Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.

Tumor miofibroblástico inflamatorio de vías biliares en un paciente pediátrico / Inflammatory miofibroblastic tumor of the biliary tract in a pediatric patient

RESUMEN El tumor miofibroblástico inflamatorio es una neoplasia mesenquimal infrecuente, realizar el diagnóstico clínico así como el patológico por biopsias es un desafío. Presentamos un caso de un paciente pediátrico con tumor miofibroblástico inflamatorio localizado a nivel de las vías biliares. Se realizaron estudios de laboratorio así como imagenológicos en los cuales se planteó un diagnóstico inexacto, del mismo modo cuando se envió la muestra de la lesión para el análisis intraoperatorio a través de técnicas de congelación, el reporte microscópico también fue incorrecto. Sin embargo cuando se realizó la revisión de las láminas tras la inclusión de la lesión y complementando con estudios de inmunohistoquimica, se concluyó que la lesión correspondió a un tumor miofibroblástico inflamatorio.

ABSTRACT The inflammatory myofibroblastic tumor is an infrequent mesenchymal neoplasm, making the clinical as well as the pathological diagnosis by biopsies is a challenge. We present a case of a pediatric patient with an inflammatory myofibroblastic tumor located at the level of the bile ducts. We sent the lesion sample for intraoperative analysis through freezing techniques, the microscopic report was also incorrect. However, when the plates were reviewed after the inclusion of the lesion and supplemented by immunohistochemical studies, it was concluded that the lesion corresponded to an inflammatory myofibroblastic tumor.

Inflammatory myofibroblastic tumor of the prostate after transurethral resection of the prostate with negative expression of anaplastic lymphoma kinase: a case report

ABSTRACT CONTEXT: Inflammatory myofibroblastic tumors are a rare type of soft-tissue tumor. Inflammatory myofibroblastic tumors are characterized by rearrangements involving the anaplastic lymphoma kinase gene locus on 2p23. Case Report: We report the case of a 67-year-old Chinese male who presented with dysuria and fever. Magnetic resonance imaging showed an irregular prostatic mass with an isointense signal and obscure boundary. Histopathological evaluation showed that the mass consisted mainly of spindle-shaped cells. Immunohistochemical evaluation showed that the tumor cells were negative for anaplastic lymphoma kinase. CONCLUSIONS: Inflammatory myofibroblastic prostate tumors are rare lesions with unclear etiology. The pathological diagnosis is very important.

Determination of the Initial Time of Peripheral Pulmonary Lesion by Real-time Contrast-enhanced Ultrasound / 中国医学影像学杂志

Purpose To evaluate the value of real-time contrast-enhanced ultrasound (CEUS) combined with comparative observation in determining the initial time of peripheral lung lesion,and to provide a new method for the diagnosis of peripheral lung disease by CEUS.Materials and Methods Sixty patients with peripheral lung disease diagnosed by chest X-ray or CT examination were examined by CEUS,and the lesions and perfusion of surrounding lung tissue were observed in real time and comparatively.The time of initial enhancement of peripheral lung lesion was determined by real-time comparative observation method,that is,to compare the time of contrast agent to reach the peripheral lung lesion with the time to reach the adjacent gas-containing lung tissue.All lesion specimens were obtained by surgery or ultrasound-guided percutaneous biopsy,and the pathological diagnosis was performed.According to the pathological results,the peripheral lung lesions were classified into the malignant group,the chronic inflammation group and the pneumonia group.Results Sixty cases of peripheral lung lesions were identified as 38 cases of malignant tumors (including 15 cases ofsquamous cell carcinomas,9 cases of adenocarcinoma cell carcinomas,2 cases of large cell carcinomas,9 cases of small cell carcinomas and 3 cases of metastatic carcinomas),14 cases of chronic inflammation lesions (including 7 cases of tuberculomas,3 cases of inflammatory pseudotumors and 4 cases of lung abscess) and 8 cases of pneumonia.The detection rates of pulmonary arterial phase and bronchial artery phase using the real-time comparative observation method were 100％ (60/60) and 85％ (51/60),respectively.The initial time of pulmonary arterial phase and bronchial artery phase were (6.1 ± 0.9) s and (10.5 ± 1.6) s,respectively.The initial time of pulmonary arterial phase was sooner than bronchial artery phase,the difference was statistical significance (P＜0.05).Conclusion The real-time CEUS combined with comparative observation method has important diagnostic value in judging the initial enhancement time of peripheral lung lesion and can provide a new method for the accurate diagnosis of peripheral lung disease,which is worth popularizing.

