Gastric Inflammatory Myofibroblastic Tumor Research Articles

Gastric inflammatory myofibroblastic tumor presented with severe anemia and inflammation: a case report

BackgroundInflammatory myofibroblastic tumor (IMT) is a rare stromal tumor, often found in children and young adults, and most commonly occurs in the lungs. Surgical resection is considered the standard treatment for localized IMT, although only limited data exist. Gastric IMT in adults is extremely rare, and there are no established guidelines for its treatment.Case presentationA 69-year-old male presented with persistent fatigue and weakness. Laboratory examination revealed severe anemia and inflammation. Upper gastrointestinal endoscopy at admission revealed a 40-mm type I softish tumor in the lesser curvature of the gastric body, without apparent hemorrhage. Repeated biopsies, including partial resection with snare, failed to give a definitive diagnosis. Computed tomography (CT) revealed a massive lesion at the gastric body, protruding into the gastric lumen, which was consistent with the gastric tumor. After admission, the patient developed anemia refractory to frequent blood transfusions despite the absence of apparent gastrointestinal bleeding. In addition, the patient had recurrent fevers of 38 °C or higher, and persistent high inflammatory levels. Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT 1 month after the first visit exhibited an increased FDG uptake in the gastric tumor. In addition, this CT scan revealed a rapid increase in tumor size to 75 mm. It was suspected that the undiagnosed gastric tumor caused these serious clinical symptoms, and he underwent distal gastrectomy and cholecystectomy. The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. The histopathological diagnosis was IMT. The postoperative course was uneventful, and the patient’s symptoms subsided drastically, improving both anemia and systemic inflammation. The patient has shown no recurrence or relapse of the symptoms over one and a half years.ConclusionsIn this case, the tumor resection finally enabled the diagnosis of IMT and resolved the clinical symptoms. Despite its predominantly benign morphological nature, some cases of IMT present clinically adverse courses. Surgical treatment may lead to its final diagnosis and improvement of clinical symptoms.

S3601 Gastric Inflammatory Myofibroblastic Tumor Presenting as Chronic Abdominal Pain in a Young Female

Introduction: Inflammatory Myofibroblastic Tumor (IMT) is a rare mesenchymal tumor, commonly seen in children and adolescents. Lung is the most common site. Here we present an extremely rare case of a gastric IMT in a 28 year old lady. Case Description/Methods: Pt presented with intermittent epigastric pain for 8 years. This was associated with bloating and regurgitation and weight loss.These symptoms worsened along with new symptoms of chest pain, Cardiology workup was unremarkable. CT abdomen with contrast ordered to investigate further revealed 3.9 cm x 3.6 cm intramural mass with smooth margin and areas of internal calcification, extending into the gastric lumen of the upper stomach at the left lateral fundal region. Pt was referred to a local gastroenterologist. EGD performed showed confirmation of the lesion. Pt was referred to surgical oncologist at tertiary care hospital. EGD performed with biopsy of the lesion showed Benign gastric mucosa with small separate fragment of gastric mucosa containing smooth muscle-like tissue consistent with a tangentially section muscularis mucosa vs benign smooth muscle mass. Given the inconclusive diagnosis, partial gastrectomy was performed after detailed discussion with the patient. Gross pathology showed a submucosal mass, corresponding to the serosa lesion, measuring 4.3 x 4.2 x 3.7 cm. Microscopic pathology showed spindle cells with variable Cellularity with prominent lymphoplasmacytic infiltrates along with dystrophic calcification and osseous metaplasia. There is regional expression of ALK-1,and regional subserosal expression of SMA and MSA. Lesional cells do not express CD117, DOG-1, and desmin. The immunoprofile supports interpretation of IMT. Patient was seen eight months post surgery with resolution of all the symptoms. (Figure) Discussion: Primary gastric IMT is extremely rare. There have been a handful of cases in literature. Gastric IMT is most commonly associated with abdominal pain and upper GI bleeding. Most common treatment is partial gastrectomy. There is some potential of IMT to turn into malignancy. IMT are associated with high local recurrence rates. There are no guidelines on surveillance though common consensus is to perform EGD 6 months to a year initially followed by increasing the interval later. As GI clinicians, we should be aware of these symptoms associated with IMT.Figure 1.: CT images and Histology.

Clinicopathological features of gastric inflammatory myofibroblastic tumor: Report of five cases.

