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1
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Liu JB, Gu QB, Liu P. Inflammatory myofibroblastic tumor of the pancreatic neck misdiagnosed as neuroendocrine tumor: A case report. World J Gastroenterol 2023; 29:3216-3221. [PMID: 37346157 PMCID: PMC10280791 DOI: 10.3748/wjg.v29.i20.3216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumor (IMT) is a relatively rare tumor. The global incidence of IMT is less than 1%. There is no specific clinical manifestation. It usually occurs in the lungs, but the pancreas is not the predilection site.
CASE SUMMARY We present a case of a male patient, 51 years old, who was diagnosed with a pancreatic neck small mass on ultrasound one year ago during a physical examination. As he had no clinical symptoms and the mass was relatively small, he did not undergo treatment. However, the mass was found to be larger on review, and he was referred to our hospital. Since the primal clinical diagnosis was pancreatic neuroendocrine tumor, the patient underwent surgical treatment. However, the case was confirmed as pancreatic IMT by postoperative pathology.
CONCLUSION Pancreatic IMT is relatively rare and easily misdiagnosed. We can better under-stand and correctly diagnose this disease by this case report.
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Affiliation(s)
- Jia-Bei Liu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha 410005, Hunan Province, China
| | - Qian-Biao Gu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
| | - Peng Liu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, Hunan Province, China
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2
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A G H, Kumar S, Singla S, Kurian N. Aggressive Inflammatory Myofibroblastic Tumor of Distal Pancreas: A Diagnostic and Surgical Challenge. Cureus 2022; 14:e22820. [PMID: 35399449 PMCID: PMC8980218 DOI: 10.7759/cureus.22820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare soft tissue neoplasm of unknown etiology. It is a slow-growing tumor of borderline malignant potential. Distant metastases and recurrence after complete excision are rare. Establishing a preoperative diagnosis is difficult because of its nonspecific clinic-radiological features. Although the majority of cases have been reported in the lungs, it can affect any part of the body. The pancreatic inflammatory myofibroblastic tumor is very rare and only 26 cases have been reported in the medical literature. These tumors mostly arise from the head of the pancreas, whereas occurrence in the body or tail region is rather unusual. Here, we report a case of a 55-year-old male patient with a locally advanced inflammatory myofibroblastic tumor arising from the pancreatic tail. Complete excision of tumor required multi-visceral resection (distal pancreaticosplenectomy with jejunal and colonic segmental resection). The diagnosis of inflammatory myofibroblast tumor was made on the basis of histopathology and immunohistochemistry.
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3
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Geiselmann MT, Acampa DJ, Melamed J, Arif F, Takabe K, Seitelman E, Datta R, Gunasekaran G, Takahashi H. Immunoglobulin G4-Negative Inflammatory Pseudotumors of the Pancreas. World J Oncol 2022; 12:240-245. [PMID: 35059084 PMCID: PMC8734500 DOI: 10.14740/wjon1432] [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: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT) can occur in any organ, but rarely shows pancreatic involvement. While surgical excision has been recommended as the primary treatment for IPT of the pancreas in the past, some authors suggest observation while medical management often results in regression. Corticosteroids, nonsteroidal anti-inflammatory drugs and immunosuppressive therapy have been used to treat IPTs. Spontaneous regression has also been reported in IPT managed without surgical intervention. A 62-year-old female was evaluated for worsening abdominal pain and a mass in the neck of the pancreas that was identified on ultrasound. Further imaging with magnetic resonance imaging revealed a pancreatic mass with dilated pancreatic duct and an atrophic parenchyma of the pancreatic neck. Her serum tumor markers were not elevated. As this lesion appeared to be resectable pancreatic cancer based on cross-sectional imaging, no biopsy was performed prior to surgical resection. Distal pancreatectomy and splenectomy was recommended and the patient desired to proceed. Her recovery was uneventful with no postoperative complications, including pancreatic fistula. Final pathology revealed a lesion consistent with the diagnosis of immunoglobulin G4 (IgG4)-negative IPT without neoplasm. IPT of the pancreas is a difficult entity to diagnose and treat due to clinical and imaging characteristics closely resembling pancreatic adenocarcinoma. Biopsy with immunohistochemical analysis can be useful in diagnosing IPT; however, symptomatic lesions and concerning findings on cross-sectional imaging may warrant more definitive surgical intervention.