IgG4-Related Disease Presented as a Mural Mass in the Stomach

Isolated gastric IgG4-related disease (IgG4-RD) is a very rare tumefactive inflammatory condition, with only a few cases reported to date. A 48-year-old woman was incidentally found to have a subepithelial tumor in the stomach. Given a presumptive diagnosis of gastrointestinal stromal tumor or neuroendocrine tumor, she underwent wedge resection. The lesion was vaguely nodular and mainly involved the submucosa and proper muscle layer. Microscopically, all classical features of type I autoimmune pancreatitis including lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and numerous IgG4-positive plasma cells were seen. She had no evidence of IgG4-RD in other organs. Although very rare, IgG4-RD should be considered one of the differential diagnoses in the setting of gastric wall thickening or subepithelial mass-like lesion. Deep biopsy with awareness of this entity might avoid unnecessary surgical intervention.

Mid-term effects of total hip arthroplasty using metal-on-metal prosthesis with large diameter femoral head / 中华骨科杂志

Objective To evaluate mid?term clinical outcomes associated with total hip arthroplasty using metal?on?met?al prosthesis with large diameter femoral head. Methods From March 2007 to December 2009, 153 patients (177 hips) with ad?vanced hip diseases undergoing large diameter femoral head metal?on?metal total hip arthroplasty in our hospital were retrospec?tively analyzed in this study. Clinical physical examination and radiographic examination were used to evaluate hip function and the incidence of complications (implant loosening and inflammatory pseudotumor);ICP?MS method was used to determine serum cobalt ion and chromium ion levels and compare with normal values;revision was set as the prosthesis endpoint to evaluate the five year survival rate of implant. Results A total of 145 patients (169 hips) were followed up for average 72.4 months (67-80 months), the follow?up rate was 94.8% (145/153). For the involved patients, 85 were male (104 hips), 60 were female (65 hips);age 20-78 years old, average 49.3±12.6 years old. All patients received ASRTM?XL large femoral head metal?on?metal to?tal hip arthroplasty operation. At the end of follow?up, the average Harris hip score improved from 44.2±12.6 points preopera?tively to 91.5±5.7 points. A total of 8 patients received revision, 3 for acetabular implant spinout?out and 5 for hip inflammato?ry pseudotumor. The prosthetic survival rate 5 years after operation was 95.3% (161/169) for revision. Serum cobalt (2.89 μg/L) and chromium (3.31 μg/L) ion levels were significantly increased compared with normal value (<0.5 μg/L). Conclusion For the fixation and friction interface disadvantages, acetabular implant spinout?out and inflammatory pseudotumor might occur for patient receiving large femoral head metal?on?metal THA. The mid?term prosthetic survival rate was also low, with metal ion levels increased significantly. For primary THA, large femoral head metal?on?metal prosthesis cannot be the first choice.

Unusual Radiologic Finding of Intracranial Inflammatory Myofibroblastic Tumor Presenting a Cyst with Mural Nodule

An intracranial cyst tumor with a mural nodule can be representative of some types of brain tumors, but is a rare presentation of intracranial inflammatory myofibroblastic tumor (IMT). Herein, we report the case of an intracranial IMT in a 48-year-old woman presenting with the extremely unusual radiologic findings of a cyst with a mural nodule.

