Inflammatory pseudotumor

Rare pediatric cardiac tumor presentation

A case of cardiac inflammatory pseudotumor with a unique presentation is reported. This especially rare case belongs to a subset of pseudotumor caused by an infectious etiology. Furthermore, it is unique in that the patient experienced unexplained sinus tachycardia, which resolved with resection of the tumor. This report also emphasizes the importance of multiple imaging methods combined with the usefulness of surgery for treatment and diagnosis.

Imaging findings of head and neck inflammatory pseudotumor

OBJECTIVE

The purpose of this article is to describe imaging features of head and neck inflammatory pseudotumor in the brain, orbit, sinonasal cavity, temporal bone or skull base, and other rare locations.

CONCLUSION

Although the radiologic differentiation from malignancy is not clearly possible, we suggest that familiarity with the manifestations of inflammatory pseudotumor can help avoid unnecessary radical surgery before histopathologic proof of malignancy.

Inflammatory myofibroblastic tumor involving lung and brain in a 10-year-old boy: a case report

Inflammatory myofibroblastic tumors are rare tumors of unknown etiology, composed of proliferating myofibroblasts and accompanying lymphoplasmacytic infiltration. A 10-year-old boy who developed inflammatory myofibroblastic tumors in the lung as well as the brain is described. Surgery and radiation therapy were not feasible. The authors review the current literature and treatment options.

Surgical treatment of a rare case of tracheal inflammatory pseudotumor in pediatric age

Tracheal inflammatory pseudotumor (IPT) is a rare solid lesion with an unpredictable biological course. Treatment can vary and surgical resection may sometimes be necessary, even in pediatric age. We report the case of a 12-year-old male patient who presented to our institution with sudden dyspnoea after some months of wheezing and cough, wrongly considered and treated as asthma. Neck-chest CT-scan and fiberbronchoscopy showed an intraluminal tracheal mass, originating from the left antero-lateral wall at the level of the 5th cartilagineous tracheal ring, involving three rings, that was removed by rigid bronchoscopy. Histopathology revealed a tracheal IPT. Due to rapid tendency to recurrence of the lesion, two more endoscopic recanalizations were performed, but a new recurrence appeared, with CT evidence of transmural involvement of the tracheal wall. Resection of the three involved tracheal rings and termino-terminal tracheal anastomosis were successfully performed through cervicotomy and sternal split. CT-scan and fiberbronchoscopy at 17 months from surgery show a stable tracheal lumen without signs of recurrence. A tracheal IPT should be suspected in any pediatric patients with tracheal mass and asthmatic symptoms. After radical removal prognosis is generally excellent and recurrences after tracheal resection are rare.

Inflammatory pseudotumor of the trigeminal nerve: a neoplastic mimic you do not want to miss

Inflammatory pseudotumor is a rare non-neoplastic mass that may clinically and radiologically mimic a spectrum of benign and malignant neoplasms. It is uncommon in the head and neck and particularly rare at the skull base. We present a case of pseudotumor originating from the trigeminal nerve in a patient who presented with headache and facial numbness. A high index of suspicion is necessary to diagnose this benign but locally aggressive entity.

Imaging of the pediatric airway

Airway compromise can be fixed, dynamic (with varying degrees of collapse during the respiratory cycle), or exhibit both components. The location of the abnormality can be classified as extrinsic (located outside but exerting mass effect on the airway) or intrinsic (intramural and/or intraluminal). The etiologies of airway compromise are categorized as: congenital, infectious, inflammatory, traumatic, vascular, or neoplastic (1). The role of imaging of the airway is to determine the presence, nature and anatomic level of airway compromise, categorize it as intrinsic or extrinsic, provide a differential diagnosis, and guide further imaging or management (1). The differential diagnosis of a lesion takes into account the patient's age and gender, location of the lesion, clinical presentation, and imaging appearance.

Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation

Tumors and tumorlike lesions that secondarily involve the mesothelial or submesothelial layers of the peritoneum are a diverse group of disorders that range in biologic behavior from benign to highly malignant. The anatomy of peritoneal ligaments and mesenteries and the normal circulation of peritoneal fluid dictate location and distribution of these diseases within the peritoneal cavity. Peritoneal carcinomatosis is the most common secondary tumor to affect the peritoneal cavity. When it arises from carcinomas of the gastrointestinal tract or ovary, the prognosis is grave. However, when low-grade mucinous adenocarcinoma of the appendix spreads to the peritoneal cavity, the consequence is typically pseudomyxoma peritonei, which is a clinical syndrome, characterized by recurrent and recalcitrant voluminous mucinous ascites due to surface growth on the peritoneum without significant invasion of underlying tissues. Carcinomas from elsewhere in the body, as well as lymphomas and sarcomas, may also produce diffuse peritoneal metastasis. Granulomatous peritonitis is the consequence of disseminated infection such as tuberculosis or histoplasmosis, foreign materials, or rupture of a tumor or hollow viscus. Finally, a group of benign miscellaneous conditions that range from common disorders such as endometriosis and splenosis to very rare conditions such as gliomatosis peritonei and melanosis may also affect the peritoneum diffusely. Secondary tumors and tumorlike lesions of the peritoneum have overlapping imaging features when compared with each other and primary peritoneal tumors. Knowledge of peritoneal anatomy, normal fluid circulation within the peritoneal cavity, and clinical and pathologic features of secondary peritoneal lesions is essential for identification of these lesions.

Imaging features of meningeal inflammatory myofibroblastic tumor

BACKGROUND AND PURPOSE

Meningeal inflammatory myofibroblastic tumor (IMT) has been rarely reported, and its prognosis is still unclear. Our purpose was to describe the imaging features of patients with meningeal IMT and their results on follow-up studies.

MATERIALS AND METHODS

Twenty-four MR images in 10 consecutive patients with pathologically proved meningeal IMTs were retrospectively evaluated, focusing on the lesion distribution, signal intensity (SI), and contrast-enhancement pattern with a review of the clinical records.

RESULTS

Eight patients with intracranial IMT showed localized (n = 4) or diffuse (n = 4) dural thickening, a single mass (n = 5) or 2 (n = 2) dural-based masses with surrounding edema, dural venous sinus thrombosis (n = 5), and leptomeningeal involvement (n = 5). Extracranial involvement of the mastoid (n = 2) and orbit (n = 2) was also associated. Each of the 2 patients with intraspinal IMT showed a dural-based mass and a segmental dural thickening, respectively. All of the thickened dura showed low SI on T2-weighted images, iso-SI on T1-weighted images, and diffuse contrast enhancement. Variable recurrences with dural-based masses, mastoid involvement, or nasolacrimal duct involvement were observed in all 4 patients with diffuse intracranial IMT, but not in the others.

CONCLUSIONS

Localized or diffuse dural thickening of T2 low SI and diffuse contrast enhancement combined with dural-based masses are a common MR imaging finding of meningeal intracranial IMT. Adjacent leptomeningeal involvement and dural venous sinus thrombosis are frequently associated. The diffuse type has a tendency toward recurrence.

Inflammatory myofibroblastic tumor of the lung: recurrence after steroid treatment

We report a case of a patient with inflammatory myofibroblastic tumor of the lung, which recurred after steroid treatment. The diagnosis of the tumor was confirmed by a core needle lung biopsy and pathology. The patient was initiated on steroid therapy, which on complete response was slowly tapered and discontinued. Few months later, the patient presented with dyspnea again. Chest radiography and computed tomography scans depicted recurrence at the tumor resection site in the right lobe of lung and a new tumor in the left lower lobe. Restarting the steroid therapy, led to regression of the tumors at both sites. This is a rare case of inflammatory myofibroblastic tumor recurring poststeroid therapy and adds to the current clinical knowledge about this peculiar manifestation of this disease entity.

Indolent fever, weight loss and spleen infiltrate

This is a case of a young female who was admitted to our department with fever of one month in duration, without a specific pattern, anemia, lymphadenopathy and weight loss. The initial clinical and radiological evaluation and laboratory tests, although extensive, were unrevealing. The patient's general situation was temporarily improved and she was dismissed, but she revisited our hospital 2, 5 months later because of fever recurrence and a new pain at the upper left abdomen. This time the pathological findings were more prominent. The abdomen CT scan revealed a splenic mass. The evidence was suggestive of lymphoma, granulomatous or unusual infectious disease. However, it was not possible to establish a certain diagnosis, so we proceeded to open splenectomy and histological analysis that disclosed an inflammatory pseudotumor of the spleen. This procedure apart from diagnostic proved to be also therapeutic. The patient was cured and at six-month follow up she was in perfect health. Our case suggests that a high index of suspicion regarding this entity is needed, particularly if the disease course is variable and protracted.