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Affiliation(s)
- Matthew T Geiselmann
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Daniel J Acampa
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Joshua Melamed
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Farzana Arif
- Department of Pathology, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eric Seitelman
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Rajiv Datta
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Ganesh Gunasekaran
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA.,Department of Surgery, Division of HPB Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Hideo Takahashi
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
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4
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Chen ZT, Lin YX, Li MX, Zhang T, Wan DL, Lin SZ. Inflammatory myofibroblastic tumor of the pancreatic neck: A case report and review of literature. World J Clin Cases 2021; 9:6418-6427. [PMID: 34435007 PMCID: PMC8362560 DOI: 10.12998/wjcc.v9.i22.6418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic inflammatory myofibroblastic tumor (IMT) is a relatively rare disease that is often confused with pancreatic cancer or pancreatic neuroendocrine tumors. The histological features of IMTs show that tissue from this type of tumor contains an intermingling of fibroblast and myofibroblast proliferation, accompanied by a varying degree of inflammatory cell infiltration.
CASE SUMMARY The management of an IMT occurring at the neck of the pancreas is presented in this paper. A 66-year-old female patient was diagnosed with a pancreatic neck mass after a series of tests. The patient underwent enucleation of the pancreatic neck tumor after a pathological diagnosis of IMT. Previous research on the clinical features, pathological diagnosis and treatment of pancreatic IMTs was reviewed. Compared with previous reports, this is a unique case of enucleation of a pancreatic IMT.
CONCLUSION The enucleation of pancreatic IMTs may be a safe and efficient surgical method for managing such tumors with a better prognosis. Further cases are required to explore surgical measures for pancreatic IMTs.
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Affiliation(s)
- Zhi-Tao Chen
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
- School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Yao-Xiang Lin
- School of Medicine, Hangzhou Normal University, Hangzhou 310003, Zhejiang Province, China
| | - Meng-Xia Li
- School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ting Zhang
- Department of Pathology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
| | - Da-Long Wan
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Sheng-Zhang Lin
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, Zhejiang Province, China
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5
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Liu Z, Li G, Gou A, Xiao Z, Xu Y, Song S, Guo K, Ma G. Inflammatory myofibroblastic tumor in the pancreatic neck: a rare case report and literature review. Gland Surg 2021; 10:1832-1839. [PMID: 34164329 DOI: 10.21037/gs-21-303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare disease of unknown etiology. It usually occurs in abdominal soft tissues and lung, and is extremely rare in the pancreas. IMT can occur in any part of a person at any age, however, it mostly affects children and young people. Its clinical manifestations are atypical, imaging examinations are not specific, and the differential diagnosis of pancreatic malignancies is difficult, making it easily misdiagnosed. Surgical resection is the preferred method of treatment for IMT. In this case report, we report a rare case of IMT in the neck of the pancreas and reviewed the relevant literature. In our case, the patient was a 57-year-old woman with an IMT in the neck of the pancreas. Abdominal pain was the only clinical symptom, and imaging features were not specific. She underwent surgery to remove the pancreatic mass, and the final diagnosis of IMT was based on histopathology and immunohistochemistry. After 6 months of regular follow-up, the patient had no complications or further incidents. The purpose is to emphasize the difficulty of the preoperative diagnosis of pancreatic IMT and the difficulty of distinguishing it from pancreatic malignancies. It is hoped that clinicians can gain a deeper understanding of pancreatic IMT through this case report.
