sarcoma is a recently described rare tumor and considered a unique entity, with different histologic appearances and behavior from those of the classical FDC sarcoma. This study analyzed the clinical and pathological findings of two such cases that the authors encountered and 36 previously reported cases identified in the literature. Assessment of all 38 cases showed a slight female predominance (2.2:1) with a median age of 56.5 years. Seventeen patients complained of abdominal discomfort or pain, while fifteen patients had no clinical symptom. Almost all cases occurred in liver (n=20) or spleen (n=17). Except in one case, all patients underwent surgical resection of the tumor alone. Histologic features showed a mixture of chronic inflammatory cells and variable amounts of spindle cells with vesicular nuclei and distinct nucleoli. The tumor cells expressed conventional FDC markers such as CD21 (75%), CD35 (92%), CD23 (62%), clusterin (75%), and CNA.42 (100%). EBV was detected in thirty-five cases (92.1%) by Epstein-Barr virus (EBV)-encoded RNA in situ hybridization, and EBV-latent membrane protein-1 was expressed in 90% of the cases. With a median follow-up of 21 months, 29 patients (85.3%) were alive and well, 4 (11.8%) were alive with disease, one patient (2.9%) died of disease. Only four patients with hepatic tumors underwent recurrence or metastasis after initial treatment. Epstein-Barr virus is thought to play a role in the development of the tumor; however, the pathogenesis of the disease and the origin of tumor cells remain unclear.

Inflammatory pseudotumour of urinary bladder - a rare cause of massive macroscopic haematuria

PURPOSE

Authors analyzed their experience with urinary bladder tumours. This article discusses clinical and histopathological diagnostics and treatment procedures, and follow up of patients with rare benign urinary bladder tumours.

METHODS

406 patients with bladder tumours were treated in our department between January 2000 and December 2008. 322 patients had superficial tumours and 84 had primary invasive tumours. All patients who underwent transurethral resections of these tumours were operated under general or spinal anaesthesia. The resected specimens were histologically examined in the department of Pathology.

RESULTS

399 of the 406 patients had urothelial bladder cancer, 7 patients had a histologically uncommon type of bladder tumour, one female was diagnosed with sarcomatoid bladder cancer, one patient had a histologically confirmed feochromocytoma of the urinary bladder. Two males had epidermoid carcinoma. One female had a histologically described uncommon benign pseudoneoplastic lesion, chararacteristic for endosalpingiosis. Another two patients were diagnosed with inflammatory myofibroblastic tumour of the urinary bladder. Both patients presented with gross macroscopic haematuria. Authors performed complete transurethral tumour resections, which required several sessions and the deliberation of a blocked ureter through nephrostomy in one case.

CONCLUSION

More than 98 % of all treated patients had urothelial bladder cancer in different stages and grades. Two patients had rare benign inflammatory proliferation of the bladder wall which formed large tumorous bleeding masses obstructing the ureter in one case. These types of bladder tumour could be treated conservatively with meticulous long term follow up similarly to patients with bladder cancer (Tab. 1, Fig. 4, Ref. 15). .

Multiple plasma cell granulomas of the larynx in a young man

Plasma cell granuloma of the larynx is a rare benign lesion of unknown etiology, with only 21 cases reported previously. We report an additional case of plasma cell granuloma in which a 26-year-old man experienced a 1.5 × 3.4-cm, completely obstructing subglottic lesion. Because of the patient's young age, history of hemoptysis, bleeding from his tracheostomy, and the rarity of plasma cell granulomas, the patient was assumed to have hemangioma until proven otherwise. He presented with a partially obstructing glottic lesion 4 months later. Both the subglottic and glottic lesions were excised endoscopically. Multiple modalities have been used to treat plasma cell granulomas, including radiation, endoscopic CO2 laser ablation, high-dose prednisone, and open excision. In our case, steroids were given in the interim between the 2 excisions. This is the first report of a patient with two laryngeal plasma cell granulomas and the 22nd reported case of laryngeal plasma cell granuloma.