Comparative study of inflammatory pseudoneoplasm of the liver in rabbits with fatty liver and normal liver by contrast-enhanced ultrasonography / 中华超声影像学杂志

Objective To analyze hepatic inflammatory pseudoneoplasm with fatty liver and normal liver perfusion blood characteristics and quantitative parameters using real-time contrast-enhanced ultrasound (CEUS) and time intensity curve.Methods Twenty rabbits (including ten with fatty liver and ten with normal liver) with thirty-nine inflammatory pseudoneoplasm of the liver (IPL) were studied by low mechanical index CEUS with bolus injection of SonoVue via peripheral auricular vein and QontraXt quantitative analysis software.IPL contrast-enhanced ultrasound blood perfusion characteristics with two different liver background were analyzed.Results ①According to the different pathological elements,IPL showed four kinds of CEUS types:one lesion showed absent contrast enhancement pattern (type Ⅰ),nineteen lesions showed iso-enhancement pattern (type Ⅱ),six lesions showed hypo-enhancement pattern (type Ⅲ),thirteen lesions showed fast-in and fast-out pattern (type Ⅳ).②Compared with normal liver,arrival time of fatty liver was later and its peak intensity was lower.②Compared with peripheral parenchyma,arrival time of IPL was later,peak intensity was lower and its sharpness was sharper (P ＜0.05).④Between IPL lesions with two different liver background,there was no significant difference about parameters of the time-intensity curve (P ＞0.05).Conclusions Due to different pathological elements,IPL lesions have multiform perfusion patterns in CEUS.CEUS and time intensity curve could provide enough perfusion information for IPL and liver parenchyma more accurately.

Extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty / 中华骨科杂志

Objective To retrospectively analyze the diagnosis and treatment of the extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty (THA).Methods From March 2006 to June 2011,7 patients (7 hips) who presented with a progressive pain and/or swelling,discomfort in groin or upper thigh after metal-polyethylene THA were admitted to our hospital.There were 2 males and 5 females,with an average age of 48.8 years (range,32-65 years).All 7 patients were identified with a periprosthetic osteolysis at the acetabular and/or femoral components and a mass in the iliac fossa or the thigh; however,the components were all well-fixed.The masses were confirmed by CT scanning and/or ultrasound examination.The revision procedures were done through ilioinguinal approach and posterior-lateral approach,and the pseudotumors were excised and osteolytic lesions were debrided and packed tightly with morselized cancellous allograft.The liner and femoral head were also exchanged at the same time.Clinical and radiographic outcomes of revision THA were evaluated.Results All 7 patients were followed up for 3-42 months (average,30 months).At final follow-up,all hips were functioning well and the average Harris hip score was 92.4.All acetabular components remained radiographically well-fixed.All cavitary defects had complete radiographic incorporation of the bone grafts.There were no new pseudotumor or osteolytic lesions identified,and no revision of the components.Conclusion The presence of abdominal or pelvic pseudotumor in patient with a THA may be associated with polyethylene wear.Once the extra-articular pseudotumor and the periprosthetic osteolysis are identified,the surgical treatment,including pseudotumor excise,osteolytic lesion debride and bone defect grafting and bearing surface exchange,can achieve retention of well-fixed components.

Clinical and magnetic resonance imaging features in idiopathic orbital myositis:5 cases report / 中华神经科杂志

Objective To report the clinical and magnetic resonance imaging(MRI)features of 5 eases with idiopathic orbital myositis.Methods Four females and one male,aged 27 to 57 years,presented department of neurology in the First Hospital of Peking University in October 2008 to September 2009.The duration of disease Was between 3 months and 4 years.Recurrent course appeared in 3 of them.0rbital MRI Was performed in all of them.After diagnosis they underwent long.term corticosteroid treatment.Results All patients presented ocular pain,asymmetrical and incomplete ophthalmoplegia and mild proptosis.EMG revealed no significant decline in repetitive stimulation.Muscle biopsies of limb muscle were unremarkable.Creatine kinase and thyroid function test were in normal limits.MRI revealed unilateral.focal or difluse enlargement and enhancement of extraocular muscles,involving 1 extraocular muscle in 2 cases,2extraocular muscles in 2 cases,more extraocular muscles in 1 case.No evidence indicated bone destruction or cavernous sinus abnormalities.Five Cases showed improvement and remission after long-term administration of steroids.Conclusion Persistent and asymmetrical ophthalmoplegia is connnon in orbital myositis.Extraocular muscle swelling characterized the MRI changes.