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Affiliation(s)
- Zhe Liu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Guichen Li
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Anjiang Gou
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Zhihuan Xiao
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Yuanhong Xu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Shaowei Song
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Kejian Guo
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
| | - Gang Ma
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang, China
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6
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İflazoğlu N, Kaplan Kozan S, Biri T, Ünlü S, Gökçe H, Doğan S, Gökçe ON. Pancreatic inflammatory myofibroblastic tumor presenting with extracolonic obstruction. Turk J Surg 2020; 36:233-237. [PMID: 33015570 DOI: 10.5578/turkjsurg.4325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 09/26/2019] [Indexed: 12/14/2022]
Abstract
Inflammatory myofibroblastic tumor is a rare soft tissue tumor which can be detected in many parts of the body. Its etiology and clinical behavior are not fully understood, and its treatment is controversial. This study aimed to present the management of a pancreatic tail case presenting with extracolonic obstruction findings. Unblock distal pancreatectomy + left surrenalectomy + left hemicolectomy + splenectomy operation was made with R0 resection principles. Although there are some medical treatments reported in children and unresectable tumors in the medical literature, complete surgical resection following oncological principles seems to be the most important and main treatment modality in the treatment of inflammatory myofibroblastic tumors. However, inflammatory myofibroblastic tumor has many aspects that are not yet clearly understood, and it is a disease being continuously researched.
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Affiliation(s)
- Nidal İflazoğlu
- Department of Surgical Oncology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Serpil Kaplan Kozan
- Department of Pathology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Tuğba Biri
- Department of Pathology, Inonu University School of Medicine, Malatya, Turkey
| | - Serkan Ünlü
- Department of Radiology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Hasan Gökçe
- Department of Pathology, Inonu University School of Medicine, Malatya, Turkey
| | - Serhat Doğan
- Department of General Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - Oruç Numan Gökçe
- Department of General Surgery, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
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7
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A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review. Diagnostics (Basel) 2019; 9:diagnostics9040150. [PMID: 31627359 PMCID: PMC6963339 DOI: 10.3390/diagnostics9040150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 12/17/2022] Open
Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare tumor that can develop in any systemic organ. Its features are generally benign, but it often resembles malignancies and is treated surgically. Our patient was an 82-year-old female complaining of abdominal discomfort. Computed tomography demonstrated a 5 cm, ill-enhanced mass at the pancreas head. Upper gastrointestinal endoscopy revealed a duodenal submucosal tumor with apical erosion. Endoscopic ultrasonography (EUS) demonstrated a heterogeneous, low-echoic pancreas mass without clear margins. Fine-needle aspiration biopsy (FNAB) demonstrated spindle myofibroblastic tissues with lymphoplasmacyte and eosinophil infiltration, confirming an IMT diagnosis. Surprisingly, the tumor spontaneously regressed in one month without medication. Histological diagnosis using EUS-FNAB is essential for the rare pancreatic solid tumor like IMT.
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8
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Abstract
The pancreas is a complex organ that may give rise to large number of neoplasms and non-neoplastic lesions. This article focuses on benign neoplasms, such as serous neoplasms, and tumorlike (pseudotumoral) lesions that may be mistaken for neoplasm not only by clinicians and radiologists, but also by pathologists. The family of pancreatic pseudotumors, by a loosely defined conception of that term, includes a variety of lesions including heterotopia, hamartoma, and lipomatous pseudohypertrophy. Autoimmune pancreatitis and paraduodenal ("groove") pancreatitis may also lead to pseudotumor formation. Knowledge of these entities will help in making an accurate diagnosis.
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Affiliation(s)
- Olca Basturk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gokce Askan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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9
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Abstract
In this review, we will focus on rare pancreatic tumors. Most of these tumors do not have distinct characteristic appearances so the key to diagnosis requires a combination of imaging appearance, laboratory data, patient demographics, and associated medical syndromes in order to narrow the differential diagnosis. Nonetheless, imaging plays a vital role in narrowing the differential and guiding management. While there are many variant pathologic entities that cannot be encompassed by a single review, we aim to illustrate the imaging appearance of less common pancreatic tumors highlighting key distinctive diagnostic characteristics and discuss the implications for management. While there is overlap in the imaging appearances of many of these entities, for educational purposes, lesions will be categorized into solid (hypoenhancing and hyperenhancing), cystic lesions, mesenchymal neoplasms, and neoplasms seen in younger patients (< 40 years).
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Affiliation(s)
- Jonathan Steinman
- Columbia University Medical Center, 622 W. 168th Street, PB 1-301, New York, NY, 10032, USA
| | - Atif Zaheer
- Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
| | - Michael D Kluger
- Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Helen Remotti
- Columbia University Medical Center, 630 West 168th Street, VC 14-215, New York, NY, 10032, USA
| | - Elizabeth M Hecht
- Columbia University Medical Center, 622 W. 168th Street, PB 1-301, New York, NY, 10032, USA.
