Abstract
Pulmonary inflammatory myofibroblastic tumors (PIMTs) are extremely rare in adults. If occurring in patients >40 years old, PIMT should be rapidly distinguished from lung cancer. The present study aimed to characterize the imaging features of PIMT in patients >40 years old in order to improve the diagnosis of PIMT. The imaging data of 10 patients with PIMT were reviewed retrospectively. Of the patients, eight underwent computed tomography (CT), two underwent positron emission tomography (PET)/CT and four underwent single-photon emission computed tomography (SPECT). Unenhanced CT revealed 10 lesions with a maximum diameter ranging between 5 and 57 mm located in the lower (n=6) or upper (n=4) lobe, in a peripheral (n=9) or central (n=1) region, and that were well- (n=4) or ill-defined (n=6), and round to oval (n=5) or irregular (n=5) in shape. Calcification (n=3), necrosis (n=6), cavity (n=4), air bronchogram (n=6) and obstructive pneumonia (n=1) were also observed in the patients. Contrast-enhanced CT revealed six lesions with moderate to high contrast enhancement in the arterial and venous phases, including four lesions with delayed enhancement. PET/CT identified two lesions with increased tracer uptake that were homogeneous and heterogeneous and each exhibited a maximal standard uptake value (SUVmax) of 6.0 and 5.4, respectively. The delayed PET/CT revealed foci that each exhibited an increased SUVmax of 6.9 and 5.9, respectively. SPECT demonstrated no definitive bone metastases, but did reveal atypical hypertrophic pulmonary osteoarthropathy in one patient. The combined imaging methods may lead to a more precise evaluation of PIMT in patients >40 years old.
Highlights
Inflammatory myofibroblastic tumor (IMT) is a rare disorder that was previously referred to by a variety of synonyms, including inflammatory pseudotumor, plasma cell granuloma, fibroxanthoma, fibrous histiocytoma and xanthogranuloma [1]
The computed tomography (CT) findings of Pulmonary inflammatory myofibroblastic tumors (PIMTs) in the present study were based on 10 patients, consisting of eight who underwent routine CT examination and two who underwent the unenhanced CT component of positron emission tomography (PET)/CT (Table II)
It is reported that ~40% of all cases occur in adults >40 years old [15] who are more likely to be affected by lung cancers
Summary
Inflammatory myofibroblastic tumor (IMT) is a rare disorder that was previously referred to by a variety of synonyms, including inflammatory pseudotumor, plasma cell granuloma, fibroxanthoma, fibrous histiocytoma and xanthogranuloma [1]. Reported cases of IMTs exhibiting aggressive growth, local invasion, recurrence and even distant metastasis, supports this concept [5,6,7,8,9,10]. IMT may occur at any age, but usually affects children and adults 40 years old, a relatively small number of studies concerning PIMT have been published, due to its rarity. The most common malignant tumor of the lung, lung cancer, predominantly affects this age group. It is of great importance to identify PIMT in patients over the age of 40
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