Simultaneous inflammatory pseudotumors of the coronary arteries and abdominal aorta

We herein report a rare case of cardiac and abdominal aortic inflammatory pseudotumors (IPTs). A 64-year-old male presented with a loss of appetite, abdominal distension and general fatigue. A cardiac tumor was suspected on the basis of computed tomography scans. A needle biopsy was performed, but it did not lead to a definitive diagnosis. At the same time, a 70-mm abdominal aortic aneurysm (AAA) was also detected. A full sternotomy was performed, and a huge, elastic hard tumor was found around the bilateral coronary arteries, anterior side of the right atria, ascending aorta and pulmonary artery. The pathological diagnosis was IPT, which was judged to be inoperable because of its anatomical location and the fact that the patient was a Jehovah's Witness, which precluded the administration of heterologous blood transfusions. The AAA was surgically treated, and the pathological diagnosis of the aneurysmal tissue also revealed IPT. Perioral steroid therapy was initiated, and the size of the tumor did not change for 1-2 years, but then gradually increased. The patient eventually died 8 years later, and the cause of his sudden death was considered to be heart failure caused by the pressure on the right atrium and ventricle due to the enlarged cardiac tumor.

Necrotic hepatocellular carcinoma occurring within an inflammatory pseudotumor-like nodule

Hepatocellular carcinoma (HCC) and inflammatory pseudotumor of the liver (IPL) are often difficult to differentiate before surgery. To date, colocalization of IPL and HCC has not been reported. We experienced a case of necrotic HCC surrounded by IPL-like tissue. The raised levels of alpha-fetoprotein and PIVKA-II declined to within the normal ranges after resection of the tumor. The IPL-like nodule most likely developed as a process of an inflammatory reaction such as abscess formation after the spontaneous destruction of the HCC. Our case is a warning that the presence of a 'pseudotumor' does not rule out the possible simultaneous presence of carcinoma.

[An inflammatory pseudotumor of the liver]

BACKGROUND

Inflammatory pseudotumours are rare benign tumours that can present as solid and potentially malignant tumours on diagnostic images.

CASE DESCRIPTION

A 59-year-old male presented at the emergency department with continuous pain in his right upper abdomen, attacks of colic and intermittent fever. CT scans of the abdomen revealed a solid lesion in the liver. Histopathological analysis of a biopsy showed an inflammatory pseudotumour. Since the pain persisted and a malignancy could not be excluded with certainty, surgical resection of the tumour was performed. The specimen showed an inflammatory pseudotumour with an increase in IgG4 positive plasma cells as well as a purulent infection around aggregates of Actinomyces.

CONCLUSION

It is important to realise that a pseudotumour caused by an inflammatory reaction can mimic a malignancy.

A rare case of fever of unknown origin: inflammatory myofibroblastic tumor of the liver. Case report and review of the literature

We present the case of a rare cause of fever of unknown origin (FUO). FUO is challenging for patients as well as for physicians as there are more than 200 differential diagnoses of FUO (1,2). Pointing out a diagnosis often requires numerous noninvasive and invasive procedures that sometimes even fail to explain the fever. Our patient was admitted twice to our hospital due to remitting fever rising up to 40 degrees C without any subjective discomfort. At the first presentation no clinical focus could be identified. This included the examination of multiple blood and urine cultures, serology, autoimmune serology, transesophageal echocardiography, CT-scan of the lung and the abdomen, and bone scintigraphy. Elevated C-reactive protein (268 mg/l) decreased spontaneously and fever disappeared after 4 weeks. However, the patient was re-admitted 4 months later with identical symptoms. Multiple blood and urine cultures, serology, bone marrow examination, CT-scan of the lung and the abdomen, esophago-gastro-duodenoscopy and colonoscopy still showed no pathological findings. MRI-scan of the abdomen identified a liver tumor of 3.3 cm in diameter in segment 6 without typical signs of an adenoma, focal nodular hyperplasia or hepatocellular carcinoma. Biopsy of the suspect liver lesion revealed an inflammatory myofibroblastic tumor (inflammatory pseudotumor). After surgical resection of the tumor elevated inflammation markers as C-reactive protein normalized and fever disappeared. One year after surgery no more episodes of fever re-occurred. An inflammatory myofibroblastic tumor of the liver can be a rare cause of fever of unknown origin. MRI-scan can be an additional imaging tool to identify previously not recognized liver tumors.

Surgical treatment of the haemophilic pseudotumour: a single centre experience

PURPOSE

Haemophilic pseudotumour was defined by Fernandez de Valderrama and Matthews as a progressive cystic swelling involving muscle, produced by recurrent haemorrhage into muscles adjacent to the bone. The pseudotumour mainly occurs in the long bones and the pelvis. The treatment of the haemophilic pseudotumour poses a challenge, and extensive clinical experience is essential to appropriately address this serious complication in patients with haemophilia. Consequently, the aim of this study is to present our own clinical experience and treatment results of the haemophilic pseudotumour.