Metachronous inflammatory myofibroblastic tumour in the temporal bone: case report

Objective:

We report an extremely rare case of metachronous inflammatory myofibroblastic tumour in the temporal bone.

Method:

Case report and review of the world literature on metachronous inflammatory myofibroblastic tumour.

Results:

Inflammatory myofibroblastic tumour in the temporal bone is rare, and metachronous inflammatory myofibroblastic tumour in the temporal bone has never been reported in the English medical literature. We report a case of inflammatory myofibroblastic tumour in the right temporal bone in a 27-year-old woman presenting with right-sided otalgia and progressive hearing loss. A metachronous lesion was discovered in the left temporal bone one year later. The patient underwent surgical excision of the tumour via canal wall down mastoidectomy for both lesions. Long term steroids were prescribed after both surgical procedures. At follow up three years after the last procedure, the patient remained free of disease.

Conclusion:

To the best of our knowledge, this is the first reported case of metachronous inflammatory myofibroblastic tumour in the temporal bone.

Time lag between the increase of IL-6 with fever and NF-kappaB activation in the peripheral blood in inflammatory myofibroblastic tumor

We describe a case of inflammatory myofibroblastic tumor (IMT) that occurred in the retroperitoneum. The patient manifested systemic symptoms, such as intermittent fever, anemia, thrombocytosis, and hypergammaglobulinemia. In order to elucidate the mechanism of intermittent fever in IMT, we analyzed nuclear factor-kappa B (NF-kappaB) activation in peripheral blood mononuclear cells (PBMCs) using flow cytometry, and serum cytokine levels. NF-kappaB activation was observed in the peripheral blood T cells and monocytes/macrophages. Among the measured cytokines, only interleukin (IL)-6 levels were elevated. IL-6 levels during pyrexia in the afternoon were higher than those during apyrexia in the morning. In contrast to IL-6, NF-kappaB activation in PBMCs was lower during pyrexia than during apyrexia; this is considered to be because the activation is subject to negative feedback. The time lag between the increase of IL-6 in the serum and NF-kappaB activation in the PBMCs at the onset of intermittent fever in IMT may provide further insight into the role of cytokines and NF-kappaB activation in febrile inflammatory diseases.

Cardiac valvular inflammatory pseudotumor

Inflammatory pseudotumors are quasineoplastic lesions that occur in the lungs as well as other extrapulmonary sites. The heart is an uncommon site of origin. We report a valvular pseudotumor that produced chronic mitral and aortic regurgitation in an elderly woman.

Bowel wall thickening in children: CT findings

A wide variety of bowel diseases, some of which are unique to or more prevalent in pediatric patients, may manifest with intestinal wall thickening at computed tomography (CT). Common causes of bowel wall thickening include edema, hemorrhage, infection, graft-versus-host disease, and inflammatory bowel disease; more unusual causes include immunodeficiencies, lymphoma, hemangioma, pseudotumor, and Langerhans cell histiocytosis. Radiologists must be familiar with the CT signs of bowel disease and should take careful note of the bowel characteristics (eg, extent and distribution of disease involvement, bowel dilatation, mural stratification, perienteric findings) to generate an adequate differential diagnosis. The study should be tailored and optimized in advance according to the clinical scenario to decrease radiation exposure due to repeated or delayed scanning. With spiral CT scanners, studies can be performed quickly, thereby eliminating the need for sedation, and multiple reconstructed images can be generated. CT is an invaluable diagnostic tool in the evaluation of pediatric diseases involving the bowel, in spite of the use of ionizing radiation.

