Inflammatory Pseudotumor (IPT) and Inflammatory Myofibroblastic Tumor (IMT): A Representative Literature Review Occasioned by a Rare IMT of the Transverse Colon in a 9-year-old Child
Abstract:The liver and biliary tract were the most commonly affected of all body regions, at 32%. This was followed by the lung, including the respiratory tract, at 27%, and by the gastrointestinal tract, at 10%. Lesions of the large bowel, as in the present case of a 9-year-old boy, are very rare. There were organ-related as well as nonspecific clinical symptoms, such as fever, weight loss, and fatigue. Laboratory test results revealed anemia and elevated inflammation-dependent parameters. The patterns in medical imag… Show more
“…However, IMTs can be found in any site of the body, including the abdominal cavity. 3 Despite the relative uncertainty about its pathogenesis and aetiology, in some cases, it is thought to be the result of an inflammatory reaction following infection, autoimmune response or surgery.…”
INTRODUCTION A colorectal inflammatory myofibroblastic tumour (IMT) is a rare but benign entity masquerading as a malignant tumour. Although the lung is considered the most common site of occurrence, IMTs may arise in diverse extrapulmonary locations. We describe a case of a colonic IMT in a patient who presented in the emergency setting. CASE HISTORY A 77-year-old man was admitted at our emergency department with acute abdominal pain. Physical examination revealed vague tenderness of the lower abdomen and non-palpable masses. Preoperative evaluation revealed a mass in the right lower quadrant of the abdomen, possibly originating from the terminal ileum, 1-2cm from the caecum. Owing to the clinical impression of a potentially malignant lesion, the patient underwent subtotal colectomy and omentectomy. The pathology report suggested the morphological and immunohistochemical features were more compatible with a colonic IMT. CONCLUSIONS A colorectal IMT is a rare clinical entity that can easily mimic a highly malignant tumour and cannot be distinguished clinically or radiologically. An accurate diagnosis is based on histological examination and surgical resection is therefore usually required.
“…However, IMTs can be found in any site of the body, including the abdominal cavity. 3 Despite the relative uncertainty about its pathogenesis and aetiology, in some cases, it is thought to be the result of an inflammatory reaction following infection, autoimmune response or surgery.…”
INTRODUCTION A colorectal inflammatory myofibroblastic tumour (IMT) is a rare but benign entity masquerading as a malignant tumour. Although the lung is considered the most common site of occurrence, IMTs may arise in diverse extrapulmonary locations. We describe a case of a colonic IMT in a patient who presented in the emergency setting. CASE HISTORY A 77-year-old man was admitted at our emergency department with acute abdominal pain. Physical examination revealed vague tenderness of the lower abdomen and non-palpable masses. Preoperative evaluation revealed a mass in the right lower quadrant of the abdomen, possibly originating from the terminal ileum, 1-2cm from the caecum. Owing to the clinical impression of a potentially malignant lesion, the patient underwent subtotal colectomy and omentectomy. The pathology report suggested the morphological and immunohistochemical features were more compatible with a colonic IMT. CONCLUSIONS A colorectal IMT is a rare clinical entity that can easily mimic a highly malignant tumour and cannot be distinguished clinically or radiologically. An accurate diagnosis is based on histological examination and surgical resection is therefore usually required.
“…Höhne et al ont bien insisté sur la différence de ces deux entités au travers d'une revue de la littérature regroupant 938 cas. Ils différenciaient explicitement : les TMI qui sont le fruit d'une prolifération tumorale de cellules myofibroblastiques et les PTI qui repré-sentent, plus qu'une formation tumorale, une réaction inflammatoire importante mimant le développement d'une tumeur [5]. L'analyse anatomopathologique montre généralement un infiltrat inflammatoire avec des cellules fusiformes et surtout l'absence de cellules malignes.…”
“…Most common site is lung, followed by mesentery and omentum but very rarely seen in esophagus. 2,3 Various nomenclatures are given for this rare entity including Plasma cell granuloma, Plasma cell pseudo tumour, Inflammatory myofibro histiocytic proliferation, Xanthomatous pseudotumour, Fibrous xanthoma, Omental / mesenteric myxoid hamartoma. 4 Exact etiology and nosology of the lesion is uncertain.…”
Inflammatory pseudo tumor (IPT) also known as inflammatory myofibroblastic tumor (IMT) is a tumor like mass of inflammatory origin. It is a pseudo sarcomatous lesion that has been reported most commonly in liver, followed by lung, mesentery and omentum but very rarely seen in esophagus. Proliferation of myofibroblastic cells is more in IMT. In IPT it is more of an inflammatory reactive or regenerative entity and has an overlapping with immunoglobulin G4-related disease. Lesion often mimics malignancy. A 20 year old male patient with history of dysphagia, more for liquids, underwent CT thorax, showing dilated oesophagus, with a moderately contrast enhancing eccentric soft tissue density lesion involving mid and lower esophagus extending for a length of 6cm. Patient underwent right thoracotomy, and a 5x3x3cm hard lesion involving lower esophagus was excised. Histopathology pointed towards inflammatory myofibroblastic tumor or inflammatory pseudotumor. Proliferation of myofibroblastic cells is more in IMT. In IPT it is more of an inflammatory reactive or regenerative entity and has an overlapping with immunoglobulin G4-related disease. Lesion often mimics malignancy.
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