Diagnosis Of Inflammatory Pseudotumor Research Articles

Imaging features of inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen.

Inflammatory pseudotumor (IPT)-like follicular dendritic cell sarcoma (FDCS) is an extremely rare malignant neoplasm. Retrospective analysis of imaging features of splenic IPT-like FDCS, including ultrasonography, computed tomography (CT), and magnetic resonance (MR) and contrast-enhanced imaging were performed. When the masses were small, the ultrasound images showed homogeneous hypoechoic signals, clear boundaries, and complete capsules. Abdominal plain CT scans showed equal density (easy to miss diagnosis), unclear boundaries, and no capsules. Magnetic resonance images (MRI) showed slightly shorter T1, slightly shorter T2, and clear boundaries. When the masses were large, the ultrasound images still showed clear boundaries and complete capsules, but the echoes of the masses were not uniform, and some of the masses showed dendritic hyperechoic centers. Abdominal plain CT scans showed irregular low densities in the center (unclear boundaries) and equal densities in the periphery. MRI showed short T1 and T2, but the central signals were mixed. When the mass was accompanied by extensive necrosis, abdominal plain CT scan showed mostly cystic lesions and slight calcifications in low density lesions. Contrast-enhanced CT showed only moderate enhancement in peripheral and septal areas. MRI showed that T1 and T2 were mainly mixed signals. Contrast-enhanced MR showed moderate enhancement of peripheral areas and septum. This is the first report to describe the IPT manifestations of the spleen (ultrasonography, CT, and MR). The diagnosis of IPT can be made by combining three imaging features.

Inflammatory Pseudotumor: A 20-Year Single Institutional Experience.

Background: Inflammatory pseudotumor (IPT) is a relatively rare benign disease. The aim of the study was to demonstrate the demographic distribution, clinical presentation, and histomorphological characteristics of IPT while highlighting its associated diagnostic challenges.Materials and Methods: A retrospective cross-sectional review of all the IPT diagnosed in our institution between January 1999 and December 2018 was conducted. The samples were received from within and outside the hospital facility. The demographic data, clinical history, and histologic reports were reviewed.Results: A total of 25 cases of histologically confirmed IPT were seen. Patients' age ranges from 7 to 74 years with a mean age of 38.96 years and standard deviation ± 17.94 years. There was a bimodal peak occurrence in the third and fifth decades. Most of the patients were adults (23, 92%), whereas only 2 (8%) were children. There was a female preponderance with a male-to-female ratio of 1:2.6. The head and neck had the highest number of cases (44%), followed by the gastrointestinal tract (GIT) (40%). Eight (73%) of head and neck cases occurred in the orbit. The presenting complaints depended on the site of the lesion with pain and swelling being the commonest symptoms irrespective of the site of the lesions. Two cases of bilateral IPT were observed. Immunohistochemistry was used in a certain condition of diagnostic dilemma.Conclusion: This study showed a female preponderance of IPT with the head and neck and GIT being the most common location. It is important to rule out other differentials in the diagnosis of IPT.

Retropharyngeal soft-tissue mass with multiple cranial neuropathies

Retropharyngeal lesions have different spectrum of presentations. We herein present a case with step-wise progression of ambiguous symptoms and signs of polycraniopathy, caused by a soft-tissue mass in the retropharyngeal space extending into the cavernous sinus, as detected by magnetic resonance imaging. Initially, he was presented with hemifacial pain and lately progress rapidly to involve all cranial nerves; 3rd through 12th cranial nerves. The differential diagnosis was malignant tumor or aggressive infectious mass, which were excluded by histopathological examination. The diagnosis of inflammatory pseudotumor was a diagnosis of exclusion and decided based on a combination of clinical profile, blood test, radiological, and histopathological results.

Inflammatory Pseudotumor of the Spleen

Evaluation of effectiveness in the differential diagnosis of the very rare entity of inflammatory pseudotumor (IPT) of the spleen, with presentation of its pathology and pathogenicity. The case is presented of a 60-year-old female who underwent ultrasound (US) examination of the upper abdomen, after an accidental fall from a height, which revealed a splenic mass. Meticulous clinical and laboratory examination and imaging confirmed the presence of the splenic mass, which mimicked malignant lymphoma. Splenectomy was performed and the histopathology report revealed a tumor consisting of inflammatory cells intermingled with spindle and mast cells, consistent with the diagnosis of IPT. IPTs are very rare benign tumors which mimic other benign or malignant tumors. The clinical diagnosis is difficult, but they have a very good prognosis. Surgeons should be aware of the condition in order to avoid misdiagnosis and inappropriate treatment.