Inflammatory pseudotumor of the kidney with renal artery penetration

Inflammatory pseudotumor (IPT) is a quasineoplastic lesion that most commonly involves the lung and the orbit; kidney involvement is rare. We report a case of inflammatory pseudotumor of the kidney. The patient was a 61-year-old man who presented with no symptoms. Nonenhanced computed tomography (CT) demonstrated an ill-defined, isodensity mass measuring 3.5 cm in the lower portion of the left kidney. Contrast-enhanced CT showed that branches of the renal artery without encasement penetrated the tumor; there was a little enhancement in the mass on the arterial phase and homogeneous enhancement on the venous phase. On magnetic resonance imaging the mass showed intermediate signal intensity on T1-weighted images (T1WIs) and low signal intensity on T2WIs. Most IPTs of the kidney appear as an ill-defined, hypovascular, homogeneous tumor on CT images, with variable signal intensity on MRI T1WIs and low signal intensity on T2WIs. Our case had the same imaging findings, with branches of the renal artery penetrating the tumor. If the renal tumor has these radiological findings, the tumor may be IPT.

Myofibroblastic inflammatory tumor of the lung: CT findings with pathologic correlation

The objective of this study was to describe the computed tomographic (CT) features of myofibroblastic inflammatory tumor of the lung with histopathologic correlation. The medical records and imaging studies of eight patients with pathologically proven myofibroblastic inflammatory tumor of the lung were reviewed. On radiographs and CT images, a poorly circumscribed mass or nodule was evident in five patients (six lesions), and a well-circumscribed lesion was evident in three patients (three lesions). Seven lesions were peripheral and two were centrally located. At CT, five lesions were of heterogeneous attenuation and four homogeneous. Increased perilesional parenchymal abnormalities, which were caused by peribronchial inflammatory infiltrates, were observed in three cases. The predominant histopathologic feature was organizing pneumonia type in three cases, lymphoplasmacytic type in three cases, and both organizing pneumonia and lymphoplasmacytic type in two cases. Variable degree of fibrous histiocytoma type was observed in all cases. The imaging characteristics of myofibroblastic inflammatory tumor of the lung are variable and nonspecific. The authors conclude that most cases appear as solitary, peripheral lesions with a predilection for the lower lobes. Associated findings may include perilesional inflammatory changes. Because myofibroblastic inflammatory tumor cannot be reliably differentiated from other pulmonary lesions based solely on the imaging appearance diagnostic biopsy is mandatory. Interpretation of the imaging findings combined with the histopathologic features of disease may help make correct diagnosis.

Vanishing liver tumours

Spontaneous resolution of liver tumours is a rare, but recognized entity that has been reported to occur within the spectrum of benign and malignant liver tumours occurring in both adult and paediatric population. The aetiology of this unusual phenomenon is not clearly understood. In this article we present case examples of various benign and malignant liver tumours that have regressed spontaneously without treatment together with a review of the literature, and a summary of the current understanding of the pathogenesis of these tumours.

The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa

CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

Gastrointestinal malignancies in HIV-infected or immunosuppressed patients: pathologic features and review of the literature

The gastrointestinal (GI) tract is a common internal organ to be involved by human immunodeficiency virus (HIV)-related malignancies. It is the second most common site for Kaposi sarcoma after skin, and the commonest visceral site, for Kaposi sarcoma in AIDS patients. GI lymphomas have been documented in approximately 25% of AIDS patients with systemic lymphomas. Moreover, GI involvement of AIDS-lymphoma has been associated with poor prognosis and short survival. Several other malignancies that occur in the GI tract are also closely related to HIV-infected or immunosuppressed individuals; these include posttransplant lymphoproliferative disorder, Epstein-Barr virus-associated smooth muscle tumors, anal precancerous lesions, and squamous cell carcinoma. As a result of active antiretroviral therapy, patients infected with HIV are living longer and are consequently at increased risk for development of cancer. Therefore, it is possible that the number of AIDS-associated malignancies will rise and the pattern of tumors may change in the future. In this paper, the clinicopathologic features of GI malignancies associated with AIDS patients are reviewed and the differential diagnosis with other mimic lesions is discussed.