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10
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Battal M, Kartal K, Tuncel D, Bostanci O. Inflammatory myofibroblastic pancreas tumor: a case report. Clin Case Rep 2016; 4:1122-1124. [PMID: 27980746 PMCID: PMC5134138 DOI: 10.1002/ccr3.717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 07/24/2016] [Accepted: 09/01/2016] [Indexed: 12/20/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) histologically characterized by fibroblastic and myofibroblastic proliferation with inflammatory infiltrate. The therapy adopted was Whipple's pancreaticoduodenectomy with a histological diagnosis of the inflammatory myofibroblastic tumor. The disease that should be considered as the differential diagnosis is pancreatic cancer. The diagnosis and treatment of IMT is surgical resection.
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Affiliation(s)
- Muharrem Battal
- General Surgery Clinic Sisli Hamidiye Etfal Training and Research Hospital Sisli Istanbul Turkey
| | - Kinyas Kartal
- General Surgery Clinic Sisli Hamidiye Etfal Training and Research Hospital Sisli Istanbul Turkey
| | - Deniz Tuncel
- Department of Pathology Sisli Hamidiye Etfal Training and Research Hospital Sisli Istanbul Turkey
| | - Ozgur Bostanci
- General Surgery Clinic Sisli Hamidiye Etfal Training and Research Hospital Sisli Istanbul Turkey
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11
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Chen M, Zhang L, Cao G, Zhu W, Chen X, Fang Q. Partial response to chemotherapy in a patient with retroperitoneal inflammatory myofibroblastic tumor. Mol Clin Oncol 2016; 5:463-466. [PMID: 27699044 DOI: 10.3892/mco.2016.967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/26/2016] [Indexed: 11/06/2022] Open
Abstract
Retroperitoneal inflammatory myofibroblastic tumor (IMT) is a rare lesion of unknown etiology. The management of IMT may be challenging due to its intermediate malignant potential, the possibility of local recurrence after surgical resection and its unique anatomic location, which makes radical resection impossible due to its proximity to vital structures. Thus, treatment for recurrence and metastasis mainly relies on chemotherapy. We herein report a case of a 60-year-old man with an IMT sized 6.7×5.1 cm, located in the left adrenal area, which was identified by a computed tomography (CT) scan of the abdomen. Radical surgical resection of the tumor was not feasible, as it was fixed to the left renal artery. After 5 months, the patient underwent CT-guided radiofrequency ablation of the re-growing tumor. An unresectable mass was detected in the patient's rectum by a CT scan of the pelvis. Subsequently, the patient underwent chemotherapy for the recurring and metastatic tumors. The chemotherapeutic regimens included epirubicin, dacarbazine and docetaxel. Over the last 6 months, after three cycles of therapy, the sizes of the primary and metastatic tumors had decreased on the follow-up CT scan. Thus, chemotherapy effectively controlled the disease in this case, following unsuccessful surgical resection and radiofrequency ablation. The present case report highlights the complexity of treatment in such cases and the significance of designing a clinical protocol for the treatment of IMT.
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Affiliation(s)
- Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Lihua Zhang
- Department of Pathology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Guochun Cao
- Department of Internal Medicine, Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Weidong Zhu
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Xuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
| | - Quan Fang
- Department of Urology, Zhongda Hospital, Southeast University College of Medicine, Nanjing, Jiangsu 210009, P.R. China
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Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate biological potential with a predilection for the lung and abdominopelvic region. IMT represents the neoplastic subset of the family of inflammatory pseudotumors, an umbrella term for spindle cell proliferations of uncertain histogenesis with a variable inflammatory component. IMTs show characteristic fasciitis-like, compact spindle cell and hypocellular fibrous histologic patterns and distinctive molecular features. Imaging findings reflect pathologic features and vary from an ill-defined, infiltrating lesion to a wellcircumscribed, soft tissue mass owing to variable inflammatory, stromal, and myofibroblastic components.