The present study reported on the histomorphological observations and immunohistochemical features of five cases of gastric inflammatory myofibroblastic tumor (IMT). Loosely arranged fat fusiform myofibroblast-fibroblasts and diffusely or patchily distributed inflammatory cells, which formed a diverse morphological structure, were observed. In the mucous vascular structure, mucoid or collagenous areas, fibromatosis- or scar-like lesions were generally <10 mm in size and both had diffuse or patchy plasma cells, lymphocytes and other inflammatory-cell infiltration backgrounds. The immunophenotype was vimentin- and smooth muscle actin-positive with pan-cytokeratin, desmin and calponin expression and CD34-positive foci; furthermore, three cases were positive for anaplastic lymphoma kinase expression. Gastric IMT is rare, with unique histopathological changes and corrosion-like invasion of the smooth muscle of the stomach wall, blood vessels, nerves and adipose tissue. It should be differentiated from a variety of spindle cell tumor types and tumor-like lesions.

Gastric Inflammatory Myofibroblastic Tumor with Fludeoxyglucose (18F, FDG) Uptake on Positron Emission Tomography (PET): A Case Report and Literature Review

Inflammatory Myofibroblastic Tumor (IMT) is a very rare neoplasm usually seen in young people and children [1]. While the lung is the most common site..

Gastric Inflammatory Myofibroblastic Tumor in a 10-Year-Old Patient in Macao—Case Report and Literature Review

Inflammatory myofibroblastic tumor (IMT) is a special type of mesenchymal tumors. The tumors can occur all over the body. The most common organs involved were lung, followed by mesentery, omentum, retroperitoneum, and pelvic cavity. But it occurs very rarely in the stomach. This article mainly reports a 10-year-old patient who complained of progressive dysphagia for 4 years. Esophagogram suggests esophageal achalasia. Abdominal CT examination revealed a huge mass with calcification in the cardiac region of stomach with metastatic lymphadenopathy. PET-CT was also performed that consistent with malignant gastric tumor with metastatic lymphadenopathy. Gastroscopy also indicated that there was a huge mass in the cardia that compressed the esophagus, and biopsy was performed to reveal chronic gastritis. Pathological analysis was performed after surgical exploration and tissue samples were taken out and the final pathology was consistent with inflammatory myofibroblastic tumors. The patient was not able to undergo surgical treatment, so crizotinib chemotherapy was used. After treatment, the patient's tumors were significantly reduced, and the effect was obvious. The patient is now in stable condition and continues to follow up. This article hopes to review the literature of imaging diagnosis of inflammatory myofibroblastic tumors through this case report, so as to improve the understanding of this disease.

Gastric CLTC-ALK fusion-positive inflammatory myofibroblastic tumor showing an endoscopic superficial depressed-type appearance

We present a 76-year-old Japanese male who had a history of removal of a gastric gastrointestinal stromal tumor (GIST) 6 years ago. Although asymptomatic and having no evidence of recurrence, follow-up endoscopy revealed a small, white depressed lesion of approximately 1 cm with converging mucosal folds in the greater curvature of the fundus, which was suspicious of depressed-type early gastric cancer (GC) by conventional endoscopy. However, no evidence of GC except a “white globe appearance”-like area was identified by magnifying endoscopy with blue laser imaging. The biopsy specimens showed a proliferation of anaplastic lymphoma kinase (ALK)-positive spindle cells in the gastric mucosa, and ALK-rearrangement was detected by fluorescent in situ hybridization. Furthermore, clathrin heavy chain (CLTC)-ALK fusion was seen by genetic analysis, thus the lesion was preoperatively diagnosed as gastric inflammatory myofibroblastic tumor (IMT). For the curative intent, a laparoscopic endoscopic cooperative surgery (LECS) was performed. On the specimens resected by LECS, ALK-positive cells were sporadically distributed in the gastric mucosa and submucosa in the depressed area. In addition, two sporadic GISTs originating from the muscularis propria were found under the gastric IMT. Although there have been many reported cases of gastric IMTs, almost all those cases showed huge elevated tumors. Thus, this lesion is an extremely rare IMT case presenting a superficial depressed-type appearance, like 0-IIc type early GC.

Gastric inflammatory myofibroblastic tumor treated with combined laparoscopic and endoscopic gastric wedge resection: a case report

BackgroundInflammatory myofibroblastic tumor is an uncommon soft tissue neoplasm rarely reported in the stomach.Case presentationWe identified a tumor highly suggestive of poorly differentiated gastric adenocarcinoma in the lesser curvature of the stomach of a 53-year-old female during screening endoscopy. Although the patient’s gastric biopsy did not reveal cancer, the tumor configuration was strongly suspicious for malignancy, and we performed a gastric wedge resection using a combined laparoscopic and endoscopic method. The lesion was diagnosed as inflammatory myofibroblastic tumor based on its morphological and immunohistological features.ConclusionsInflammatory myofibroblastic tumor should be considered in the differential diagnosis of soft tissue tumors in the stomach. We present a case of inflammatory myofibroblastic tumor safely treated with combined laparoscopic and endoscopic gastric wedge resection.

