Aggressive Inflammatory Myofibroblastic Tumor of Distal Pancreas: A Diagnostic and Surgical Challenge.

Harisankar A G,Saurabh Singla,Saket Kumar,Nishant Kurian

doi:10.7759/cureus.22820

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.

Highlights

The term inflammatory myofibroblastic tumor was first proposed in 1990 by Pettinato et al based on their study on 20 cases of inflammatory tumors of the lung and esophagus [1]
We report a rare case of distal pancreatic Inflammatory myofibroblastic tumors (IMT) with extensive local infiltration in a middle-aged man that necessitated multivisceral resection for complete excision
IMT is a rare neoplasm of unknown etiopathogenesis

Summary

Introduction

The term inflammatory myofibroblastic tumor was first proposed in 1990 by Pettinato et al based on their study on 20 cases of inflammatory tumors of the lung and esophagus [1]. According to the current World Health Organisation (WHO) guidelines, Inflammatory myofibroblastic tumors (IMT) are typically low-grade neoplasms with occasional malignant potential [2] It is mostly reported in children and young adults but can affect people of any age. We report a rare case of distal pancreatic IMT with extensive local infiltration in a middle-aged man that necessitated multivisceral resection for complete excision. To achieve complete tumor resection, distal pancreaticosplenectomy with segmental resection of the jejunum and transverse colon was performed, and the specimen was sent for histopathological examination. The tumor was infiltrating a segment of the proximal jejunum (Figure 2, panels a, b) as well as the transverse colon. The histopathological examination revealed a fairly circumscribed tumor composed of fascicles of spindle cells to plump cells exhibiting moderate nuclear pleomorphism (Figure 3). On the basis of histopathology and IHC markers, a diagnosis of pancreatic IMT was made

Discussion

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Disclosures

WHO Classification of Tumours