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Inflammatory myofibroblastic tumor of ileum with intussusception in adult. Clin J Gastroenterol 2020; 13:1116-1120. [PMID: 32651869 DOI: 10.1007/s12328-020-01179-4] [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: 05/18/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
A 62-year-old man was referred to our department with suspected intussusception due to an ileal tumor. Tumor markers including soluble interleukin-2 receptor were not elevated. Contrast-enhanced computed tomography and color Doppler ultrasonography showed a distinct ileal tumor without intratumoral blood flow or surrounding lymphadenopathies. Retrograde single-balloon enteroscopy revealed a submucosal tumor in the ileum that was hard and ulcerated. Partial intestinal resection was performed, and the lesion was diagnosed as an inflammatory myofibroblastic tumor. The patient had no recurrence over 2 years without additional treatment after surgery. This rare tumor should be kept in mind as a cause of ileal intussusception in adult and a multidisciplinary approach is vital to characterize it.
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Yagnik VD. ALK 1 Negative Inflammatory Myofibroblastic Tumor of the Ileum: A Rare Cause of Ileocecal Intussusception. Surg J (N Y) 2020; 6:e101-e104. [PMID: 32440556 PMCID: PMC7237234 DOI: 10.1055/s-0040-1710531] [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: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 10/29/2022] Open
Abstract
An inflammatory myofibroblastic tumor is a rare tumor of mesenchymal background commonly found in the pulmonary system. It is rarely found as a primary tumor in the gastrointestinal tract. We report an unusual presentation of this rare lesion causing intussusception and intestinal obstruction in a 39-year-old male.
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Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
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3
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Wang K, Guo R, Siegal GP, Wei S. Inflammatory myofibroblastic tumor of bone harboring an ALK gene amplification. Pathol Res Pract 2019; 215:152535. [PMID: 31326196 DOI: 10.1016/j.prp.2019.152535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/14/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a neoplastic proliferation of myofibroblastic/fibroblastic cells with a variable admixture of inflammatory cells. It primarily affects soft tissue and viscera of children and young adults. IMT occurring in bone is extremely rare. Approximately 50% of IMTs carry a clonal rearrangement of the anaplastic lymphoma kinase (ALK) gene, while other receptor tyrosine kinase gene rearrangements have been seen in a small subset of IMT. Herein, we report the first case of IMT which harbors an ALK gene amplification rather than a rearrangement thus resulting in overexpression of the protein, arising from the femur of a 24-year-old man. Our case provides a novel pathogenesis for IMT. An overview of cytogenetic abnormalities of IMT is also integrated into this report.
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Affiliation(s)
- Kai Wang
- Department of Pathology, the University of Alabama at Birmingham, Birmingham, AL 35249, United States
| | - Rongjun Guo
- Department of Pathology, the University of Alabama at Birmingham, Birmingham, AL 35249, United States
| | - Gene P Siegal
- Department of Pathology, the University of Alabama at Birmingham, Birmingham, AL 35249, United States; Department of Genetics, the University of Alabama at Birmingham, Birmingham, AL 35249, United States
| | - Shi Wei
- Department of Pathology, the University of Alabama at Birmingham, Birmingham, AL 35249, United States.
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Atypical Presentation of Intestinal Intussusception Caused by Insidious Inflammatory Myofibroblastic Tumor of the Bowel Wall. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00235.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction:
Inflammatory myofibroblastic tumor (IMT) is a rare but real tumor, which is histologically characterized by myofibroblastic spindle cells proliferation with inflammatory infiltrate. The lung is the most common affected organ, and extrapulmonary IMTs are less common. However, IMT seldom presents in the gastrointestinal tract, and intussusception is a rare complication of this tumor.
Case presentation:
We documented this rare case of a 12-year-old Chinese girl presenting with abdominal pain. The clinical and radiologic impression was bowel intussusception and bowel obstruction. No sign of abdominal mass was found before surgery, neither physical examination nor radiologic images. Operative findings revealed intestinal intussusception secondary to a little mass. Histopathlogic evaluation of this mass revealed IMT.
Conclusion:
In conclusion, IMT may present with bowel intussusception. However, at the intestinal location, the tumor may be found as an abdominal mass or may be insidious; hence, detailed history, physical examination, and imaging studies are necessary for early recognition and diagnosis.