Inflammatory pseudotumor of the middle ear masquerading as Bell's palsy

We describe the case of a 28-year-old woman who presented with an acute dense left facial paralysis. Magnetic resonance imaging demonstrated enhancement of the labyrinthine portion of the facial nerve, and Bell's palsy was the presumed initial diagnosis. After 2 months without recovery despite receiving steroid and antiviral therapy, the patient underwent further workup. Computed tomographic scan demonstrated a mass lesion adjacent to the tympanic portion of the facial nerve, and electromyography showed active denervation and prominent fibrillation potentials. Surgical excision of the tumor was performed with decompression and sparing of the facial nerve. Histologically, the tumor proved to be an inflammatory pseudotumor (IPT). At the 3-year follow-up, the patient had an improvement in her facial nerve function, progressing to a House-Brackman grade III. An IPT can masquerade as Bell's palsy with sudden complete facial paralysis. Failure to obtain even slight recovery in Bell's palsy should prompt further workup, including appropriate imaging, to assess for a mass lesion. Confusion of an IPT with a nerve-based tumor on frozen section and imaging could lead to inappropriate resection and cable grafting of the facial nerve. Therefore, the relationship between an IPT and facial nerve paralysis is vital and must be recognized for treatment and to maximize postoperative facial nerve function.

Inflammatory myofibroblastic tumor on intercostal nerve presenting as paraneoplastic pemphigus with fatal pulmonary involvement

Inflammatory myofibroblastic tumors (IMTs) are benign neoplasms that can occur at different anatomic sites with nonspecific clinical symptoms. A 48-yr-old woman presented with a 2-month history of a relapsed oral ulcer, progressive dyspnea, and a thoracic pain induced by breathing. A tumorous mass was noticed in the right costodiaphragmatic recess on chest computed tomography and magnetic resonance imaging, and the patient underwent a right costotransversectomy with excision of the tumor, which originated from the 12th intercostal nerve. Histology and immunohistochemistry showed that the tumor was an IMT of the intercostal nerve. The patient's postoperative course was not favorable; dyspnea persisted after surgery, and a progressive pulmonary compromise developed. The cause of the respiratory failure was found to be bronchiolitis obliterans, which in this case proved to be a fatal complication of paraneoplastic pemphigus associated with an IMT. This case of IMT of the spinal nerve in the paravertebral region is unique in terms of its location and presentation in combination with paraneoplastic pemphigus, which is rare. A brief review of the heterogeneous theories concerning the pathogenesis, clinicopathological features, and differential diagnosis of this disease entity is presented.

Treatment of inflammatory myofibroblastic tumor of the chest: the extent of resection

BACKGROUND

Owing to the rarity of inflammatory myofibroblastic tumor, its pathology and clinical course are poorly understood.

METHODS

We performed a retrospective chart review of patients diagnosed with inflammatory myofibroblastic tumor in the chest who underwent surgical resection.

RESULTS

From 1995 to 2006, 15 patients (10 males and 5 females) underwent surgical procedures owing to inflammatory myofibroblastic tumors. The mean age of these patients was 31.3 years (range, 7 months to 61 years). Among them, 13 patients (86.7%) presented with respiratory symptoms such as cough, dyspnea, and hemoptysis. Seven patients presented with the tumor located in the lung parenchyma, 4 in the trachea, 2 in the main bronchus, 1 in the segmental bronchus, and 1 in the chest wall. The diagnosis was confirmed before surgery for only 1 patient (6.3%). The types of operations performed included lobectomies for 4 patients, wedge resections using video-assisted thoracic surgery for 4 patients, tracheal/bronchial resections with end-to-end anastomoses for 6 patients, and chest wall resection for 1 patient. Only 2 patients received adjuvant radiation therapy. We followed up with all patients postoperatively for a mean of 33.3 months (range, 1.2 months to 8.4 years). Fourteen patients were free of local recurrence or distant metastasis during the follow-up period.

CONCLUSIONS

Inflammatory myofibroblastic tumor usually requires surgical resection for both proper diagnosis and adequate treatment. Complete resection and achieving negative margins leads to excellent outcome.

Imagerie des pseudo-tumeurs inflammatoires hépatiques

PURPOSE

To describe the imaging features of inflammatory pseudotumors of the liver.

INTRODUCTION

Inflammatory pseudotumors of the liver are rare benign lesions that may simulate malignancy on imaging studies. Diagnosis is most frequently confirmed after surgical resection of the lesion.