Two pseudotumor cases mimicking liver malignancy.

Inflammatory pseudotumor of the liver is a rare benign tumor that can be confused with malignant tumors of the liver. It is usually diagnosed after pathologic evaluation of the resected lesion. If a mass lesion in the liver is suspicious for malignancy on radiologic evaluation then surgical resection is planned for suitable patients rather than a biopsy. Inflammatory pseudotumors are similar to malignant tumors on macroscopic assessment, but microscopically they are characterized by the presence of inflammatory cells. In case of clinical or radiologic suspicion, the lesion is biopsied and once the diagnosis of inflammatory pseudotumor is made the lesion is managed by conservative-medical treatment. It must be kept in mind as part of differential diagnosis to avoid unnecessary surgery.

A Diagnosis of Inflammatory Pseudotumor of the Liver by Contrast Enhaced Ultrasound and Fine-Needle Biopsy: A Case Report.

Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion of unclear etiology, which may be misdiagnosed as hepatocellular carcinoma, cholangiocarcinoma, secondary tumor or abscess, because of its non-specific clinical, biochemical and radiologic findings. We present the case of a 48-old-year male in whom diagnosis of liver IPT was suspected by contrast enhanced ultrasound (CEUS) and confirmed by fine-needle liver biopsy. The diagnosis is in contrast to most of the literature reports in which the diagnosis was made only based on a surgical specimen.LEARNING POINTSThe inflammatory pseudotumor (IPT) of the liver is a rare benign disease that may be misdiagnosed as a malignant primary or secondary tumor.The diagnosis of IPT may be improved by the use of contrast enhanced ultrasound (CEUS) and the fine-needle liver biopsy without surgical intervention.The therapy of IPT may be monitored by ultrasonography (US) and CEUS.

Inflammatory pseudotumor in the submandibular region: A case report with immunohistochemical findings

Background: Inflammatory pseudotumor is a rare, benign non-neoplastic lesion. Clinically it behaves as an aggressive lesion, which can be mistaken for malignant tumor. Case presentation: This article presents a rare case of submandibular inflammatory pseudotumor in a 44-year-old man patient. The submandibular mass presented rapid enlargement in one month’s duration after initial examination. The patient was treated with surgery. Histologic examination of the resected specimen showed florid myofibroblastic and fibrohistiocytic proliferations in an inflammatory background. Immunohistochemically, the cells expressed vimentin, α-smooth muscle actin and CD68 indicating a diagnosis of inflammatory pseudotumor. The patient had an uneventful postoperative recovery and no evidence of recurrence. Conclusions: We report a case of inflammatory pseudotumor occurring at the site of submandibular region.

Aggressive Inflammatory Pseudotumor of the Maxillary Sinus and Orbit

Inflammatory pseudotumor (IPT) is a rare, locally aggressive, benign neoplasm of unknown etiology. It is uncommon in the head and neck region, particularly in the paranasal sinuses. We present an unusual case of IPT of the maxillary sinus and orbit in a 27-year-old woman who presented with cheek swelling, right orbital swelling, double vision, and associated fever and trismus. Computed tomography identified a mass with radiologic features suggestive of a malignancy of the maxillary sinus and orbit; the mass extended into the infratemporal fossa, parapharyngeal space, anterior antral wall, and surrounding soft tissue. A diagnosis of IPT was established on the basis of histologic and immunohistochemical analysis, which identified a proliferation of bland spindle cells and a mixed inflammatory cell infiltrate. Despite its aggressive appearance, IPT is associated with a good prognosis. Our patient was treated successfully with a combination of surgery, steroid therapy, and methotrexate. Chemotherapeutic agents are generally reserved for recalcitrant cases.

Persistent Spontaneous Pneumothorax for Four Years: A Case Report

Pneumothorax, defined as the presence of air in the pleural space, is usually classified as spontaneous or traumatic; it is unusual for pneumothorax to be categorized as being acute or chronic. Even if conservative treatment is chosen, the pneumothorax is cured when air in the pleural space dissolves into the venous blood. A 50-years-old Japanese man with no prior medical history was referred to our department with a right pneumothorax and two rightsided pulmonary nodules on chest X-ray and CT. The chest radiographs of past mass screening which was taken four years ago showed right pneumothorax and right-sided pulmonary nodules. From then, all chest radiograph and chest computed tomography showed right pneumothorax and pulmonary nodules. But he underwent no medical interventions. We designed to perform an operation for a treatment of right pneumothorax and the diagnosis of pulmonary tumors. We underwent right upper lobectomy and pleural decortication under video assisted thoracic surgery. We obtained pathological diagnosis of inflammatory pseudotumor and surrounding atelectasis. He was cured from pneumothorax and pulmonary tumors. A unique case of spontaneous pneumothorax presenting with a pleural air space that was confirmed by chest radiographs and computed tomography examinations over a 4-year period is reported.