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Paiva C, Soares F, da Inez Correia R, Valente V. Inflammatory myofibroblastic tumor presenting as ileocecal intussusception-A case report. Int J Surg Case Rep 2016; 24:146-9. [PMID: 27262346 PMCID: PMC4900436 DOI: 10.1016/j.ijscr.2016.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/28/2016] [Accepted: 05/15/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMFT) is an uncommon mesenchymal solid tumor commonly documented in children and young adults. It is usually located in lungs however, extrapulmonary involvement has also been reported. Here we report a case of IMFT presenting as an ileocecal intussusception. PRESENTATION OF CASE A 55-year-old man presented with a two months history of colicky abdominal pain, more intense at the right inferior abdominal quadrant, and unintentional weight loss of 8kg in the previous four months. Computer tomography showed an image of intussusception at the cecum. Colonoscopy demonstrated a pediculated tubular lesion, with the base near ileocecal valve. We performed a right hemicolectomy. Histopathological examination of the tumor revealed an IMFT. DISCUSSION IMFT usually affects lungs with rare gastrointestinal involvement. Clinical presentation is related with location of the neoplasm. Intussusception in adults presents with non-specific symptoms and classical image signs facilitate preoperative diagnosis. IMFT diagnosis is histopathological which usually implies surgical resection. Complete surgical excision, with microscopically clear margins, is the mainstain of treatment, with virtually no local recurrence or metastasis. CONCLUSION Gastrointestinal IMFT are rare in the adult population and clinical features depend on its location. Surgical approach with total excision of the neoplasm confirms the diagnosis. Prognosis is good with the main prognostic indicator being the adequacy of the primary excision.
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Affiliation(s)
- Cláudia Paiva
- Department of General Surgery, Hospital de Santo António, Centro Hospitalar do Porto, EPE, Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
| | - Filomena Soares
- Department of General Surgery, Hospital de Santo António, Centro Hospitalar do Porto, EPE, Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
| | - Raquel da Inez Correia
- Department of General Surgery, Hospital de Santo António, Centro Hospitalar do Porto, EPE, Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
| | - Vítor Valente
- Department of General Surgery, Hospital de Santo António, Centro Hospitalar do Porto, EPE, Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
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Inflammatory Pseudotumor (IPT) and Inflammatory Myofibroblastic Tumor (IMT): A Representative Literature Review Occasioned by a Rare IMT of the Transverse Colon in a 9-year-old Child. TUMORI JOURNAL 2015; 101:249-56. [DOI: 10.5301/tj.5000353] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 12/18/2022]
Abstract
Aims and Background Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) represent different entities. However, it is only in recent years that this has been taken into increasing consideration. Some authors still use both terms synonymously or interchangeably. Inflammatory myofibroblastic tumor is a real neoplasm because of the proliferation of myofibroblastic cells. Inflammatory pseudotumor is a more inflammatory reactive or regenerative entity and shows an overlapping with immunoglobulin G4-related disease. Methods and Study Design To analyze the current situation, 443 publications from the last 5 years (2009 to February 2014) were included. Reports involved 938 patients and 956 organ sites. The age distribution is twin peaked with one maximum in childhood and the other between 50 and 60 years of age. This distribution is questionable due to the more frequent occurrence of IPT in the liver and of IMT in the lung. Inflammatory pseudotumors mainly occur in older patients; IMTs in children and young adults. Results and Conclusions The liver and biliary tract were the most commonly affected of all body regions, at 32%. This was followed by the lung, including the respiratory tract, at 27%, and by the gastrointestinal tract, at 10%. Lesions of the large bowel, as in the present case of a 9-year-old boy, are very rare. There were organ-related as well as nonspecific clinical symptoms, such as fever, weight loss, and fatigue. Laboratory test results revealed anemia and elevated inflammation-dependent parameters. The patterns in medical imaging are variable and nonspecific. Morphology often suggests a malignant process. For this reason, therapy in most cases is surgical, but this is required more often in IMTs. Many IPTs could be treated conservatively.