MATERIALS AND METHODS

Retrospective study from 1998 to 2006 of histologically proven cases of inflammatory pseudotumors of the liver. A combination of the following imaging modalities were utilized: US, contrast enhanced US, helical CT and MRI.

RESULTS

A total of seven lesions (mean diameter of 61.4 mm) were detected in 6 patients (mean age of 66 years). Clinical and laboratory results were non-specific. The following imaging studies were available: US in 5 cases, including one with contrast material, CT in 5 cases and MRI in 3 cases. All tumors were hypoechoic on US, with no enhancement after injection of Levovist. The tumors were generally hypodense on noncontrast CT and enhancement, when present, was delayed and moderate. On MRI, the tumors were iso- or slightly hyperintense on T2W images and iso- or slightly hypointense on T1W images with subtle peripheral enhancement on delayed imaging.

CONCLUSION

The differential diagnosis of inflammatory pseudotumor of the liver should be known to radiologists and could be suggested in a clinical context of chronic inflammatory process in patients with non-specific liver mass showing imaging features of partial fibrosis with delayed enhancement.

[Inflammatory pseudotumor of the spleen and radiopathologic correlation]

Inflammatory pseudotumors of the spleen (IPTS) are rare. We report a case of an IPTS in a 48-year-old woman who was admitted for drug eruption. During her hospitalization, she complained of abdominal pain. Physical examination and laboratory investigations were unremarkable. The abdominal ultrasonography and hepatic MRI detected a heterogeneous mass in the spleen measuring approximately 5 cm in diameter. Partial splenectomy was performed. Histologically, the splenic mass was composed of an admixture of inflammatory cellular elements with hemorrhage and sclerosis, suggestive of an IPTS. The postoperative course was uneventful. The authors attempt to make a radiopathologic correlation of this rare tumor.

From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation

Although the vast majority of bladder tumors are epithelial neoplasms, a variety of nonneoplastic disorders can cause either focal bladder masses or diffuse mural thickening and mimic malignancy. Some of these entities are rare and poorly understood such as inflammatory pseudotumor, which produces ulcerated, bleeding polypoid bladder masses. These masses may be large and have an extravesical component. Bladder endometriosis manifests as submucosal masses with characteristic magnetic resonance imaging features consisting of hemorrhagic foci and reactive fibrosis. Nephrogenic adenoma has no typical features, and pathologic evaluation is required for diagnosis. Although imaging features of malacoplakia are also nonspecific, characteristic Michaelis-Gutmann bodies are found at pathologic evaluation. The various types of cystitis (cystitis cystica, cystitis glandularis, and eosinophilic cystitis) require pathologic diagnosis. Bladder infection with tuberculosis and schistosomiasis produces nonspecific bladder wall thickening and ulceration in the acute phase and should be suspected in patients who are immunocompromised or from countries where these infections are common. The diagnosis of chemotherapy cystitis and radiation cystitis should be clinically evident, but imaging may be used to determine severity and to assess complications. Extrinsic inflammatory diseases such as Crohn disease and diverticulitis may be associated with fistulas to the bladder and focal bladder wall abnormality. The extravesical findings allow the diagnosis to be made easily. Finally, extrinsic masses arising from the prostate or distal ureter may cause filling defects, which can be confused with intrinsic bladder masses.

Multiple Cardiac Inflammatory Myofibroblastic Tumors in the Right Ventricle in an Infant

Reported is the successful treatment of a 2-month-old boy with multiple inflammatory myofibroblastic tumors in the right ventricle protruding into the right atrium through the tricuspid annulus. The patient underwent subtotal excision on cardiopulmonary bypass with no intraoperative or postoperative complications. Cardiac inflammatory myofibroblastic tumors are rare lesions, and surgical resections in patients as young as 2 months have not been previously described. In this report we review the relevant literature and discuss the prevalence, histology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and treatment of cardiac inflammatory myofibroblastic tumor.