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13
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Panda D, Mukhopadhyay D, Datta C, Chattopadhyay BK, Chatterjee U, Shinde R. Inflammatory Myofibroblastic Tumor Arising in the Pancreatic Head: a Rare Case Report. Indian J Surg 2015; 77:538-40. [PMID: 26884665 DOI: 10.1007/s12262-015-1322-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/18/2015] [Indexed: 12/31/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare neoplastic lesion with tendency toward local aggressive behavior and recurrence. It is primarily a visceral and soft tissue tumor; however, involvement of pancreas is extremely unusual. A localization in the pancreas needs differentiation from other tumors and chronic pancreatitis. We report a case of inflammatory myofibroblastic tumor arising in pancreatic head in a 32-year-old female who underwent Whipple's procedure.
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Affiliation(s)
- Devasis Panda
- Department of Pathology, I.P.G.M.E & R., Kolkata, 700020 India
| | | | - Chhanda Datta
- Department of Pathology, I.P.G.M.E & R., Kolkata, 700020 India
| | | | | | - Raunak Shinde
- Department of General Surgery, I.P.G.M.E & R., Kolkata, India
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14
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Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, Sarr MG. Primary pancreatic cystic neoplasms of the pancreas revisited. Part IV: rare cystic neoplasms. Surg Oncol 2012; 21:153-63. [PMID: 21816607 DOI: 10.1016/j.suronc.2011.06.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/16/2011] [Accepted: 06/29/2011] [Indexed: 02/07/2023]
Abstract
Primary pancreatic cystic neoplasms are being recognized with increasing frequency due to modern imaging techniques. In addition to the more common cystic neoplasms-serous cystadenoma, primary mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm-there are many other less common neoplasms that appear as cystic lesions. These cystic neoplasms include solid pseudopapillary neoplasm of the pancreas (the most common rare cystic neoplasm), cystic neuroendocrine neoplasm, cystic degeneration of otherwise solid neoplasms, and then the exceedingly rare cystic acinar cell neoplasm, intraductal tubular neoplasm, angiomatous neoplasm, lymphoepithelial cysts (not true neoplasms), and few others of mesenchymal origin. While quite rare, the pancreatic surgeon should at the least consider these unusual neoplasms in the differential diagnosis of potentially benign or malignant cystic lesions of the pancreas. Moreover, each of these unusual neoplasms has their own natural history/tumor biology and may require a different level of operative aggressiveness to obtain the optimal outcome.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Medical School, University of Athens, Attikon University Hospital, Athens, 12462, Greece.
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15
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Fragoso AC, Eloy C, Estevão-Costa J, Campos M, Farinha N, Lopes JM. Abdominal inflammatory myofibroblastic tumor a clinicopathologic study with reappraisal of biologic behavior. J Pediatr Surg 2011; 46:2076-82. [PMID: 22075336 DOI: 10.1016/j.jpedsurg.2011.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Inflammatory myofibroblastic tumor (IMT) is a proliferative lesion of controversial nosology and uncertain prognosis. In an attempt to acquire further understanding of pathogenesis and biologic behavior, we surveyed abdominal IMTs managed over the last 12 years at a single institution. METHODS Intra-abdominal IMTs treated between 1995 and 2007 were reviewed concerning demographic, clinical, and pathologic features as well as therapeutic management and outcome. All specimens were reevaluated by histologic examination and immunohistochemistry. RESULTS There were 7 patients (4 males; age range, 28 days to 14 years). Five lesions were located in alimentary tract: 1 gastric presenting with bleeding, 1 hepatic presenting with a thoracic wall mass, 1 pancreatic and 2 colonic presenting with obstructive symptoms. One splenic IMT was found incidentally. The remaining case arose from the adrenal gland and presented with a palpable mass. The gastric and adrenal IMTs had evidence of a previous or concomitant infectious setting. Five lesions were excised. The pancreatic IMT underwent a drainage procedure followed by steroid administration, and the hepatic lesion received antibiotics. Histopathology revealed characteristic findings of IMT. Expression of anaplastic lymphoma kinase was negative in all cases. At a median follow-up of 6 years (range, 3-15), all children were asymptomatic with no recurrences. The hepatic and pancreatic IMT displayed complete and near total regression, respectively. CONCLUSION A benign behavior of abdominal IMTs was observed even in patients not undergoing surgical excision. Although IMT remains a surgical disease, a conservative approach may be reasonable in select cases.