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Inflammatory myofibroblastic tumor of the thigh: presentation of a rare case and review of the literature. Case Rep Orthop 2015; 2015:814241. [PMID: 25945274 PMCID: PMC4402203 DOI: 10.1155/2015/814241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/14/2015] [Indexed: 01/28/2023] Open
Abstract
Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. We present a case of a 47-year-old male with fever, fatigue, and a slow-growing thigh mass. The inflammatory markers were elevated and the MR images showed a well-defined intermuscular lesion with mild heterogeneous enhancement. The lesion was excised and histologic examination was consistent with an inflammatory myofibroblastic tumor. No adjuvant therapy was needed and the patient remained asymptomatic with no evidence of tumor recurrence during the 2 years of follow-up.
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8
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Voluminous omental inflammatory myofibroblastic tumor in an elderly man: a case report and literature review. Case Rep Surg 2015; 2015:873758. [PMID: 25688324 PMCID: PMC4320915 DOI: 10.1155/2015/873758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 12/29/2014] [Accepted: 01/01/2015] [Indexed: 12/22/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential, with uncertain etiology. This tumor occurs primarily in the lung, but the tumor may affect any organ system. A 75-year-old male was evaluated for voluminous palpable high abdominal mass with continuous and moderately abdominal pain, associated with abdominal distension for the last two months. Abdominal computed tomography showed a large (32 × 29 × 15 cm) heterogeneously enhanced mass with well-defined margins. At surgery, the mass originated from the greater omentum was completely excised. Histologically the tumor was a mesenchymal neoplasm in smooth muscle differentiation and was characterized by spindle-cell proliferation with lymphocytes, plasma cells, and rare eosinophils. Immunohistochemically, the tumor cells were positive for vimentin and smooth muscle actin and negative for anaplastic lymphoma kinase. Complete surgical resection of IMTs remains the mainstay of treatment associated with a low rate of recurrence. Final diagnosis should be based on histopathological and immunohistochemical findings. Appropriate awareness should be exercised by surgeons to abdominal IMTs in combination with constitutional symptoms, abnormal hematologic findings, and radiological definition, to avoid misdiagnosed.
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Choi E, Williamson SR, Montironi R, Zhang S, Wang M, Eble JN, Grignon DJ, Lopez-Beltran A, Idrees MT, Baldridge LA, Scarpelli M, Jones CL, Wang L, MacLennan GT, Osunkoya AO, Cheng L. Inflammatory myofibroblastic tumour of the urinary bladder: the role of immunoglobulin G4 and the comparison of two immunohistochemical antibodies and fluorescencein-situhybridization for the detection of anaplastic lymphoma kinase alterations. Histopathology 2015; 67:20-38. [DOI: 10.1111/his.12619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/15/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Euna Choi
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | | | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology; School of Medicine; Polytechnic University of the Marche Region (Ancona); United Hospitals; Ancona Italy
| | - Shaobo Zhang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Mingsheng Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - John N Eble
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - David J Grignon
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | | | - Muhammad T Idrees
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Lee Ann Baldridge
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Marina Scarpelli
- Institute of Pathological Anatomy and Histopathology; School of Medicine; Polytechnic University of the Marche Region (Ancona); United Hospitals; Ancona Italy
| | - Carol L Jones
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Lisha Wang
- Department of Pathology; Fudan University Shanghai Cancer Center; Shanghai China
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
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Zhao JJ, Ling JQ, Fang Y, Gao XD, Shu P, Shen KT, Qin J, Sun YH, Qin XY. Intra-abdominal inflammatory myofibroblastic tumor: Spontaneous regression. World J Gastroenterol 2014; 20:13625-13631. [PMID: 25309095 PMCID: PMC4188916 DOI: 10.3748/wjg.v20.i37.13625] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/01/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory myofibroblastic tumors are usually treated by surgical resection. We herein report two cases of intra-abdominal inflammatory myofibroblastic tumors that were unresectable and underwent spontaneous regression without any treatment. Our case report and literature review show that regression is more common in the middle-aged and older male populations. Abdominal discomfort and fever were the most common symptoms, but the majority of patients had no obvious physical signs. There was no specific indicator for diagnosis. The majority of the lesions regressed within 3 mo and nearly all of the masses completely resolved within 1 year. We conclude that the clinical characteristics of inflammatory myofibroblastic tumors are variable and, accordingly, the disease needs to be subdivided and treated on an individual basis. Surgery is always the first-line treatment; however, for those masses assessed as unresectable, conservative therapy with intense follow-up should be considered.