22. Sclerosing variant of follicular lymphoma exhibiting a mesentric mass resembling inflammatory psuedotumour; a distinct entity

Some degree of sclerosis is common in follicular lymphoma, particularly in those involving the retroperitoneum and groin; however, the term ‘sclerosing variant of follicular lymphoma’ is applied when the sclerosis is prominent. We report an extremely rare case of follicular lymphoma with prominent sclerosis resembling inflammatory pseudotumour (IPT) of the lymph node from a 67-year-old man. Clinically he presented with the mesenteric lymphadenopathy. Histologic examination revealed a patchy and dense lymphoid infiltrate associated with complete disruption of the nodal architecture with extensive sclerosis by bands of collagen subdividing the infiltrate. The infiltrate consists predominantly of lymphocytes and includes a population of small lymphocytes, with irregular, convoluted nuclei, together with larger lymphoid cells with oval nuclei, more vesicular chromatin, small prominent nucleoli and rim of pale cytoplasm. In some areas, the lymphoid elements show a suggestion of a follicular arrangement. There was no evidence of residual lymph node and the process showed extracapsular extension into the adjacent fatty tissue. The lymphoid cells showed positive immunoreactivity for B-cell markers with co-expression of CD20, Cd79a, CD10 and Bcl2. Flow cytometry also confirmed the presence of a monoclonal population of B-cells consistent with a B-cell non-Hodgkin lymphoma. The overall features were interpreted as diffuse large B-cell lymphoma arising within a grade 1 follicular lymphoma with prominent sclerosis. There are only three cases of sclerosing variant of follicular lymphoma resembling IPT reported in the literature. This case emphasises the importance of considering the sclerosing variants of follicular lymphoma as a differential diagnosis of IPT of the lymph node.

Diagnostic Puzzle of Inflammatory Pseudotumor of the Urinary Bladder: A Case Report with Brief Literature Review

Inflammatory pseudotumor of the urinary bladder is a rare reactive proliferation with a clinical presentation similar to malignant neoplasms. We present the case of a 35-year-old woman who presented with left lower quadrant pain and gross hematuria. A diagnosis of cystitis glandularis was initially considered; however, the symptoms did not resolve following transurethral resection. Subsequently, a partial cystectomy was performed after malignancy was excluded based on intraoperative frozen sections. Further histopathological evaluation confirmed the diagnosis of inflammatory pseudotumor.

Intracranial inflammatory pseudotumor: case report and review of the literature

Inflammatory pseudotumor is an uncommon lesion of unknown etiology most frequently involving the lungs and orbits. Primary intracranial inflammatory pseudotumors are exceptionally rare. Herein, we report a case of inflammatory pseudotumor that arises from the central nervous system in a 25-year-old man. The patient presented with numbness in his right arm and right leg. Computed Tomography and Magnetic Resonance Imaging demonstrated a left fronto-parietal lobulated mass with intense contrast enhancement and perilesional edema mimicking a high grade glioma or metastasis. The lesion was removed by complete surgical resection. Pathologic examination showed spindle cell proliferation in a collagenous background with dense infiltrates of mononuclear inflammatory cells.The spindle cells were diffusely immunopositive for vimentin and focally positive smooth muscle actin but the cells did not show glial fibrillary acidic protein, epithelial membrane antigen, synaptophysin, S-100 protein, anaplastic lymphoma kinase-1 protein and CD1a immunoreactivity. Based on the morphologic and immunohistochemical findings, the diagnosis of inflammatory pseudotumor was made. After surgery, the symptoms had disappeared. No recurrence was observed at the eleven-month follow-up. Although rare, inflammatory pseudotumor of central nervous system is important in the differential diagnosis of the tumor-like intracranial lesions. We discuss the etiopathogenetic, diagnostic and therapeutic issues related to this entity, and review the literature.

Intracranial inflammatory pseudotumor: Report of a rare case

Inflammatory pseudotumors (IPs) arising in the CNS (IP-CNS) are quite rare. We report here a case of IP in a 5-year-old boy. Intraoperatively there was a well-defined extra-axial lesion in the right frontobasal region with CSF all around. There was no dural attachment. The tumor was removed piece-meal. On pathological examination, the lesion was well circumscribed and comprised of spindled cells in a collagenous background with sprinkling of inflammatory cells. The case was worked up considering the possibilities of low grade glioma, lymphoplasmacyte-rich meningioma, fungal/tubercular infection or inflammatory pseudotumors. Appropriate immunohistochemical stains were performed to rule out the rare possibility of lymphoma or plasmacytoma. The spindled cells were diffusely immunopositive for vimentin and only occasional cells were positive for smooth muscle actin (SMA). The cells did not show anaplastic lymphoma kinase-1 immunopositivity. Based on the above morphological and immunohistochemical analysis, a diagnosis of inflammatory pseudotumor was rendered.