Comparison of the clinical effect of VATS and thoracotomy pulmonary wedge resection of in treatment pulmonary inflammatory pseudotumor / 中国基层医药

Objective To compare the clinical effect of VATS and thoracotomy pulmonary wedge resection in treatment of pulmonary inflammatory pseudotumor. Methods 46 patients with pulmonary inflammatory pseudotumor were randomly divided into the observation group(24 cases) and the control group(22 cases) ,the control group were treated by thoracotomy pulmonary wedge resection and the observation group were treated by VATS wedge resection,the intraoperative blood loss,hospital stay, prognosis and complications were compared. Results All patients of two groups were cured and discharged. The intraoperative blood loss of observation group[(46. 0±12. 3 ) ml] was significantly less than the control group [(95.2 ± 18. 6) ml] ( t = 3. 19, P ＜ 0. 05 ), and the hospital stay was significantly shorter than the control group( t = 3.01,P ＜ 0. 05 ), the difference of the incidence of complications of two groups was not statistically significant( P ＞ 0. 05 ). Conclusion VATS wedge resection of pulmonary inflammatory pseudotumor had features of less bleeding and quicker healing characteristics,could be worthy of clinical application.

Inflammatory Myofibroblastic Tumor of the Kidney Misdiagnosed as Renal Cell Carcinoma

The inflammatory myofibroblastic tumor (IMT), also knowns as inflammatory pseuduotumor, is a soft tissue lesion of unknown etiology. In the urogenital tract, IMT mainly affects the urinary bladder or prostate, but rarely the kidney. It has been considered as a nonneoplastic reactive inflammatory lesion, but nowadays, it is regarded as a neoplasm due to its high recurrence rate and metastasis. We describe a case of a 61-yr-old woman that had originally been misdiagnosed as renal cell carcinoma, which was pathologically revealed to be an IMT.

Pulmonary hyalinizing granuloma / 北京大学学报(医学版)

Objective:To present clinical and pathologic features of pulmonary hyalnizing granuloma through analyzing three cases found in our institution and reviewing cases reported in the English language literature. Methods and Results: Three eases of pulmonary hyalnizing granuloma identified at our institu-tion during the past ten years were reviewed. In the first case, the patient presented with concurrent pulmonary hyalinizing granuloma and histoplasmosis. In the second case, the patient presented with a 5.5 cm lung mass and a separate smaller lesion radiologically resembling bronchogenic carcinoma. There was very prominent polyclonal lymphocytic proliferation at the periphery especially of the smaller lesion likely representing an early stage of the disease process. In the third case, the patient presented with multiple subpleural plaque-like lesions in addition to nodular lesions of the lung. All cases also demonstrated various degrees of lymphocytic infiltration within the lesions. The English literature has been reviewed through searching the PubMed. Conclusion: Since patients with pulmonary hyalinizing granuloma demonstrated a spectrum of clinical presentations, radiologic changes and histologic features with a variety of associated clinical disorders, pulmonary hyalnizing granuloma is more in keeping with a clinicopathologic entity rather than a specific pathologic disease.

Diagnosis and treatment of gingival plasma cell granuloma(report of 9 cases) / 中国医师进修杂志

Objective To study the clinical features and treatment of gingiva plasma cell granulo-ma.Method The clinical information of 9 cases with gingival plasma cell gmnuloma Was analyzed retre-spectively.Results The disease most frequently attacked the people between age 20-40 years(77.8%) and the main pathogenic position were at the gingival of bicuspid and molar teeth.Clinical maJlif.estation were gingival swelling and bleeding,dental loosening and dropping.Three patients were given focal resection. Subgingival curettage and Chinese traditional medicine.After loosening teeth found and peridental absortion shown in X-rays,6 patients were operated to extract loosening teeth and reseet their foci,in which 2 patients were given hormonotherapy and small-dose radiotherapy after operation.All cases were cured and no recurrence were found after follow-up survey from halfa year to 2 years.Conclusions The disease is rare and call result in the loss of periodontal tissue in a short time.In its premature time.the disease can be effectively cured by focal excision with subgingival curettage and Chinese traditional medicine.If Deriodontal tissue has been invaded,Surgical excision and extraction of teeth is the main way.