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Polypoid mass in the ascending colon with intussusception: a rare presentation of an inflammatory myofibroblastic tumor. J Pediatr Gastroenterol Nutr 2014; 58:e35. [PMID: 22722681 DOI: 10.1097/mpg.0b013e3182647f4c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Patel RV, Shepherd G, Kumar H, More B. Primary ileoileal intussusception without a lead point simulating appendicular mass in a 4-year-old girl. BMJ Case Rep 2014; 2014:bcr2013203390. [PMID: 24632906 PMCID: PMC3962936 DOI: 10.1136/bcr-2013-203390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 02/05/2023] Open
Affiliation(s)
| | | | - Hemant Kumar
- Department of Paediatric Surgery, LRI, Leicester, UK
| | - Bharat More
- Department of Paediatric Surgery, LRI, Leicester, UK
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Lorenzi L, Cigognetti M, Medicina D, Pellegrini V, Balzarini P, Cestari R, Facchetti F. ALK-Positive Inflammatory Myofibroblastic Tumor of the Abdomen With Widespread Microscopic Multifocality. Int J Surg Pathol 2014; 22:640-4. [DOI: 10.1177/1066896914525232] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a locally aggressive neoplasm, most frequently occurring in the abdominal cavity as multiple recurrent nodules. We report a case of IMT in a 24-year-old male presenting as multiple nodules involving the omentum, the liver, and the colon. Spindle tumor cells expressed ALK with a cytoplasmic granular distribution, the CLTC-ALK fusion gene was demonstrated by reverse-transcriptase polymerase chain reaction analysis, and break-apart fluorescence in situ hybridization (FISH) probes for the ALK gene showed a pathological pattern (single red signal associated with 1/2 normal fused signals) highly suggestive for combined gene fusion and deletion. To reduce the surgically unresectable liver mass, the patient was treated with crizotinib, and after 4 months of treatment the disease was defined stable according to RECIST criteria. Interestingly, ALK and FISH/FICTION analysis revealed that tumor cells were widely dispersed as multiple microscopic foci or as single cells beneath the omental mesothelium. These findings indicate that IMT multifocality might result either from dissemination from the main tumor mass or development of multiple independent neoplastic foci; furthermore, they underline the need of omentectomy in abdominal IMT to obtain surgical radicality.
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Affiliation(s)
- Luisa Lorenzi
- Pathology Section, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Marta Cigognetti
- Pathology Section, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Daniela Medicina
- Pathology Section, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Vilma Pellegrini
- Pathology Section, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Piera Balzarini
- Pathology Section, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili, Brescia, Italy
| | - Renzo Cestari
- Digestive Endoscopy, Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Fabio Facchetti
- Pathology Section, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili, Brescia, Italy
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Gupta RK, Samalavicius NE, Sapkota S, Sah PL, Kafle SU. Colonic inflammatory myofibroblastic tumours: an institutional review. Colorectal Dis 2013; 15:e239-43. [PMID: 23350604 DOI: 10.1111/codi.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 09/13/2012] [Indexed: 02/08/2023]
Abstract
AIM The aim of the study was to present the largest series of colonic inflammatory myofibroblastic tumour (C-IMFT) in the literature so far and to provide a review of this condition. METHOD A retrospective review was carried out of a consecutive series of patients diagnosed with a C-IMFT at a community-based hospital with a specialized gastrointestinal unit between 2002 and 2011. The main outcome measures were success rate and postoperative complications. Using a set of terms we searched the PubMed database for papers published on C-IMFT. We reviewed the data from these studies and case reports. RESULTS There were seven patients with a histopathologically proven C-IMFT. The patients' mean age was 39 ± 11.3 years. Four presented with clinical features of intestinal obstruction of varying severity and three with symptoms of anaemia. Complete surgical resection with end-to-end anastomosis was performed. The gross morphology included polypoidal myxoid tumours that served as a lead point for intussusception in two cases, a whorled mass in two and a circumferential infiltrative tumour in three. Microscopically, all tumours had typical features of IMFT with a variable expression of anaplastic lymphoma kinase (ALK-1) and tumour-free resection margins. All patients were well without local recurrence or metastasis at a mean follow-up of 46.8 ± 11.9 months. CONCLUSION Surgical resection is effective for this rare tumour which mostly behaves in a benign manner. Our review supports the need for patients to be followed up for long periods because of the possibility of metastasis or late recurrence.