Inflammatory Pseudotumor of the Liver: Analysis of Seven Resected Cases

Objectives: Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion which is commonly misdiagnosed as malignant tumor or liver abscess. Surgery is generally unnecessary because of its benign course. The purpose of this study is to determine non-surgical treatment options for IPT. Patients and Methods: Among 1262 patients who underwent liver resection for tumors from September 1989 to June 2004, seven patients had pathologically confirmed IPT of the liver. All the seven patients background characteristics, pathologic findings of the tumor, as well as early and late results were reviewed and analyzed. Results: The liver function tests were all within normal range with a normal serum α-fetoprotein (AFP) and carcinoembryonic antigen (CEA). Abdominal ultrasonography showed all tumors as hypoechoic lesions with unclear margin. Enhanced computed tomography (CT) scans showed a low-density area with marginal enhancement in six patients. One patient had liver cirrhosis. No complications occurred in any patient after surgery. All patients survived, with the longest survival time to date being 14 years. Conclusions: In patients with or without positive hepatitis seromarkers and normal tumor markers, if abdominal ultrasonography shows hypoechoic lesions with unclear margin and CT scan shows a low-density area with marginal enhancement, IPT of the liver could be suspected. If percutaneous liver needle biopsy confirms the diagnosis of IPT of the liver, surgery can be avoided.

Inflammatory Pseudotumor of the Liver Treated by Hepatic Resection: A Case Report

Inflammatory pseudotumor (IPT) of the liver is rare benign tumor. When the diagnosis of IPT is established with biopsy, simple observation or conservative therapy is preferred because of the possibility of regression. But IPT is unresponsive to the conservative treatment, surgical resection should be considered. We experienced a 63-year-old male, who was suspected hepatocellular carcinoma in abdominal computed tomography (CT) and magnetic resonance image (MRI) scan, presented with 2-month history of intermittent fever and weight loss. Percutaneous ultrasound guided core biopsy confirmed IPT of the liver. Non-steroidal anti-inflammatory drugs and antibiotics were administered for 8 and 4 weeks, respectively, but fever continued. So, extended right hepatectomy was performed for IPT of the liver and then fever subsided. The patient remains well during a follow-up period of 12 months.

Follicular dendritic reticulum cell tumor mimicking inflammatory pseudotumor of the spleen

In the course of a routine clinical check up of the 54 year old male a splenic well circumscribed tumor like mass of 12 cm in diameter was discovered. Splenectomy with removal of splenic hilar lymph nodes and liver wedge biopsy were performed. Four years later the patient is symptom free. In the removed spleen the tumor like lesion showed a pattern consistent with the diagnosis of inflammatory pseudotumor. However, besides lymphocytes, plasma cells, macrophages, eosinophils and myofibroblasts a high number of slightly polymorphic, frequently binucleated cells positive for CD21 and CD23 were seen. These cells which were scattered or formed smaller or larger groups and fascicles were considered to represent follicular dendritic reticulum cells (FDRCs) and the lesion a FDRC tumor. Flow cytometric DNA ploidy analysis showed a hyperdiploid cell population inside the tumor like lesion. Besides FDRC tumors of high and of intermediate malignancy the present case may represent a low grade type of moderate proliferation activity. The FDRCs of the lesion and a few smaller spindle cells were EBER positive indicative of the presence of EBV. No EBER positive cells were seen in the uninvolved spleen.

Diagnosis of inflammatory pseudotumor of the liver

Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown origin, it has the appearance of a malignant tumor but has a benign histology and clinical course. Therefore, we studied five patients with IPT of the liver to determine what examination can aid in its diagnosis. Five cases of inflammatory pseudotumor of the liver were analyzed. All patients were examined by echography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiography (ERC) and angiography to diagnose the liver tumor. In all patients echography and CT scan showed a similar appearance while MRI showed a variable pattern. In two patients ERC showed a stenotic image of intra-hepatic bile ducts. In the angiographic study, the arterial phase in three patients showed a hypervascular tumor and in one patient, a hypovascular tumor. Vascular abnormality was presented in one patient. Similarly, portography in four patients showed some abnormality. We performed ultrasonography-guided percutaneous needle biopsy in two patients in order to diagnose IPT. Histological examinations of two patients were consistent with IPT. The other three patients underwent surgical treatment for a cholangiocellular carcinoma or abscess. It is difficult to diagnose IPT of the liver exclusively with an image examination. Ultrasonography-guided percutaneous liver biopsy should be performed in order to diagnose IPT by histology.