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Affiliation(s)
- Ana Catarina Fragoso
- Division of Pediatric Surgery, Faculty of Medicine, University of Porto, Hospital S. João, 4200-319 Porto, Portugal
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16
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Hassan KS, Cohen HI, Hassan FK, Hassan SK. Unusual case of pancreatic inflammatory myofibroblastic tumor associated with spontaneous splenic rupture. World J Emerg Surg 2010; 5:28. [PMID: 21092210 PMCID: PMC2995784 DOI: 10.1186/1749-7922-5-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 11/22/2010] [Indexed: 12/31/2022] Open
Abstract
Background Spontaneous splenic rupture considered a relatively rare but life threatening. The three commonest causes of spontaneous splenic rupture are malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. We describe a unique and unusual case of inflammatory myofibroblastic tumor of the tail of pancreas presented with massively enlarged spleen and spontaneous splenic rupture. Case presentation A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue. Massively enlarged spleen was detected. Hypotension and rapid reduction of hemoglobin level necessitated urgent laparatomy. About 1.75 liters of blood were found in abdominal cavity. A large tumor arising from the tail of pancreas and local rupture of an enlarged spleen adjacent to the tumor were detected. Distal pancreatectomy and splenectomy were performed. To our knowledge, we report the first case of massively enlarged spleen that was complicated with spontaneous splenic rupture as a result of splenic congestion due to mechanical obstruction caused by an inflammatory myofibroblastic tumor of the tail of pancreas. A review of the literature is also presented. Conclusion Inflammatory myofibroblastic tumor of the tail of pancreas should be included in the differential diagnosis of the etiological causes of massively enlarged spleen and spontaneous splenic rupture.
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Affiliation(s)
- Kamal S Hassan
- Clalit Health Services, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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17
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Chen ZY, Wei W, Guo RP. Inflammatory myofibroblastic tumour of the spleen: A case report and literature review. SURGICAL PRACTICE 2010. [DOI: 10.1111/j.1744-1633.2010.00517.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Schütte K, Kandulski A, Kuester D, Meyer F, Wieners G, Schulz HU, Malfertheiner P. Inflammatory Myofibroblastic Tumor of the Pancreatic Head: An Unusual Cause of Recurrent Acute Pancreatitis - Case Presentation of a Palliative Approach after Failed Resection and Review of the Literature. Case Rep Gastroenterol 2010; 4:443-451. [PMID: 21113286 PMCID: PMC2988857 DOI: 10.1159/000320953] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are a rare cause of echo-poor pancreatic head enlargement. Histologically, IMTs are characterized by spindle-shaped myofibroblasts or fibroblasts accompanied by a mixed immune cell infiltration. The most common localizations of IMTs have been reported in lung, mesentery and omentum, especially in children and young adults. IMTs show infiltrating growth, multilocular appearance and also metastasis have been reported. Curative resection is the only therapeutic option so far. In the palliative situation, evident data and clear guidelines for this rare tumor entity are missing. We report on a 44-year-old male with an unresectable IMT of the pancreatic head causing recurrent episodes of acute pancreatitis that resulted in a chronic obstructive course of the disease. The patient entered a palliative therapeutic regimen including radiation therapy and antiinflammatory medication. In a regular follow-up of 12 months, he presented with stable disease after initial progression. This case of local progressive IMT of the pancreatic head was managed with a palliative therapeutic regimen and is discussed based on the current literature.
