Inflammatory pseudotumor: A diagnostic dilemma in cytopathology

Abstract

Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinicoradiological and pathological examination. A review of the cytopathology archives at The Johns Hopkins Hospital identified 12 cases from eight patients with histologically proven IPT (lung, seven patients; liver, five patients). There were six men and two women with an age range of 28-84 yr (mean age, 59 yr). Presenting complaints of IPT of the lung included shortness of breath and hemoptysis, and in cases of IPT of the liver complaints included abdominal pain and elevated liver function tests (LFTs). All cases were found to have mass lesions suspicious for a neoplasm on radiographic examination. Cytological specimens consisted of fine-needle aspiration (FNA; seven specimens) and bronchial brush/wash (five specimens). Diagnostic accuracy of cytology for IPT was low (5/12, 42%). IPT showed hypercellular smears (on FNA) with an admixture of various cell types including inflammatory cells with predominance of plasma cells, fibroblastic proliferation, granulation tissue formation, and atypical-appearing histiocytes with enlarged nuclei and intranuclear inclusions. Fibroblastic proliferation with mitoses may mimic mesenchymal neoplasms. Cytomorphology is nonspecific and IPT usually is a diagnosis of exclusion.

Spindle Cell Neuroendocrine Carcinoma of the Lung

“…All of the above can have a long clinical history. MFT has been described in its plasmacellular and fibrohistiocytic variants on FNAC samples, [7][8][9] while IT has never been described, to our knowledge, on FNAC samples. 10 MFT is a complex and not entirely understood group of lesions that may show indolent, locally aggressive or malignant behavior.…”

“…[2][3][4][5][6][7][8][9][10] Immunocytochemical staining was performed on destained Papanicolaou smears and on unstained ThinPrep™ preparations (Cytyc) of the aspirate by using a 3-step streptavidin-biotin method (Dako LSAB™, Glostrup, Denmark). The fusiform cells showed cytoplasmic positivity for chromogranin A and negativity for cytokeratin 19.…”

Clinical Cytology in the Diagnosis and Management of Melanoma

“…Often, we have observed them as artifactual change in the cervicovaginal smears (perhaps due to air drying artefact) and in degenerated cells on FNAC. Uncommonly, they have also been noticed in certain benign lesions such as pigmented villonodular synovitis and inflammatory psedotumors (Gangane et al, 2003;Hosler et al, 2004). The table1 highlights some of the common, as well as, rare conditions that manifest with INCIs along with the clinical and cytologic features that assist in their distinction from each other.…”

Pulmonary Inflammatory Myofibroblastic Tumor Resected by Video-Assisted Thoracoscopic Surgery: Report of a Case

“…Differentiating IMT from other tumorous or infl ammatory lung diseases is essential to determine the most appropriate treatment; however, making a preoperative diagnosis of IMT is diffi cult. 8 We report a case of pulmonary IMT.…”