Inflammatory MyofibroblasticTumour of Ovary Simulating Malignancy with Review of Literature

Ruchi Sinha,Shashikant Kumar,Iffat Jamal,Shuchi Smita,Mamta Kumari,Nishi Sharma

doi:10.21276/apalm.1285

Abstract

Inflammatory myofibroblastic tumour (IMT) of ovary is an uncommon benign neoplasm that can mimic malignancy. It often occurs in children and young adults. Lung is the most common site of IMT. Precise etiology is not known but recent reports suggested the role of benign reactive process in its pathogenesis. A 32 year old female patient presented to the gynaecology out patient department with complaints of lower abdominal pain and increased frequency of micturition with burning since 15 days. On per abdominal examination, an irregular lump of 18 weeks size with restricted mobility was palpable in suprapubic region. Laboratoratory investigations revealed normocytic normochromic anaemia with neutophilic leucocytosis and raised ESR. Her serum CA 125 levels were slightly raised (44.30 u/ml). Imaging studies showed an infiltrating mass in the pelvis. The patient underwent total abdominal hysterectomy with bilateral salpingo oopherectomy and omentectomy. Histopathological examination of which revealed IMT of right ovary with extension to right parametrium and adjacent bladder. As IMT is a mimicker of malignancy due to its infiltrative growth. Histopathological examination is mandatory for its diagnosis and treatment. Misdiagnosis can lead to unnecessary extensive debulking surgeries and even chemotherapy. Rarity of this entity in the ovary has made this case worth reporting. DOI: 10.21276/APALM.1285

Highlights

Inflammatory myofibroblastic tumour (IMT), known as plasma cell granuloma, plasma cell pseudo tumour, inflammatory myofibrohistiocytic proliferation and inflammatory pseudotumour is a rare benign lesion of mesenchymal origin
The neoplasm is composed of proliferating myofibroblastic spindle cells admixed with chronic inflammatory cells such as lymphocytes, plasma cells and eosinophils
Microscopic examination showed proliferating myofibroblasts along with diffuse infiltration of chronic inflammatory cells comprising of lymphocytes with focal lymphoid aggregates, plasma cells, histiocytes and occasional eosinophils (Figure 3)

Summary

Introduction

Inflammatory myofibroblastic tumour (IMT), known as plasma cell granuloma, plasma cell pseudo tumour, inflammatory myofibrohistiocytic proliferation and inflammatory pseudotumour is a rare benign lesion of mesenchymal origin. The neoplasm is composed of proliferating myofibroblastic spindle cells admixed with chronic inflammatory cells such as lymphocytes, plasma cells and eosinophils It can arise in any organ but most frequent reported sites are lung, mesentry and omentum.[1] Female genital tract is one of the rarest site for occurance of IMT with most cases reported in the uterus.[2] Only few cases of IMT in ovary have been reported.[3]. A solid-cystic mass measuring 5 x 5 cm was seen in right ovary and filled with approximately 3040 ml of pus. The ovarian mass was densely adherent and infiltrating into uterus, bladder, vagina, gut, omentum and extending upto the lateral pelvic wall. Microscopic examination showed proliferating myofibroblasts (at places arranged in fascicles) along with diffuse infiltration of chronic inflammatory cells comprising of lymphocytes with focal lymphoid aggregates, plasma cells, histiocytes and occasional eosinophils (Figure 3).

Discussion

Inflammatory Myofibroblastic Tumour

Conclusion