Effects of transforming growth factor-beta in the development of inflammatory pseudotumour-like lesions in a murine model

Alterations in transforming growth factor (TGF)-beta signalling have been frequently implicated in human cancer, and an important mechanism underlying its pro-oncogenic nature is suppression of the host antitumour immune response. Considering the immunosuppressive effect of TGF-beta, we asked whether human tumour cells, known to secrete TGF-beta in culture, would survive and grow when implanted into the peritoneal cavity of immunocompetent mice. Therefore, we developed a xenogeneic model where mice were intraperitoneally (i.p.) injected with a TGF-beta-secreting human colorectal adenocarcinoma cell line, LISP-A10. Although animals did not develop macroscopic tumours, the recovery and isolation of human tumour cells was achieved when an inflammatory environment was locally induced by the administration of complete Freund's adjuvant (CFA). This procedure significantly increased TGF-beta concentrations in the peritoneal fluid and was accompanied by impaired activation of the host-specific immune response against LISP-A10 cells. Furthermore, inflammatory lesions resembling human inflammatory pseudotumours (IPTs) were observed on the surface of i.p. organs. These lesions could be induced by either injection of LISP-A10 cells, cells-conditioned medium or recombinant TGF-beta but only after administration of CFA. In addition, host cyclooxygenase-2 and kinin receptors played an important role in the induction of TGF-beta-mediated IPT-like lesions in our experimental model.

Xanthogranulomatous pseudotumor of stomach induced by perforated peptic ulcer mimicking a stromal tumor

Perforation is a serious complication of peptic ulcer disease occurring in 5% of such patients. Occasionally, the perforation may be sealed off by the omentum or the adjacent organs. Sealed perforated ulcer with pseudotumor formation is very rarely encountered. Here we present a case of gastric pseudotumor induced by perforation of a peptic ulcer. The imaging features in a barium sulfate study and computed tomography mimic an intramural tumor of the stomach.

Plasma cell granuloma of the maxillary sinus: a case report and literature review

BACKGROUND

Plasma cell granulomas are rare and heterogeneous tumor-like lesions of mixed inflammatory cell infiltrates of unknown etiology. Although they have the potential to occur in sites throughout the body, their occurrence in the paranasal sinuses and nasal cavity is uncommon and often associated with unique clinical characteristics and natural history.

METHODS

We present a case of an aggressive plasma cell granuloma of the maxillary sinus and a review of the literature (28 cases).

RESULTS

The patient was treated with definitive radiotherapy (45 Gy in 25 fractions) and experienced a local recurrence 2 years later. The lesion initially responded to corticosteroids and then progressed. Resection was performed and was followed by another recurrence. The patient was treated with radiosurgery and is disease free 8 years after initial treatment.

CONCLUSIONS

Review of the literature indicates that the optimal first line of treatment is high-dose corticosteroids. Surgery is indicated if the lesion fails to respond. Radiotherapy is indicated if complete resection is not feasible.

From the archives of the AFIP: benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation

Mesenteric fibromatosis, sclerosing mesenteritis, inflammatory pseudotumor, and extrapleural solitary fibrous tumor constitute a loosely associated group of benign fibrous tumors and tumorlike lesions of the mesentery. These lesions are linked histologically by the presence of fibroblasts or fibrosis and anatomically by their location within the mesentery. Although rare, and distinctly different in pathogenesis and biologic behavior, these fibrous lesions have pathologic and radiologic features that overlap with one another and with more common neoplastic and nonneoplastic lesions of the mesentery. Mesenteric fibromatosis is a locally aggressive, benign proliferative process that may occur sporadically or in association with familial adenomatous polyposis. It most frequently manifests as a focal mesenteric mass and may simulate lymphoma, metastatic disease, or a soft-tissue sarcoma. Sclerosing mesenteritis is a rare idiopathic disorder that most commonly produces a stellate mass within the mesentery and should be differentiated from metastatic disease, specifically metastatic carcinoid, because it frequently responds to conservative or medical management. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) is a benign, chronic inflammatory disorder of unknown cause that manifests as a solid mesenteric mass, indistinguishable from malignancy. Extrapleural solitary fibrous tumor is a tumor of submesothelial origin that is identical to the solitary fibrous tumor of the pleura. When located in the mesentery or peritoneal cavity, extrapleural solitary fibrous tumor has an imaging pattern that must be differentiated from metastatic disease, soft-tissue sarcomas, and other benign and malignant neoplasms of the mesentery and peritoneum. Knowledge of this group of benign fibrous tumors and tumorlike lesions of the mesentery is important in the preoperative evaluation of a mesenteric mass.

