Diagnosis Of Inflammatory Myofibroblastic Tumor Research Articles

Giant Inflammatory Myofibroblastic Tumor of Esophagus

A 55-year-old woman was admitted to our hospital with a complaint of dysphagia and weight loss for 1 year. A barium examination indicated a filling defect in the thoracic esophagus (Figs 1A and 1B), and computed tomographic chest reconstruction showed a long-column mass in the region described. An endoscopic examination revealed marked stenosis with a smooth surface and diffuse esophageal wall elevation (Fig 1C; Inset: mini-picture of Fig 1C, which was captured by endoscopy in the process of operation). An endoscopic ultrasound of the esophagus showed a submucosal heterogeneous mass with a clear margin in the thoracic esophagus. A giant neoplasm was successfully removed by opening the esophagus (Fig 2A). Microscopically, the tumor consisted of a mixture of fibroblastic cells and inflammatory cells (Fig 2B). Immunohistochemistry staining showed the tumor was positive for smooth muscle actin, and was negative for CD34, CD117, and S-100. Histology characteristic of the neoplasm supports a diagnosis of inflammatory myofibroblastic tumor. The patient recovered with an uneventful postoperative course. We believe that inflammatory myofibroblastic tumor of the esophagus similar to this case has never been reported before.

Inflammatory Myofibroblastic Tumors in Two Dogs

Two soft tissue masses from different locations in 2 dogs were submitted for histopathologic examination. Each was well demarcated and consisted of interweaving streams of bland spindle cells among which numerous plasma cells and lymphocytes were scattered. All the spindle cells reacted strongly to antibodies against vimentin and calponin, whereas a subset of the spindle cells expressed smooth muscle actin and desmin. Immunohistochemistry results were consistent with a myofibroblastic derivation for the spindle-cell population and the diagnosis of inflammatory myofibroblastic tumor (IMT) was made. This is the second report of IMT in the veterinary literature.

Inflammatory myofibroblastic tumor larynx mimicking laryngeal papillomatosis

Summary Inflammatory myofibroblastic tumor (IMT) of larynx is an unusual benign proliferate lesion rarely seen in pediatric age group. A 10-year-old male child presented with history of hoarseness of voice for 6-month duration and indirect laryngoscopy showed an ulcerative, warty growth involving the right vocal cord. The patient underwent microlaryngeal surgery under general anaesthesia and growth was excised completely. The histopathology showed spindle cells arranged in fasciculate pattern with myxoid background and focal hyalinization. The immunostaining showed positivity of spindle cells to vimentin and muscle specific actin confirming the diagnosis of IMT. The voice of child improved after 2 months and had regular follow up for 2 years with no recurrence.

Inflammatory myofibroblastic tumor of bladder: a clinicopathologic study of five cases

To study the clinicopathologic features, diagnosis and differential diagnosis of inflammatory myofibroblastic tumor of the urinary bladder. Excisional specimens from 5 cases of vesical inflammatory myofibroblastic tumor were studied by light microscopy and immunohistochemistry (EnVision). The clinical data were also analyzed. Among the 5 patients studied, 3 were males and 2 were females. The age of the patients ranged from 10 to 53 years (mean age = 35 years). The most common clinical presentation was micturition pain and hematuria. Three cases were located at the dome of the urinary bladder and the remaining 2 cases were found in the left lateral wall. Histologically, the tumor varied from myxoid to highly cellular. The tumor cells were spindle to stellate in shape, widely separated or showed a compact fascicular pattern. There were often associated with mixed inflammatory infiltrates and an irregular meshwork of small dilated vessels. Immunohistochemical study showed that the tumor cells expressed AE1/AE3 (5/5), vimentin (5/5), smooth muscle actin (5/5), calponin (5/5), caldesmon (3/5), desmin (4/5) and anaplastic lymphoma kinase protein (4/5). Follow-up data were available in 4 patients and none had local recurrence or died of this disease. Inflammatory myofibroblastic tumour of urinary bladder is a rarely encountered but distinctive neoplasm with intermediate malignant potential.

Recurrent gastric inflammatory myofibroblastic tumour in a 13-year-old male

A 13-year-old boy who had epigastric pain and pallor for 2 months and found to have an ulcerative mass in the stomach and underwent partial gastrectomy. A diagnosis of inflammatory myofibroblastic tumour (IMT) of the stomach was made on histological examination. Three years later, recurrence in the stomach, with invasion into the pancreas and hilum of the spleen was noted and was managed by wide wedge resection of the stomach, distal pancreatectomy and splenectomy. The patient has been recurrence-free for the past 2 years. Gastric IMT is an uncommon tumour in children with unpredictable prognosis.