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Affiliation(s)
- Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Magdeburg, Germany
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19
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Nagata S, Yamaguchi K, Inoue T, Yamaguchi H, Ito T, Gibo J, Tanaka M, Tsuneyoshi M. Solid pancreatic hamartoma. Pathol Int 2007; 57:276-80. [PMID: 17493175 DOI: 10.1111/j.1440-1827.2007.02090.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A case of solid pancreatic hamartoma in a 58-year-old Japanese woman is presented. She had no symptoms, and a pancreatic mass was incidentally found on screening ultrasonography 4 months before admission. The patient was not alcoholic and had no history of pancreatitis. Physical examination and laboratory data were unremarkable. Preoperative imaging demonstrated a nodule in the body of the pancreas, measuring 2.0 cm in maximum diameter, which showed marked delayed enhancement during dynamic CT. The patient underwent a distal pancreatectomy under the preoperative diagnosis of pancreatic endocrine tumor and had an uneventful postoperative course. A well-demarcated solid nodule, 1.9 cm in diameter, was evident in the body of the pancreas. Microscopically, the lesion was composed of non-neoplastic, disarranged acinar cells and ducts embedded in a sclerotic stroma with elongated spindle cells, lacking discrete islets. The stromal spindle cells were immunoreactive for CD34 and CD117. The histological diagnosis was solid hamartoma of the pancreas. There was no recurrence 5 months after surgery. Herein is reported a case of solid hamartoma of the pancreas and review of the literature. A search through the literature found only two cases of solid hamartoma of the pancreas, among the 14 cases previously reported as pancreatic hamartoma.
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Affiliation(s)
- Shigenori Nagata
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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20
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Mizukami H, Yajima N, Wada R, Matsumoto K, Kojima M, Klöppel G, Yagihashi S. Pancreatic malignant fibrous histiocytoma, inflammatory myofibroblastic tumor, and inflammatory pseudotumor related to autoimmune pancreatitis: characterization and differential diagnosis. Virchows Arch 2006; 448:552-60. [PMID: 16538442 DOI: 10.1007/s00428-006-0157-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 01/10/2006] [Indexed: 12/24/2022]
Abstract
Malignant fibrous histiocytoma (MFH) and inflammatory myofibroblastic tumor (IMT) are uncommon primary non-epithelial cell tumors of the pancreas. In addition, there are inflammatory pseudotumors (IPT) that may arise in the course of autoimmune pancreatitis (AIP). In the English language literature, only 24 cases of IMT and nine cases of MFH in the pancreas have been reported to date. We investigated three individual spindle cell tumors of the pancreas that were identified as MFH, IMT, and IPT, respectively, using immunohistochemical and molecular analysis. Both the MFH and the IMT, but not the IPT, showed nuclear p53 expression and mutations of the p53 gene. The MFH and the IMT also had higher mitotic and Ki-67 (MIB-1) indexes than the IPT. The IPT was found to be a tumor-like case of AIP. Many IgG4-positive plasma cells, which are considered to be a feature of AIP, were found in all three tumors. It is concluded that in this series of spindle cell tumors of the pancreas, apart from immunohistochemical features, the demonstration of p53 mutations may be helpful in distinguishing true neoplastic tumors from pseudotumors such as IPTs arising in the context of AIP.
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MESH Headings
- Adult
- Autoimmune Diseases/complications
- Base Sequence
- Diagnosis, Differential
- Female
- Gene Expression
- Gene Expression Profiling
- Granuloma, Plasma Cell/etiology
- Granuloma, Plasma Cell/genetics
- Granuloma, Plasma Cell/pathology
- Histiocytoma, Malignant Fibrous/genetics
- Histiocytoma, Malignant Fibrous/metabolism
- Histiocytoma, Malignant Fibrous/pathology
- Humans
- Immunohistochemistry
- Ki-67 Antigen/metabolism
- Male
- Middle Aged
- Mutation
- Neoplasms, Muscle Tissue/genetics
- Neoplasms, Muscle Tissue/metabolism
- Neoplasms, Muscle Tissue/pathology
- Pancreatectomy
- Pancreatic Neoplasms/genetics
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/pathology
- Pancreatitis/complications
- Pancreatitis/pathology
- Polymerase Chain Reaction
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- Hiroki Mizukami
- Department of Pathology, Hirosaki University School of Medicine, and Division of Surgical Pathology, National Hirosaki Hospital, 036-8562, Japan
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21
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Lee WA. Mucinous cystadenoma of the pancreas with predominant stroma creating a solid tumor. World J Surg Oncol 2005; 3:59. [PMID: 16146567 PMCID: PMC1236970 DOI: 10.1186/1477-7819-3-59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 09/07/2005] [Indexed: 12/05/2022] Open
Abstract
Background Mucinous cystic neoplasm (MCN) of the pancreas is basically cystic epithelial neoplasm, unilocular or multilocular, occurring almost exclusively in women. Case presentation A 51-year-old female presented with a pancreatic mass incidentally found on the abdominal computed tomography. She underwent distal pancreatectomy. The sectioned surface of the pancreas revealed a circumscribed, whitish gray ovoid firm mass with some cystic spaces. Microscopically, glandular or small cystic structures were scattered in the predominant stroma creating a solid appearance. The subepithelial stromal component was composed of cytologically bland looking spindle cells, which resembled ovarian stroma. The stromal cells were reactive to CD 34, vimentin, progesterone receptor and calretinin. The microscopy was consistent with mucinous cystadenoma of the pancreas. Conclusion This case of mucinous cystadenoma of the pancreas showed very interesting pathology: It was solid rather than cystic, and accompanied by abundant benign transitional epithelia, which was a very unusual and novel finding in the mucinous cystic neoplasm of the pancreas.