METHODS

We retrospectively reviewed the records of 87 patients with bleeding disorders treated between 1967 and 2011 for musculoskeletal complications of congenital bleeding disorders. We identified six patients with a haemophilic pseudotumour who were treated at our department.

RESULTS

The mean age at surgery was 45.9 (range, 40-61) years. The iliac bone was affected in three patients (one right, two left), the right tibia (distal diaphysis) in one, the right thigh in two and the right ulna (proximal part) in one patient. One patient had two pseudotumours. The perioperative course was easily controllable with adequate factor VIII substitution. At the latest follow-up after 8.4 (range, 4-24) years, normal healing with no recurrence was observed.

CONCLUSIONS

The haemophilic pseudotumour is a rare but severe complication of hereditary bleeding disorders. In the international literature the resection and postoperative course are described as challenging and difficult, requiring detailed preoperative planning. It is advisable to perform such operations in specialised centres with close co-operation between surgeons and haematologists.

Long-term outcome of an unusual haemophilic pseudotumour

Haemophilia, a lifelong congenital bleeding disease, is a highly demanding disorder, due to the costs of its replacement therapy. In the absence of this pivotal treatment, life expectancy and quality of life are deleteriously affected. As illustration, we present a 14 years long follow-up of a patient with severe haemophilia A, treated sporadically with fresh plasma, cryoprecipitate and factor concentrates, who developed a giant iliopsoas pseudotumor. Since he was an infant, under on demand therapy with fresh frozen plasma, cryoprecipitate and low doses of factor concentrates he presented many spontaneous bleedings, developing multiple disabling arthropathies. At the age of 14 years, an iliopsoas hematoma occurred, which relapsed several times, developing an iliopsoas pseudotumour. After 5 years, sepsis with Klebsiella was diagnosed. A CT scan revealed fistula between the pseudotumor and the gut. Under antibiotics, the evolution of sepsis improved, but over a period of 10 months 5 episodes of haematemesis and melena, followed by one episode of macroscopic haematuria occurred; two months later he developed an inguino-crural mass, which fistulized through the abdominal wall. A mixt german-romanian team solved the clinical concern. After 108 hospitalization days and consumption of 104840 IU factor VIII he left the clinic in good condition. One year later, the temporary colostomy with anus praeter was closed. The follow-up reveals now, after almost 10 years with favourable outcome, that the patient is well, active within his family and profession.

[A case of IgG4-related disease with deterioration in pulmonary and pituitary involvements during a 10-year clinical course of inflammatory pseudotumor]

A 71-year-old man underwent pleural biopsy due to left pleural effusion and pleural thickening in August, 2001. An inflammatory pseudotumor (IPT) was diagnosed, and therefore systemic oral steroid therapy (prednisolone [PSL] 30 mg/day) was initiated. However, after tapering PSL to 7.5 mg/day, a complication of secondary central diabetes insipidus due to hypophysitis developed in 2008. As his pulmonary condition deteriorated over time and he began to experience exertional dyspnea, he was admitted to our hospital for re-evaluation of the disease in October, 2010. High-resolution CT (HRCT) revealed pulmonary involvements distributed in the interstitium and a high serum IgG4 level (240 mg/dl). Upon re-evaluating the pleural biopsy specimens of the first visit, we found lymphoplasmacytic-type IPT with approximately 10% IgG4-positive plasma cells in the affected areas. After increasing the PSL dose up to 0.6 mg/kg/day, his serum IgG4 levels decreased, his dyspnea improved, and the radiological findings of his pulmonary and pituitary involvements improved. This case was diagnosed as lymphoplasmacytic type IPT which appeared to be highly homologous with IgG4-related disease due to high serum levels of IgG4, pituitary involvements and the observed efficacy of PSL.

Vanek's polyp or inflammatory fibroid polyp. Case report and review of the literature

BACKGROUND

Intussusception in an adult must make us suspect the presence of a tumor (benign or potentially dangerous) as the most frequent cause. Accurate diagnosis is of great importance in order to provide appropriate treatment and improve patient prognosis.