Treatment of pseudotumors with nonsteroidal antiinflammatory drugs

Large inflammatory pseudotumors (IPT) traditionally are managed with extensive surgical resection. This approach, which often is associated with significant morbidity, has been deemed necessary because of the uncertainty of diagnosis, symptomatology, and involvement of vital structures. Also, there is a lack of other reliable therapy for this clinically aggressive yet histologically benign disease characterized by an overreactive inflammatory response. The authors treated 2 cases of abdominal IPT with nonsteroidal antiinflammatory drug (NSAID) with successful results. After a diagnosis of IPT on tumor biopsy, an NSAID trial can confirm the diagnosis and treat the disease by causing tumor shrinkage and eventual resolution. Excision remains indicated in easily resectable tumors and in nonresponders to NSAID therapy. J Pediatr Surg 35:1635-1637. Copyright © 2000 by W.B. Saunders Company.

Inflammatory pseudotumors of the lung

Background. Inflammatory pseudotumors of the lung are rare and often present a dilemma for the surgeon at time of operation. We reviewed our experience with patients who have this unusual pathology.Methods. Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at the Mayo Clinic. Twenty-three patients (0.04%) had resection of an inflammatory pseudotumor of the lung. There were 12 women and 11 men. Median age was 47 years (range, 5 to 77 years). Six patients (26%) were less than 18 years old. All pathologic specimens were re-reviewed, and the diagnosis of inflammatory pseudotumor was confirmed. Eighteen patients (78%) were symptomatic which included cough in 12, weight loss in 4, fever in 4, and fatigue in 4. Four patients had prior incomplete resections performed elsewhere and underwent re-resection because of growth of residual pseudotumor. Wedge excision was performed in 7 patients, lobectomy in 6, pneumonectomy in 6, chest wall resection in 2, segmentectomy in 1, and bilobectomy in 1. Complete resection was accomplished in 18 patients (78%). Median tumor size was 4.0 cm (range, 1 to 15 cm). There were no operative deaths. Follow-up was complete in all patients and ranged from 3 to 27 years (median, 9 years).Results. Overall 5-year survival was 91%. Nineteen patients are currently alive. Cause of death in the remaining 4 patients was unrelated to pseudotumor. The pseudotumor recurred in 3 of the 5 patients who had incomplete resection; 2 have had subsequent complete excision with no evidence of recurrence 8 and 9 years later.Conclusions. We conclude that inflammatory pseudotumors of the lung are rare. They often occur in children, can grow to a large size, and are often locally invasive, requiring significant pulmonary resection. Complete resection, when possible, is safe and leads to excellent survival. Pseudotumors, which recur, should be re-resected.

What has become of our idiopathic inflammatory pseudo-tumors of the orbit?

OBJECTIVE . We looked for the development of specific systemic disease or malignant lymphoma in patients whose initial diagnosis was idiopathic inflammatory pseudo-tumor of the orbit (IOPT). PATIENTS AND METHODS . IOPT was diagnosed in 24 patients on the basis of imaging findings and surgical biopsies (70%). Nineteen of these 24 patients (10 men and 9 women, age range 19- 83 years) were reassessed 1-12 years after the initial diagnosis. RESULTS . The initial diagnosis described diffuse inflammation (33%), dacryoadenitis (20%) or myositis (47%). At reassessment, 4 patients had developed a specific disease: generalized lymphoma, Wegener's disease, necrotizing vasculitis, and Crohn's disease. All four were recognized within one year of the IOPT diagnosis. A biopsy was obtained in these four patients and was not contributive. One case of non-specific granulomatous proliferation was found 6 years after the initial diagnosis. One case of orbital meningioma occurred 10 years after radiotherapy of the orbit and could not be attributed to a definite cause. The other patients had a common non-specific clinical course; recurrent inflammation required corticosteroid therapy in 55% and complementary external radiotherapy of the orbit in 22%. DISCUSSION AND CONCLUSION . Specific diseases that developed after an initial diagnosis of inflammatory pseudo-tumor of the orbit occurred early and appeared more often in diffuse forms, suggesting the need for more extensive histopathological diagnostic procedures. The clinical course tended to be more quiescent in patients who passed the critical period of the first year.