Postcricoid inflammatory myofibroblastic tumor (inflammatory pseudotumor) in a 10-year-old girl

Summary Inflammatory myofibroblastic tumor (IMT) is a benign spindle cell tumor of disputed nosology and unknown etiology that occasionally presents in the head and neck but is known to occur throughout the body in patients of all ages. IMT is identified by several alternative names in the literature; inflammatory pseudotumor and plasma cell granuloma are among the most prominent. We present a case of IMT arising in the postcricoid region of the hypopharynx in a 10-year-old girl and review the literature of IMT involving the head and neck. To the best of our knowledge, this is the first report of an IMT arising in this location. The patient was treated with endoscopic surgical excision and remains free of disease 2 years following the initial surgical resection. Histologically, the differential diagnosis of IMT includes both benign and malignant neoplasms, making frozen section interpretation challenging. Highlighting this is a case report wherein the presumptive frozen section diagnosis was interpreted as rhabdomyosarcoma, while permanent histology was consistent with IMT. Therefore, surgical decisions based purely on a frozen section diagnosis of malignancy may result in inappropriate and overly aggressive surgical treatment.

Pseudotumeur myofibroblastique inflammatoire de la langue

Inflammatory myofibroblastic tumor (IMT) is a new entity recently described, first in the lung. IMT are found throughout the body. We report a very rare tongue localization in a 22-year-old white woman. After a first diagnosis of fibrosarcoma, a new examination of the slide and immunohistochemical examination led to the definitive diagnosis of inflammatory myofibroblastic tumor of the tongue and not fibrosarcoma. IMT are rarely encountered in the head and neck region. Only 2 cases of IMT of the tongue have been reported in the world literature. Diagnosis of IMT is immunohistochemical. Spindle cells were reacted for smooth-muscle actin and vimentin. Treatment is surgical. The contribution of radiotherapy is not clear because of the small population of patients studied.

Intramandibular inflammatory myofibroblastic tumor—A true neoplasm or reactive lesion?

Inflammatory myofibroblastic tumor (IMT) is an uncommon lesion reported to arise in various organs and by convention believed to be a nonneoplastic reactive inflammatory condition. Because of its radiographic and histologic similarities to malignancy, IMT can pose a considerable diagnostic dilemma. The purpose of this study is to report the first intramandibular IMT and to discuss the possible nature of this lesion. Detailed documentation of clinical, radiographic, and histologic features; literature review. This lesion showed distinct radiographic, histologic, and immunohistochemical features. The lesion recurred 14 months after initial removal with almost identical histology. This is the first documented case of an intramandibular IMT. Due to the rarity of these lesions, their clinical sequelae and prognosis are undetermined. As a result of specific immunohistochemical phenotyping and clinical behavior of this lesion, we favored a diagnosis of inflammatory myofibroblastic tumor. Wide excision with a long-term clinical follow-up is required.

PERITONEAL INFLAMMATORY MYOFIBROBLASTIC TUMOR IN A BRUSH-TAILED PORCUPINE (ATHERURUS MACROURUS)

An 8-yr-old, male brush-tailed porcupine (Atherurus macrourus) presented for necropsy examination in good nutritional status. It had received treatment for Strongylus spp. infection 1 yr earlier, and it had a short episode of diarrhea 2 days before death. Postmortem examination revealed disseminated, variably discrete, soft to firm, white-gray nodules over the omentum, mesentery, intestinal serosa, and at the liver surface. Histologically, these tumors were mainly arranged as proliferating spindle cells growing in interlacing fascicles or in a storiform pattern associated with ropy collagenous stroma and vascularization. Inflammatory cells, consisting of lymphocytes, plasma cells, and macrophages, infiltrated between the tumor cells. Cytoplasmic immunoreactivity of antibodies to alpha-smooth muscle actin and vimentin was observed in the tumor cells. Antidesmin immunoreactivity varied with area. The morphologic features, the presence of inflammatory infiltrates, and the immunohistochemical expression were consistent with a diagnosis of inflammatory myofibroblastic tumor as reported in humans, horses, and cats.

Inflammatory myofibroblastic tumor of the breast

Three patients developed firm, mobile, nontender masses in their breasts. Two were discovered by the patients and one after mammography. Macroscopically, the nodules were firm, circumscribed, yellow on cut sections, and composed of interlacing cytologically bland spindle cells admixed with chronic inflammatory cells, the latter predominantly of lymphocytes and plasma cells. Immunohistochemistry yielded strong smooth-muscle actin reactivity within the spindle cells; 2 lesions were negative for pankeratin, 1 was focally and weakly positive. No lesions were positive for anaplastic lymphoma kinase-1, desmin, S-100, CD34, CD21, or CD35. In each case, a diagnosis of inflammatory myofibroblastic tumor was made (aka, inflammatory pseudotumor). After conservative excision with apparently negative margins, there have been no recurrences, except in one patient who developed a recurrence after 3 months. The latter recurrence was managed successfully with a second excision. We report these patients to emphasize the diagnostic features of inflammatory myofibroblastic tumor of the breast and discuss how they can be distinguished from other spindle-cell breast lesions with which they can be confused, especially spindle-cell carcinoma.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the maxillary sinus mimicking malignancy: a case report of an unusual location (is that a true neoplasm?)