CLINICAL CASE

We report the case of a 42-year-old male with abdominal pain. We performed a CT and found a small bowel intussusception. Definitive diagnosis according to the surgical specimen was inflammatory fibroid polyp (Vanek's polyp).

CONCLUSIONS

Vanek's polyp is a benign lesion that occurs most frequently in the stomach and secondarily in the small bowel. Generally, it is uncommon, and its etiology is not completely known. Accurate diagnosis is done with immunohistochemistry. Because of the consequences that depend on the size and location of the lesion, it may be considered a malignant lesion. Treatment is resection.

Adult intussusception with perforation and secondary peritonitis. Case report

BACKGROUND

Intussuception is an uncommon condition in adults. It is usually secondary to an organic lesion that may be malignant. The most common clinical presentation is as a partial bowel obstruction that requires surgical management. Preoperative diagnosis remains difficult; therefore, this paper presents a case report and a brief review of adult intussusception.

CLINICAL CASE

We present the case of a 24-year-old female with a 36-h evolution of lower abdominal pain with nausea, vomiting and diarrhea and a previous episode 8 days earlier. Pneumoperitoneum was observed on chest x-ray and surgery was decided upon. Peritonitis due to ileoileal intussusception was found, caused by an inflammatory fibroid polyp with microperforations. Small bowel resection with end-to-end anastomosis was performed and the patient had an uneventful recovery.

CONCLUSIONS

Adult intussusception is an infrequent condition with nonspecific symptoms such as pain, nausea and vomiting. With more frequent use of tomography in patients with abdominal pain, correct diagnosis can be achieved. Treatment requires resection of the involved bowel without attempted reduction.

Inflammatory myofibroblastic tumor of the liver in an elderly woman following a second liver biopsy: a case report

Inflammatory myofibroblastic tumor (IMT) is a rare benign lesion of unknown etiology reported in numerous anatomic sites. Hepatic IMT is rare. It is composed of a dominant spindle cell proliferation with a variable inflammatory component that has unique histological appearance. The tumor is more common in women, who often present with fever of unknown origin or other vague, nonspecific symptoms. A 74-year-old female presented with fever of unknown origin. Abdominal CT-Scan showed focal mass effect with luminal narrowing at the distal sigmoid colon, highly suggestive of a sigmoid neoplasm as well as numerous hypodense lesions scattered throughout the liver, likely representing metastatic disease. Liver biopsy revealed an IMT. Patient was treated conservatively and remained without symptoms. It is extremely difficult to differentiate an IMT from neoplastic disease. Most cases require complete resection to obtain an accurate diagnosis. This entity should be considered in the differential diagnosis in patients with hepatic lesions to avoid unnecessary surgical procedures.

Inflammatory myofibroblastic tumor of the trachea

This report described a 2-year-old boy who presented with severe respiratory distress and stridor. Bronchoscopy and CT revealed a mass in the left anterolateral tracheal wall and histopathology showed a tracheal inflammatory myofibroblastic tumor. Initial removal by rigid bronchoscopy resulted in prompt recurrence of the tumor. Therefore he underwent tracheal surgical resection. A bronchoscopy at 12 months after surgery did not show any recurrence sign.

Plasma cell granuloma of the sigmoid colon associated with diverticular disease and accompanying IgM-type monoclonal gammopathy

Plasma cell granuloma is a pseudoneoplastic lesion composed of reactive plasma cells of a polyclonal nature and must be distinguished from plasmacytoma. We report a case of plasma cell granuloma in the sigmoid colon associated with diverticulosis. In this case, the lesion consisted of multiple submucosal tumors with prominent infiltration of polyclonal plasma cells. Although the patient exhibited IgM-type monoclonal gammopathy, the expression of a monoclonal immunoglobulin was not detected in the sigmoid colonic lesion, but in the bone marrow cells. Plasma cell granuloma in the lower alimentary tract has been rarely reported. Recurrent inflammatory process with diverticular disease was considered as a pathogenesis of the pseudoneoplasm and a possible cause of monoclonal proliferation of IgM-producing lymphoid cells in this case.

[An abdominal inflammatory pseudotumor in a 9-year-old girl with newly diagnosed diabetes mellitus type 1--a case report]

An inflammatory tumor is a rare, benign pathology with a variable natural course. The hypotheses of the etiology of the inflammatory tumor are associated with trauma, infections or the immune mechanisms. To our knowledge, in the literature are described some single cases of solid omental and peritoneal masses as an uncommon cause of abdominal lump in children. We describe a case of a 9-year-old girl with clinical symptoms at onset of type 1 diabetes and accidentally diagnosed omental and peritoneal tumor.

