Co-existence of acute appendicitis and inflammatory myofibroblastic tumor of the small intestine: A case report

Abstract

IntroductionInflammatory myofibroblastic tumor as a rare neoplastic lesion is seen most commonly in the pulmonary system. Beside the presence of limited number of inflammatory myofibroblastic tumors of the gastrointestinal tract in the literature, co-existence with acute appendicitis has not been reported before.Presentation of caseA 27-year-old woman admitted to emergency department with acute abdominal pain at the right lower quadrant. The initial diagnosis was as acute appendicitis. Intraoperatively, a mass with a diameter of almost 5 cm originated from the distal ileal segments neighboring the appendix was seen. The patient was managed by segmental resection of the small intestine including the mass with appendectomy. Histologically, there were bundles of spindle cells accompanied by lymphoplasmocytic infiltration. The immunohistochemical studies showed that tumor cells were positive for smooth muscle actin, vimentin, perinuclear activity for anaplastic lymphoma kinase and CD 68. The final pathologic diagnosis was inflammatory myofibroblastic tumor.DiscussionConcomitant resection of tumoral lesions detected in the neighbor intestinal segments during appendectomy should be considered to diagnose and treat.For the diagnosis of inflammatory myofibroblastic tumor, immunohistochemistry pattern including positivity for actin, vimentin, CD 68 and anaplastic lymphoma kinase plays a crucial role. Therefore, detailed immunohistochemistry analysis should be performed in suspicious cases.ConclusionCoexistence of inflammatory myofibroblastic tumor located in the gastrointestinal system with acute appendicitis is a rare event. Complete surgical excision should be regarded as the mainstay of the treatment. Long-term follow up with serial imaging techniques is recommended.

An Extremely Rare Coexistence: Acute Appendicitis and Multiple Intussusceptions in an Adult

“…Limited cases regarding the coexistence of intestinal malrotation with intussusception and inflammatory myofibroblastic tumor with acute appendicitis have been reported in previous studies [8,9]. This unique report adds precious clinical and imaging findings of acute appendicitis coexisting with multiple spontaneously resolving intussusceptions, to the literature.…”

Inflammatory myofibroblastic tumor presenting as ileocecal intussusception—A case report

“…IMFTs were first well described in the lungs and later became recognized in extrapulmonary locations [2] , [3] , [4] , [5] − 43% of extra-pulmonary involvement affects the mesentery and omentum [7] . Gastrointestinal (GI) involvement is rare however there are reports of involvement of any part of GI tract [2] , [6] , [7] , [8] , [9] . It occurs mostly in childhood and young adults but patients of any age and sex can be affected [2] .…”

ALK 1 Negative Inflammatory Myofibroblastic Tumor of the Ileum: A Rare Cause of Ileocecal Intussusception

“…5 The World Health Organization classifies IMT as tumors of intermediate biological potential since both local recurrence and metastases are possible. 1,2 Coffin et al 3 showed that IMT developed at a mean age of 9.7 years, and in 36 of 84 cases (43%), IMTs arose from the mesentery and omentum. Höhne et al 6 reviewed 443 publications from between 2009 to February 2014; their reports involved 938 patients and 956 organ sites.…”

“…The World Health Organization classifies IMTs as tumors of intermediate biological potential since both local recurrence and metastases are possible. 1,2 IMT affects children and young adults predominantly, but patients of any age and sex can be affected. 3 Gastrointestinal tract (GIT) IMT presents with clinical symptoms of anemia, loss of appetite or weight, fecal blood positive, abdominal pain, GIT obstruction, or intussusception.…”