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Affiliation(s)
- Won Ae Lee
- Department of Pathology, College of Medicine, Dankook University, Cheonan, Republic of Korea.
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22
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Behranwala KA, Straker P, Wan A, Fisher C, Thompson JN. Inflammatory myofibroblastic tumour of the gallbladder. World J Surg Oncol 2005; 3:24. [PMID: 15862123 PMCID: PMC1097763 DOI: 10.1186/1477-7819-3-24] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 04/29/2005] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Inflammatory myofibroblastic tumour (IMT) is a benign, nonmetastasizing proliferation of myofibroblasts with a potential for local infiltration, recurrence and persistent local growth. CASE REPORT: We report a case of a 51 year-old female, who had excision of a gallbladder tumour. Histopathology showed it to be IMT of the gallbladder. CONCLUSION: The approach to these tumours should be primarily surgical resection to obtain a definitive diagnosis and relieve symptoms. IMT has a potential for local infiltration, recurrence and persistent local growth.
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Affiliation(s)
- Kasim A Behranwala
- Gastrointestinal Surgery Unit, Royal Marsden NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Peter Straker
- Gastrointestinal Surgery Unit, Royal Marsden NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Andrew Wan
- Gastrointestinal Surgery Unit, Royal Marsden NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Cyril Fisher
- Department of Pathology, Royal Marsden NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Jeremy N Thompson
- Gastrointestinal Surgery Unit, Royal Marsden NHS Trust, 203 Fulham Road, London SW3 6JJ, UK
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23
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Yamaguchi M, Yoshino I, Osoegawa A, Kameyama T, Tagawa T, Fukuyama S, Oda Y, Tsuneyoshi M, Maehara Y. Inflammatory myofibroblastic tumor of the mediastinum presenting as superior vena cava syndrome. J Thorac Cardiovasc Surg 2003; 126:870-2. [PMID: 14502173 DOI: 10.1016/s0022-5223(03)00611-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Masafumi Yamaguchi
- Department of Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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24
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Overstreet K, Wixom C, Shabaik A, Bouvet M, Herndier B. Adenomatoid tumor of the pancreas: a case report with comparison of histology and aspiration cytology. Mod Pathol 2003; 16:613-7. [PMID: 12808068 DOI: 10.1097/01.mp.0000072803.37527.c8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a 58-year-old woman who presented with a 1.5-cm, hypodense lesion in the head of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration yielded bland, monotonous cells with wispy cytoplasm, slightly granular chromatin, and small nucleoli. A presumptive diagnosis of a neuroendocrine lesion was rendered. Whipple procedure yielded a well-circumscribed, encapsulated lesion with dense, hyalinized stroma and a peripheral rim of lymphocytes. Spindled and epithelioid cells formed short tubules, cords, and nests. The neoplasm stained for CK 5/6, calretinin, vimentin, CD 99, pancytokeratin, and EMA, consistent with mesothelial origin. This characteristic histology and immunohistochemistry is consistent with an adenomatoid tumor. We believe we are the first to report this benign neoplasm in such an unusual location. Herein we address the diagnosis of adenomatoid tumor by histology, immunohistochemistry, and aspiration cytology. Our case is particularly unique in that the histology and cytology are compared and correlated.
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Affiliation(s)
- Kerith Overstreet
- Department of Pathology, University of California, San Diego Medical Center, San Diego, California 92103, USA.
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