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Affiliation(s)
- R K Gupta
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
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15
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Ong HS, Ji T, Zhang CP, Li J, Wang LZ, Li RR, Sun J, Ma CY. Head and neck inflammatory myofibroblastic tumor (IMT): evaluation of clinicopathologic and prognostic features. Oral Oncol 2011; 48:141-8. [PMID: 22014665 DOI: 10.1016/j.oraloncology.2011.09.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 09/11/2011] [Accepted: 09/13/2011] [Indexed: 12/31/2022]
Abstract
Owing to rarity and awareness deficiency towards inflammatory myofibroblastic tumor (IMT), we sought to review on its clinicopathological features; arising awareness to achieve early diagnosis; exploring prognostic factors and then establishing a treatment protocol. Retrospective study was performed on patients with histological proven IMT between January 2003 and December 2010. Their demographic data, clinical and histological presentations were recorded. Overall survival (OS) and progression-free-survival (PFS) were estimated via Kaplan-Meier method. Cox regression model was applied to determine the significant of prognostic factors. Logistic regression model was established to predict the probability of relapse. A total of 28 patients. Five-year PFS was 65%. Surgical margins primarily and independently determined the survival, followed by size, pseudocapsule of the lesion, intra-lesional necrosis and lastly Ki-67 and ALK overexpression. Logistic model in prediction of relapse was established, with the formula as probability of relapse = 1/(1 + e(-z)) where e = exponential function, z = constant value (3.9) + B*margin + B*size + B*immunohistochemical expression + B*pseudocapsule + B*intra-lesional necrosis. Immunohistochemical overexpression was significant if Ki-67 was strongly expressed with a conditioned ALK overexpression simultaneously. Staining intensity must be at least moderate for those ALK nuclear staining was less than 25%. Weak ALK staining intensity is only significant if nuclear staining was more than 25%. Diagnosis of IMT is achieved via exclusion. Radical resection and obtaining negative margins remains the mainstay of treatment. Both high and moderate-risk groups required post-operative radiotherapy. In low-risk group, post-operative radiotherapy was recommended if the lesion is larger than 5 cm in diameter with a conditioned ALK & Ki-67 overexpression.
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Affiliation(s)
- Hui Shan Ong
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China.
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A propósito de un caso: tumor miofibroblástico inflamatorio de localización inusual. RADIOLOGIA 2010; 52:473-6. [PMID: 20541783 DOI: 10.1016/j.rx.2010.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/23/2010] [Accepted: 04/12/2010] [Indexed: 11/17/2022]
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17
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Sacco O, Gambini C, Gardella C, Tomà P, Rossi UG, Jasonni V, Bush A, Rossi GA. "Atypical steroid response" in a pulmonary inflammatory myofibroblastic tumor. Pediatr Pulmonol 2010; 45:721-6. [PMID: 20575096 DOI: 10.1002/ppul.21237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 6-year-old girl was evaluated for the presence of a paratracheal mass with right upper lobe atelectasis due to an endobronchial mass. Bronchoscopic biopsy established a diagnosis of inflammatory myofibroblastic tumor (IMT) and prednisone initially led to a significant reduction of the endobronchial lesion. However, 8 weeks later, when still on prednisone, the mediastinal mass enlarged dramatically. At thoracotomy, a well-circumscribed, multilobulated mass was partially resected and a diagnosis of IMT confirmed. Immunosuppression by corticosteroids may have favored the rapid progression of this apparently benign, indolent tumor.