Computed tomographic features of inflammatory myofibroblastic tumour of the stomach in adult patients: An analysis of five multicentre cases with literature review.

The aim of this study was to describe the clinical and computed tomography (CT) features of gastric inflammatory myofibroblastic tumour (IMT) in adult patients and provide a review of the literature. Five adult patients with surgically resected and pathologically confirmed gastric IMT were included in the study from four tertiary referral centres. Clinical history was assessed for determination of patient demographics and symptoms at presentation. All patients underwent contrast-enhanced abdominal CT, and two radiologists assessed the CT features by consensus. Also, abdominal CT findings from previous case reports of nine adult patients with gastric IMT were reviewed and summarised. Of five gastric IMTs, four (80%) appeared as a well-defined subepithelial mass and only one (20%) appeared as an irregular wall thickening. All of five gastric IMTs showed strong enhancement. When we analysed the CT features of nine cases from previously published literatures combined with our five cases, predominant imaging feature of gastric IMT was a well-defined subepithelial mass with strong enhancement. Perigastric infiltration or direct invasion of the neighbouring organs was rarely seen. Gastric IMT in adult patients appeared either as a well-defined subepithelial mass or irregular wall thickening, with mostly strong enhancement. Although rare, these imaging feature may be helpful for diagnosis of gastric IMT.

Gastric inflammatory myofibroblastic tumor identified as ectopic pancreas and treated by endoscopic submucosal dissection

Gastric inflammatory myofibroblastic tumor identified as ectopic pancreas and treated by endoscopic submucosal dissection

Fever,Weight Loss and Early Satiety due to Gastric Inflammatory Myofibroblastic Tumor; Case Report and Literature Review

Gastric inflammatory myofibroblastic tumor (IMT) is a rare tumor with and unpredictable prognosis usually find in young adults. We present an 18-yearold man with gastric IMT. He complained of epigastric pain, intermittent fever and night sweating associated with weight loss since two years ago. Physical examination showed anemic and cachestic features with mild abdominal tenderness in palpitation as well as an abdominal mass in epigastrium. Abdominal CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy revealed a submucosal lesion in fundus of stomach of approximately 8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous fundal mass with areas of calcification. The patient underwent laparoscopic partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed an IMT.

Primary Gastric Inflammatory Myofibroblastic Tumor in an Adult—Case Report With Brief Review

The term inflammatory myofibroblastic tumor more commonly referred to as "pseudostumor ", denotes a pseudosarcomatous inflammatory lesion that contains spindle cells, myofibroblasts, plasma cells, lymphocytes and histiocytes. It exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 45-year-old diabetic man with a gastric Inflammatory myofibroblastic tumor. The histopathological and immunohistochemical analysis was the key to reach diagnosis.

Synchronous gastric inflammatory myofibroblastic tumour with gastrointestinal stromal tumour of the stomach and hepatic syringious haemangioma.

Inflammatory myofibroblastic tumour of the stomach is a very rare lesion. A case of a gastric inflammatory myofibroblastic tumour associated with gastrointestinal stromal tumour of the stomach and hepatic syringious haemangioma is described. We report an 80-year-old male who had an exophytic mass in the area of the pylorus and the duodenum, where hepatic cysts were found in the magnetic resonance (MRI) scan on examination of hypochromic microcytic anaemia, and prolapsus and torsion of the bulb of the stomach found during gastroscopy. During surgical excision of the exophytic mass, a gastrointestinal stromal tumour from the gastric fundus and a syringious haemangioma from the superior hepatic surface were resected. All tumours were treated successfully by surgical excision. The patient had an uneventful recovery. Neither recurrence nor metastasis was found after a 12-month follow-up. To our knowledge, this is the first time that such an association is reported in the literature.

Rare Gastric Inflammatory Myofibroblastic Tumor in an Adult Woman: A Case Report with Review of the Literature

Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 37-year-old woman with a gastric IMT. She presented epigastric pain since 2 months, anemia and weight loss associated. Physical examination showed cutaneous pallor and mild abdominal tenderness in the epigastrium. Abdominal ultrasonography showed a tumor near the pancreas and the CT scan revealed that the lesion was arising from the stomach. Upper endoscopy showed a submucosal lesion of approximately 7.5 cm located in the posterior wall of the gastric body such as a gastrointestinal stromal tumor (GIST). The patient underwent a subtotal gastrectomy and Billroth I reconstruction. The histopathological and immunohistochemical analysis revealed an IMT that originated from the gastric wall.

