Abdominal inflammatory masses mimicking neoplasia in children—experience of two centers

Abstract

Despite progress in modern imaging, some inflammatory masses are difficult to distinguish clinically from neoplastic processes. In such cases the pathology report has a great distinctive value, but even then the final diagnosis may be difficult to reach. Eight patients with abdominal tumors of inflammatory origin were treated in two institutions, the Department of Pediatric Surgery of the Medical University of Gdansk, Poland, and Helios Center of Pediatric Surgery in Berlin, Germany, during the last 10 years. Four tumors were located in the pelvis, two in the liver, and two in the colonic mesentery. Five of them were inflammatory pseudotumors (two subclassified as inflammatory fibrosarcoma), one had nonspecific inflammatory changes, one was diagnosed as idiopathic retroperitoneal fibrosis, and one was diagnosed as bacillary angiomatosis. All patients underwent surgical tumor biopsy, excisional in four and incisional in four. All but two children underwent macroscopically complete tumor excision (four primarily, two secondarily). In one case the tumor resolved with antibiotherapy. Surgery in retroperitoneal masses was often extensive and associated with significant complications because of invasive tumor growth. In conclusion, intraabdominal inflammatory lesions may closely mimic neoplasia in children. Clinical doubts result in repeated biopsies, and for this reason excisional biopsy should be preferred. In some cases, when excisional biopsy is not feasible due to invasive growth of the tumor, delayed complete mass excision should follow, despite occasional significant morbidity. The etiology and exact nature of inflammatory pseudotumors are still obscure, and it is unknown whether they represent inflammatory lesions or true neoplasia.

Abdominal inflammatory myofibroblastic tumor

“…Surgical excision has been the cornerstone of therapy because of the uncertainty in diagnosis, risk of disease progression, and lack of reliable alternative options [40]. Radiotherapy and chemotherapy have unclear roles as adjunctive modalities, but there are increasing reports of successful resolution with antibiotics, steroids, imatinib, or nonsteroidal anti-inflammatory drugs [41][42][43][44][45][46][47][48]. In our series, because tumor resection was considered mutilating and/or extensive, 2 patients (nos.…”

Solid Tumors of the Peritoneum, Omentum, and Mesentery in Children: Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives

“…Rarely, inflammatory myofibroblastic tumors have been reported to metastasize, indicating a neoplastic origin (13). predominantly fibrotic (23). Mitotic activity is typically low (7,21).…”

Anemia and B Symptoms as Leading Symptoms for a Hepatic Inflammatory Pseudotumor – 2 Case Reports

“…Its diagnosis and treatment are still controversial. Imaging is usually not reliable for detecting their character and surgical biopsy is needed for final diagnosis [3]. Peripheral hIPT can be treated with simple observation or conservative therapy.…”

“…Laboratory evidence of inflammatory response has been described in patients with IPT as well as hypochromic microcytic anemia, increased immunoglobulins, and elevated ESR [9]. The exact nature of IPT is most probably an exuberant inflammatory response to tissue injury [3]. The etiology is unclear, even though several associations were reported between IPT and infections (organizing pneumonia, Mycobacterium avium intracellulare, Corynebacterium equi, Campylobacter jejuni, Bacillus sphaericus, Coxiella burnetti, EBV, HHV etc.…”