Inflammatory myofibroblastic tumor of the right ventricle causing tricuspid valve regurgitation

Cardiac inflammatory myofibroblastic tumor is a rare lesion consisting of inflammatory cells and myofibroblastic spindle cells. We describe a case of inflammatory myofibroblastic tumor that involved the right ventricle, thereby causing tricuspid valve regurgitation in an 18-year-old man who presented with a fever of unknown origin and of 1 month's duration. With the patient on cardiopulmonary bypass, we excised the lesion and replaced the tricuspid valve without serious intraoperative or postoperative sequelae. The patient had a favorable outcome.

Inflammatory myofibroblastic tumor of the small intestine: a case report of a 2 month-old infant

Benign intestinal tumors are rare in children; however, the authors describe an inflammatory myofibroblastic tumor (IMT) of the terminal ileum in a 2-month-old infant who presented with an intestinal obstruction. During laparotomy, an annular mass around the terminal ileum was resected, from which a histological diagnosis of IMT was made. A review of the literature for this rare condition was done to delineate the natural history of this tumor and to do a histological confirmation of its benign nature. Because of the risk of local recurrence, IMT cases should have a long-term follow up.

Pseudotumoural hypertrophic neuritis of the facial nerve

In a retrospective study of our cases of recurrent paralysis of the facial nerve of tumoural and non-tumoural origin, a tumour-like lesion of the intra-temporal course of the facial nerve, mimicking facial nerve schwannoma, was found and investigated in 4 cases. This was defined as, pseudotumoral hypertrophic neuritis of the facial nerve. The picture was one of recurrent acute facial palsy with incomplete recovery and imaging of a benign tumour. It was different from the well-known recurrent neuritis, hypertrophic neuropathy and perineuroma. A portion of the intra-temporal course of the nerve with concurrent dilatation of the osseous walls was diagnosed pre-operatively as facial nerve schwannoma. The pathological picture showed inflammatory hypertrophy which was not a schwannoma but was likely of viral origin, with degeneration-regeneration of fibres and new connective tissue. Resection of the involved portion of the facial nerve and autologous graft in two cases was performed, decompression with biopsy in the other two. No recurrence of new episodes of paralysis after surgery was observed.

Inflammatory pseudotumors in multiple organs associated with elevated serum IgG4 level: recovery by only a small replacement dose of steroid

A 62-year-old man developed a fever, fatigue, anorexia and arthralgia. Central hypocorticoidism and central hypothyroidism were observed, and a low serum antidiuretic hormon level without symptoms of diabetes insipidus, as well. Images showed swelling of pituitary stalk, mediastinal and hilar lymphnodes and pancreas, pulmonary infiltrates and retroperitoneal mass. Serum CRP level was 20.6 mg/dL, and IgG4 level was 292 mg/dL. Lung biopsy revealed pseudotumor containing IgG4-positive plasmacytes, and obliterative vasculitis both in arterioles and venules. These features were similar to those of reported IgG4-related autoimmune disease. However, replacement steroid therapy for hypocorticoidism brought about almost complete recovery except that diabetes insipidus got apparent. This is the first report on the efficacy of only a small dose of steroid, and on features of pituitary stalk involvement and central hypocorcicoidism.

Inflammatory myofibroblastic tumor presenting as acute abdomen: report of one case

Inflammatory myofibroblastic tumor (IMT) is a very rare benign tumor composed of myofibroblastic spindle cells of uncertain etiology, which can occur at any age and affect any organ system. More and more cases of IMT in children have been described in pediatric literature in recent years. However, this tumor occurring intraabdominally in children has rarely been reported in Taiwan. Here we present a 1-year-9-month-old boy who had fever and abdominal pain only for 2 days, symptoms mimicking acute abdomen. After imaging study, a huge tumor nearly 10 cm in diameter was incidentally found over the right abdomen with unknown origin and nature. After surgical removal of the tumor, IMT was confirmed by the pathological findings. It is very difficult to make an accurate preoperative diagnosis on this tumor according to past experience, so the role of pathological diagnosis with immunohistochemical study becomes important. This case illustrates that IMT should be considered as a possible cause of intra-abdominal mass in children who have fever of unknown origin.