Inflammatory Myofibroblastic Tumor: A Rapidly Growing Soft Tissue Mass in the Posterior Mandible

Abstract

The term inflammatory myofibroblastic tumor (IMT) encompasses a diverse group of spindle cell entities that traverses a clinical and histologic spectrum, extending from reactive to benign neoplastic to highly aggressive with malignant inclinations. Head and neck IMTs are rarely seen and comprise less than 5 % of tumors. Here we report a case of a 30 year old male who presented with a rapidly enlarging and extremely painful growth in the right posterior mandible, post extraction. Histopathological examination revealed a highly cellular connective tissue stroma comprised of spindle shaped cells arranged in fascicles, admixed with inflammatory cells, predominantly plasma cells. Apart from routine hematological investigations, serum protein electrophoresis was also performed. The final diagnosis was confirmed by a panel of immunomarkers consisting of MPO, CD34, CD20, CD3, CD23, CD138, SMA and ALK. To the best of our knowledge, this is the third case of oral IMT arising from an extraction socket.Keywords Inflammatory myofibroblastic tumour Á Inflammatory pseudotumor Á Gingiva Á Plasma cells Á Myofibroblasts Á Immunohistochemistry Case PresentationA 30-year old male presented with a painful, rapidly enlarging growth in the right posterior mandible of 1 month duration. The patient had undergone extraction of the right mandibular third molar about 4 months back, with persistence of postoperative pain in that region. The medical history was unremarkable. Clinical examination revealed a 7 9 5 cm reddish pink mass with an irregular surface in the right mandible. The mass extended from the extraction socket of the third molar to the canine and involved both buccal and lingual surfaces, almost covering the occlusal aspects of the teeth (Fig. 1a). The swelling was soft in consistency and elicited tenderness on palpation. Routine hematological investigations revealed mild leukocytosis (15,400 cells/mm 3 ) and an elevated erythrocyte sedimentation rate (107 mm). Fine needle aspiration cytology and histopathological examination following an incisional biopsy were inconclusive. The lesion continued to display rapid growth with involvement and progressive mobility of all the posterior teeth. Computed tomography of the mandible in the transverse plane revealed a hypodense area involving the premolar and molar region, associated with a breach in the continuity of the lingual cortical plate (Fig. 1b). 3-dimensional CT reconstruction confirmed this to be an osteolytic lesion giving the impression of an aggressive neoplasm, which necessitated repeating the incisional biopsy at two representative areas of the lesion.Parul Sah and Aditi Amit Byatnal have contributed equally to the manuscript.

Inflammatory myofibroblastic tumour of the mandible – A case report

“…Oral lesions develop over a short duration of time and often exhibit a disturbingly rapid growth rate. 10 In this case report, the patient was middle aged women and her oral lesion developed over a short duration of time and exhibit a rapid growth rate. The etiopathogenesis of inflammatory myofibroblastic tumours (IMT) remains unresolved.…”

“…These lesions were traditionally considered a benign reactive process, possibly as an exaggerated immune response to trauma, Epstein-Barr virus, human herpes virus-8, surgery or a foreign body. 10 The etiopathogenesis of inflammatory myofibroblastic tumour (IMT) was not investigated in the present case. Inflammatory myofibroblastic tumours (IMT) are tumours with unpredictable clinical behaviour, requiring complete surgical excision and continuous monitoring of clinical consequences.…”

“…12 The controversial treatment options of the neoplastic nature of inflammatory myofibroblastic tumours (IMT) is surgical excision, curettage, corticosteroid therapy, radical surgery and radiotherapy. 10 Although there are no prospective studies reported in the literature specify the treatment protocols for inflammatory myofibroblastic tumours (IMT) -the best prognosis have been documented following radical surgical resection with negative margins were associated with 87% reduction in mortality and considered it as the most important prognostic indicator for local recurrence. 2 Complete surgical excision was the only treatment modality employed in this case.…”

Inflammatory myofibroblastic tumour: A case report and a clinical update

“…9,10 IMTs can be treated by surgical excision, curettage, steroid therapy, radical surgery and radiotherapy. 11,4 Biopsies may have to be performed multiple times on account of its variable histological presentation and the final diagnosis is one that is based on exclusion and is further confirmed on immunohistochemical The IMT is a rare benign pathology of the head and neck region that tends to mimic a malignancy on account of its aggressive clinical and radiographic features. Immunohistochemical analysis also aids in the differential diagnosis.…”

ALK+ Inflammatory Myofibroblastic Tumor of the Tongue in a Neonate Treated With Crizotinib

“…To date, there are published cases of IMT involving the head and neck, including the oral cavity, but to our knowledge, there are no reported studies of inflammatory myofibroblastic tumor with anaplastic lymphoma kinase (ALK) positivity of the tongue in a neonate [2,4,[6][7][8][9][10][11][12][13][14][15][16].…”