Abdominal inflammatory myofibroblastic tumor: a clinicopathologic study with reappraisal of biologic behavior

Background and Purpose Inflammatory myofibroblastic tumor (IMT) is a proliferative lesion of controversial nosology and uncertain prognosis. In an attempt to acquire further understanding of pathogenesis and biologic behavior, we surveyed abdominal IMTs managed over the last 12 years at a single institution. Methods Intra-abdominal IMTs treated between 1995 and 2007 were reviewed concerning demographic, clinical, and pathologic features as well as therapeutic management and outcome. All specimens were reevaluated by histologic examination and immunohistochemistry. Results There were 7 patients (4 males; age range, 28 days to 14 years). Five lesions were located in alimentary tract: 1 gastric presenting with bleeding, 1 hepatic presenting with a thoracic wall mass, 1 pancreatic and 2 colonic presenting with obstructive symptoms. One splenic IMT was found incidentally. The remaining case arose from the adrenal gland and presented with a palpable mass. The gastric and adrenal IMTs had evidence of a previous or concomitant infectious setting. Five lesions were excised. The pancreatic IMT underwent a drainage procedure followed by steroid administration, and the hepatic lesion received antibiotics. Histopathology revealed characteristic findings of IMT. Expression of anaplastic lymphoma kinase was negative in all cases. At a median follow-up of 6 years (range, 3-15), all children were asymptomatic with no recurrences. The hepatic and pancreatic IMT displayed complete and near total regression, respectively. Conclusion A benign behavior of abdominal IMTs was observed even in patients not undergoing surgical excision. Although IMT remains a surgical disease, a conservative approach may be reasonable in select cases.

Gastric inflammatory myofibroblastic tumor masquerading as a pancreatic cystic neoplasm

Gastric inflammatory myofibroblastic tumor masquerading as a pancreatic cystic neoplasm

Primary gastric inflammatory myofibroblastic tumor: A clinicopathologic and immunohistochemical study of 5 cases

Primary gastric inflammatory myofibroblastic tumors are rare. Here we report on 5 such cases (4 males and 1 female, age range 36–45 years). Their presenting symptoms included abdominal mass (5 patients), abdominal pain (4 patients), and upper gastrointestinal hemorrhage (1 patient). Tumor size ranged from 4.5 to 8 cm in the greatest dimension. Histologically, these tumors showed three patterns: myxoid hypocellular, fascicular, and hyalinized. A lymphoplasmacytic infiltrate was present in all 5 tumors. One to two mitotic figures were recognized in 10 high power fields (HPFs) in 4 patients and focally up to 5 in 10 HPFs in 1 patient. No prominent nuclear atypia or necrosis was observed. ALK, smooth muscle actin, and vimentin staining were observed in all tumors. One tumor focally expressed desmin. S-100, CD21, CD34, CD35, CD68, and CD117 were negative in all IMTs. The patients were followed up for 2–5 years (mean 3.4 years), and none of them had tumor metastasis or died. Only one patient developed local recurrence and is now alive with no evidence of disease after the second surgery (11 months after the second surgery). Our results indicate that primary gastric IMTs have an intermediate behavior as seen at other sites.

Exophytic inflammatory myofibroblastic tumor of the stomach in an adult woman: A rare cause of hemoperitoneum

Inflammatory myofibroblastic tumor (IMT) of the stomach in adults is extremely rare, with unpredictable prognosis. We present a 55-year-old woman with a gastric IMT. She experienced sudden abdominal pain 4 d previously. Physical examination showed mild abdominal tenderness in the hypogastrium, but no palpable abnormal abdominal mass. Abdominal CT showed a mass of approximately 8 cm in the gastrocolic ligament. On laparoscopic exploration, unexpected hemoperitoneum of approximately 1.5 L of blood was found, and an exophytic gastric mass of approximately 10 cm, appeared from the anterior wall of the gastric body along the greater curvature. Laparoscopy further showed that non-clotting blood in the abdominal cavity seemed to be from the gastric tumor. After conversion to open surgery for more precise evaluation of the cause of hemoperitoneum and the large friable tumor, gastric wedge resection, including the tumor, was conducted. The final diagnosis was consistent with IMT that originated from the gastric wall.

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.

Gastric Inflammatory Myofibroblastic Tumor: Case Report

We report a case of gastric inflammatory myofibroblastic tumor in a 25-month-old boy. The condition is very rare and is of unknown pathogenesis. Because it is large and invades adjacent organs, imaging procedure do not provide easy differentiaion between an inflammatory myofibroblastic tumor and malignacy, and it should thus be inclued in the differential diagnosis of an infiltrative upper abdominal mass occurring in children.