The inflammatory myofibroblastic tumor (IMT) is a space-occupying lesion of unknown etiology and a distinctive but controversial lesion. This type of tumor is recently considered neoplastic rather than inflammatory. It is usually occurring during childhood, composed of fascicles of bland myofibroblastic cells admixed with a prominent inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils. IMT of the maxilla is very rare. The diagnosis of IMT can be made on the basis of histopathology and immunohistoche-mistry. Herein, we presented a patient who had IMT of the maxillary sinus that was initially misinterpreted as a malignant neoplasm upon clinical and radiographic examinations. We discussed the diagnostic and therapeutic procedures and may consider it a true neoplasm.

Inflammatory myofibroblastic tumor in children: Diagnosis and treatment

Background/Purpose: Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. Although it is commonly seen in children, the number of childhood cases in the current literature is limited. Furthermore, malignant degeneration or transformation to lymphoma in the recurrent or residual IMT have directed attention to this interesting entity. Herein, the authors present their experience with IMT with special emphasis on diagnosis and treatment. Methods: All records of children treated with diagnosis of IMT between 1977 and 1999 inclusive were evaluated retrospectively. Results: Seven children were treated for IMT with the mean age of 9.14 ± 2 years (range, 6 to 12 years). Male to female ratio was 5:2. Respiratory symptoms and clubbing were present in a patient with pulmonary IMT (n = 1). Abdominal pain (n = 3), fever (n = 2), and weight loss (n = 4) were encountered in intraabdominal IMTs. The most frequent physical finding was palpable intraabdominal mass (n = 4). Plain films showed nonspecific findings such as radiodense area in the hemithorax (n = 1), displacement of bowel segments (n = 2), air-fluid levels (n = 1), and amorphous calcification (n = 4). Ultrasonography and CT showed calcified masses in 4 cases. Except the case with intrathoracic IMT, all the tumors were located in the abdomen at various sites such as cardioesophageal junction (n = 1), left hepatic lobe (n = 1), mesentery of the small bowel (n = 2), and antimesenteric wall of the descending colon (n = 1), gastrosplenic region and porta hepatis (n = 1). Tumor sizes ranged from 3 × 2 × 2 cm to 15 × 15 × 13 cm. The masses were excised totally in all but one case. Infiltrated organs (esophagogastric junction, a segment of jejunum, and spleen, stomach wall, and renal capsule) were resected in 3 cases. Total surgical excision of IMT was considered adequate for treatment in 6 cases. One patient with aggressive IMT required further treatments such as immunomodulation and chemotherapy and died of neutropenic sepsis. Conclusions: IMT is a benign neoplasm rarely presented with malignant features such as local invasiveness, recurrence, distant metastasis, or malignant transformation. IMT can be suspected preoperatively through some hematologic abnormalities and radiologic findings, but precise diagnosis should be made on the basis of histologic findings. Complete surgical resection and close follow-up are all necessary for appropriate treatment to avoid recurrences as well as unnecessary and potentially harmful therapy. The optimal management of locally aggressive and recurrent forms should be decided individually for each patient. J Pediatr Surg 36:908-912. Copyright © 2001 by W.B. Saunders Company.

Abdominal inflammatory myofibroblastic tumors in children: Report of an appendiceal case and review of the literature

Inflammatory myofibroblastic tumors (IMT) are rare, benign lesions. They mimic, clinically and radiologically, malignant tumors—especially sarcoma. IMT most often are seen in the lung of young adults, but there have been reports of these tumors occurring in children, in various sites. The authors report a case of appendiceal IMT arising in a 15-year-old boy previously treated for inherited distal renal tubular acidosis. He was admitted because of anorexia, weight loss, and a low-grade fever. The ultrasound study showed bilateral hydroureteronephrosis, with a poorly functioning right kidney noted on intravenous urography, and a retrovesical soft-tissue mass. Laboratory studies showed renal insufficiency, an elevated white blood cell count, anemia, thrombocytosis, and hypergammaglobulinemia. During laparotomy, a pelvic appendiceal mass was discovered, appendectomy was performed, and the pathological diagnosis of inflammatory myofibroblastic tumor was made. Three months later the boy was well, and the biological, sonographic, and urographic results had returned to normal. A review of 74 cases of abdominal IMT occurring in childhood emphasizes the importance of pathological differentiation of these lesions from malignancy, with early total excision whenever possible. Long-term follow-up is necessary to detect local recurrence, which may develop many years later, and to confirm the allegedly benign nature of these tumors.