Granulomatose de Wegener: relatos de casos / Wegener's granulomatosis: cases reports

A granulomatose de Wegener é descrita como uma tríade de lesões: granuloma necrosante do trato respiratório, vasculite disseminada e glomerulonefrite. Pode ocorrer de maneira sistêmica ou localizada. O envolvimento ocular e orbitário é comum em ambas as formas da doença, estando presente em 50 por cento dos casos. O exame anatomopatológico e o c-ANCA+ foram fundamentais no diagnóstico efetivo da granulomatose de Wegener a despeito do envolvimento sistêmico nos casos apresentados.

Wegener granulomatosis (WG) is characterized by a classic triad of granulomatous inflammation of the respiratory tract, necrotizing vasculitis and nephritis. The absence of renal disease defines a subset of " limited WG" . Approximately 50 percent of WG patients develop ophthalmic disease. The histopatological study and +c-ANCA were essential to make a definite diagnosis in these cases.

Inflamação idiopática da órbita com extensão extra-orbital: relato de caso / Idiopathic orbital inflammation with extraorbital extension: case report

Relato de caso de uma paciente com inflamação idiopática da órbita com extensão extra-orbital. Foi realizada biópsia para confirmar o diagnóstico e a tomografia computadorizada demonstrou o comprometimento extra-orbital do processo inflamatório. O tratamento foi feito com metotrexato e radioterapia.

The authors report a case of a patient with idiopathic orbital inflammation with extension beyond the orbit. Biopsy was performed to confirm the diagnosis of idiopathic orbital inflammation and computed tomography demonstrated the extraorbital extension. Treatment with methotrexate and radiotherapy was used.

Inflammatory Pseudotumor of the Inguinal Lymph Node: A Case Report

Inflammatory pseudotumor of a lymph node is a rare cause of benign inguinal lymphadenopathy, and this mimics the malignant causes of inguinal lymphadenopathy. The imaging features of inflammatory pseudotumor affecting the inguinal lymph nodes have not previously been described. We report here on a case in which the lesion was depicted on the contrast-enhanced CT scan as a well-defined mass with strong enhancement. Inflammatory pseudotumor of a lymph node may be included as one of the rare causes of inguinal lymphadenopathy.

Plasma Cell Granuloma Associated with Pulmonary Actinomycosis: A Case Report

Plasma cell granuloma (PCG) of the lung is a rare disease that usually presents as a pulmonary nodule or mass on incidental radiographic examination without symptoms. Although the etiology of PCG is still controversial, many findings have lent support to the lesion being a reactive inflammatory process rather than a neoplastic one. We describe a 53-yr-old male who presented with a hemoptysis and have a lung mass at the left upper lobe on chest radiograph. The lung mass was primarily diagnosed as PCG by percutaneous needle aspiration and biopsy, and the patient was treated with oral steroid because he and relatives refused the operation. However, the size of the lung mass did not change and open thoracotomy and lobectomy were done therefore. He was confirmed as having pulmonary actinomycosis with PCG after surgery. To our knowledge, this is the first report of PCG associated with actinomycosis in Korea.

Inflammatory Pseudotumor of the Liver / 대한간학회지

No abstract available.

A Case of Symtomatic Inflammatory Myofibroblastic Tumor (IMT) of the Liver in Adult / 한국간담췌외과학회지

An inflammatory myofibroblastic tumor (IMT) is a rare benign hepatic neoplasm that is characterized by a mass of localized proliferations of fibroblasts and infiltrations of mononuclear inflammatory cells. An IMT can occur in a variety of locations, including the lung, orbit, parotid, pleura and stomach. However, they have rarely been encountered in the liver. An IMT of the liver most often presents in young adults. The clinical presentations of a hepatic IMT vary: asymtomatic, fever, abdominal pain, palpable mass, vomiting, obstructive jaundice, anemia and hepatosplenomegaly. Their radiographic appearance and clinical presentation make them extremely difficult to distinguish from a malignant neoplasm, preoperatively. Therefore, surgical management is used when a malignancy can not be excluded preoperatively or when the IMT produces a biliary obstruction. We encountered a 31-year-old male patient who is still alive for 38 months following a resection for symtomatic IMT.