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18
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Yeh YS, Ma CJ, Yang SF, Shih MCP, Wang JY. Inflammatory Myofibroblastic Tumor of the Ileum Causing an Unusual Ileocecal Intussusception. FOOYIN JOURNAL OF HEALTH SCIENCES 2010; 2:36-39. [DOI: 10.1016/s1877-8607(10)60012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
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19
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Inflammatory myofibroblastic tumor causing ileoileal intussusception: an unusual cause of an unusual neoplasm in an adult, with a clinicopathological review of the literature. Clin J Gastroenterol 2009; 2:194-198. [DOI: 10.1007/s12328-009-0079-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Accepted: 03/18/2009] [Indexed: 11/26/2022]
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20
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Androulaki A, Papathomas TG, Liapis G, Papaconstantinou I, Gazouli M, Goutas N, Bramis K, Papalambros A, Lazaris AC, Papalambros E. Inflammatory pseudotumor associated with Mycobacterium tuberculosis infection. Int J Infect Dis 2008; 12:607-610. [PMID: 18359259 DOI: 10.1016/j.ijid.2007.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 12/11/2007] [Accepted: 12/21/2007] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumor is a relatively rare entity; originally identified in the lung, it has been described in multiple extrapulmonary anatomic locations. CASE REPORT We report on the unusual case of an inflammatory pseudotumor associated with Mycobacterium tuberculosis infection, which was initially mistaken for a renal malignancy both in clinical and radiological settings. We additionally present three brief reviews concerning: (1) infectious agents postulated to induce morphological changes of an inflammatory pseudotumor; (2) mycobacterial pseudotumors; and (3) distinction from inflammatory myofibroblastic tumors of the renal pelvis. CONCLUSIONS The present case highlights the diagnostic importance of PCR-based detection of mycobacterial DNA in granulomatous tissue responses. It is of crucial importance that clinicians are aware of this unusual manifestation of mycobacterial infection to ensure that pertinent laboratory evaluation is employed and appropriate treatment is administered in order to avoid potential clinical implications.
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Affiliation(s)
- Athina Androulaki
- 1(st) Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Plasma Cell Granuloma: A Case Report of Multiple Lesions in the Lung and Review of the Literature. Am J Med Sci 2007; 334:402-6. [PMID: 18004098 DOI: 10.1097/maj.0b013e318068d7dd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kirsch R, Gao ZH, Riddell R. Gastrointestinal stromal tumors: diagnostic challenges and practical approach to differential diagnosis. Adv Anat Pathol 2007; 14:261-85. [PMID: 17592256 DOI: 10.1097/pap.0b013e3180ca826a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the last decade, gastrointestinal stromal tumors (GISTs) have evolved from histogenetically obscure gastrointestinal mesenchymal tumors to well-defined tumors with distinctive clinical, morphologic, ultrastructural, histogenetic, and molecular characteristics, for which targeted therapy is available. This is largely attributable to the discovery of CD117 overexpression and activating mutations in c-kit or platelet-derived growth factor alpha genes in most of GISTs. The availability of specific diagnostic tests and targeted therapy for GISTs has led to an increased awareness of these tumors. At the same time, the list of potential GIST mimics has lengthened considerably and it has become increasingly important that GISTs be distinguished from their mimics because correct diagnosis has implications for both treatment and prognosis. The purpose of this review is to provide an update of the expanding differential diagnosis of GISTS, to draw attention to unusual GIST variants, to provide a practical approach the differential diagnosis of GISTs and to highlight some of the challenges faced by pathologists in resolving this differential diagnosis.
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Affiliation(s)
- Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Memba Ikuga R, Lamas Moure S, Ramos Rubio E, Climent Esteller MJ. Invaginación colocólica del adulto secundaria a tumor miofibroblástico inflamatorio. Cir Esp 2007; 81:357-8. [PMID: 17553415 DOI: 10.1016/s0009-739x(07)71342-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm composed of transformed myofibroblastic spindle cells with infiltration of a large number of inflammatory cells and/or lymphocytes. The etiology of IMT remains unknown. IMT occurs at various sites and often affects young adults and children. IMT of the liver mostly arises in the right lobe of liver. Biopsy, computed tomography (CT) and magnetic resonance imaging (MRI) are beneficial to diagnosis and differential diagnosis. Vimentin, smooth muscle actin (SMA), muscle-specific actin (MSA) are often positive by immunohistochemistry. The prognosis of most patients is favorable after surgery. In this article, we reviewed the overseas and domestic literatures and summarized the advancement of research on the IMT of the liver about etiology, pathogenesis, clinical presentations, imaging feature, histological appearance, immunohistochemical and electron microscopic feature, diagnosis, differential diagnosis and therapy.
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