Lower abdominal inflammatory myofibroblastic tumor -an unusual presentation- a case report and brief literature review

Abstract

A 9-year-old girl presented with lethargy, malaise & chest pain. Her blood counts confirmed hypochromic microcytic anemia. She was prescribed iron supplements. Subsequently she was admitted to our hospital with fever and increasing chest and abdominal pain. She was treated with antibiotics, and a diagnosis of "early chest infection" was made. Over the following 2 weeks she failed to improve, and her anemia worsened. She was readmitted, and found to have a mass in her lower abdomen with pressure symptoms on her bowel and bladder. A white-cell scan showed increased uptake in right lower quadrant. An ultrasound and a CT scan confirmed a mass adjacent to her bladder. Needle biopsy showed it to be an unusual localization of an inflammatory myofibroblastic tumor (IMT) of cecum. A presentation with chest pain, fever, anemia and pressure symptoms was highly unusual of a lower abdominal IMT mass. She had a successful excision of the tumor, with resolution of her symptoms.

Abdominal inflammatory myofibroblastic tumor

“…Additional features such as wide clinical presentation, variable course, scarce series reports, and absence of controlled studies have not allowed a definitive etiopathogenesis, an appropriate therapeutic approach, and an accurate prognosis to be established [2,[7][8][9].…”

“…Inflammatory myofibroblastic tumor is an entity with distinctive histopathologic characteristics but interchangeably designated with a vast array of terms (eg, inflammatory pseudotumor, plasma cell granuloma, inflammatory fibrosarcoma, fibrous histiocytoma, inflammatory fibroid polyp, inflammatory myofibrohistiocytic proliferation, inflammatory myofibroblastic proliferation, omental mesenteric myxoid hamartoma, xanthoma, fibroxanthoma, and xanthogranuloma) [8,9]. Additional features such as wide clinical presentation, variable course, scarce series reports, and absence of controlled studies have not allowed a definitive etiopathogenesis, an appropriate therapeutic approach, and an accurate prognosis to be established [2,[7][8][9].…”

“…It is a proliferative lesion composed of spindle cells accompanied by inflammatory infiltrate of obscure etiopathogenesis [1][2][3][4][5][6]. This issue along with confusing terminology, the wide clinical presentation, and highly variable outcome has precluded the establishment of an appropriate therapeutic approach and reliable prognosis [2,[7][8][9]. The present study encompassed abdominal lesions managed over the last 12 years at our institution in an effort to reappraise the biologic behavior of IMT.…”

Obstructing apple core lesion of the rectum: A case report of inflammatory pseudotumor masquerading as colorectal carcinoma

“…There appears to be a slight female predilection [1,7,10,12]. Most commonly, inflammatory pseudotumor originates in the lungs [1,3,8,[10][11][12]. Among the extrapulmonary lesions, 43% occur in the mesentery and omentum [1].…”

“…While it is most commonly seen in the lungs, it has been reported in almost every organ of the body with specific symptoms in each case relating to the site of origin [1][2][3][4][5][6][7][8][9]. Previously considered benign, inflammatory pseudotumor has been reclassified as an "intermediate neoplasm" by the World Health Organization [1,8].…”