Spontaneous regression of hepatic inflammatory pseudotumor with primary biliary cirrhosis: case report and literature review

Hepatic inflammatory pseudotumor (IPT) is a rare benign non-neoplastic lesion characterized by proliferating fibrous tissue infiltrated by inflammatory cells. The exact etiology of IPT remains unclear. Although the association of IPT with systemic inflammatory disorders has been well established, a specific relationship with cholangitis is distinctly rare. We report a case of spontaneous regression of hepatic IPT with primary biliary cirrhosis (PBC). To date, only two cases of IPT with PBC have been reported. In our case, however, IPT developed during the course of improvement of cholangitis of PBC induced by effective treatment, differing from two previously reported cases. Our case indicates that the development of IPT does not also relate to the activity of cholangitis and/or hyper gamma-globulinemia, since our case was confirmed radiologically to be free of IPT when biliary enzymes and immunoglobulins were much higher than the corresponding values on admission. Comparison of our case with the two previously reported cases suggests that IPT occurring with PBC does not represent the same disease entity or be a bystander for PBC.

Pulmonary parenchymal involvement of low-grade lymphoproliferative disorders

Lymphoid tissue is a normal component of the lung. The various lymphoproliferative diseases affect the lung parenchyma. The purpose of this article is to classify various lymphoproliferative diseases and to understand their computed tomography features of pulmonary involvement. The examples include follicular bronchiolitis, lymphocytic interstitial pneumonia, plasma cell granuloma, Castleman disease, lymphomatoid granulomatosis, and mucosa-associated lymphoid tissue lymphoma. Pathologic correlation is helpful for understanding imaging findings and their pathophysiology.

Cardiac pseudosarcomatous fibromyxoid tumor: a review of the literature

A cardiac pseudosarcomatous fibromyxoid tumor (PFT) is described in a previously healthy 35-year-old man, together with a review of the literature. Pseudosarcomatous fibromyxoid tumor is within the spectrum of inflammatory (myofibroblastic) pseudotumors. It has previously been described predominantly within the genitourinary tract and respiratory tract. Inflammatory pseudotumor is rare as a cardiac tumor, and cardiac PFT is not previously reported. No recurrence or metastatic disease has been reported after resection of PFTs elsewhere in the body, and this tumor seems to have a benign clinical course.

Mesenteric inflammatory pseudotumor as a cause of abdominal pain in a teenager: presentation and literature review

Inflammatory pseudotumor (IP) is an unusual cause of chronic abdominal pain in children. The management of these lesions is complicated by controversies surrounding their appropriate classification and the numerous alternate names with which they are described. Successful treatment requires careful radiologic and pathologic evaluation to distinguish IPs from other lesions, along with complete surgical resection. We present the case of a 15-year-old boy with IP and review the literature in an attempt to simplify the description of these tumors.

Mesenteric inflammatory myofibroblastic tumor mimicking a necrotized malignant mass in an adult: case report with MR findings

Inflammatory myofibroblastic tumors are lesions that usually affect young adults and children. Numerous extrapulmonary sites of these tumors have been found, but the mesentery is a very unusual location for an inflammatory myofibroblastic tumor and it is extremely rare in an older patient. Inflammatory myofibroblastic tumor of the mesentery is often demonstrated as a large and infiltrative lesion with heterogeneous enhancement. Its diagnosis is recognized as difficult and it often mimics malignant tumor. We report a case of mesenteric inflammatory myofibroblastic tumor mimicking a necrotized malignant mass in a 55-year-old man who was examined with magnetic resonance imaging. To our knowledge, this is the first report of magnetic resonance imaging of mesenteric inflammatory myofibroblastic tumor with extensive central necrosis in an older patient.

Orbital Rhabdomyosarcoma and Simulating Lesions

The appropriate diagnosis and treatment of orbital rhabdomyosarcoma requires close cooperation and communication between the radiologist, the ophthalmologist, and the medical and radiation oncologists. The clinical presentation, imaging characteristics, and staging of orbital rhabdomyosarcoma are discussed. A discussion of several important simulating lesions and their distinguishing characteristics follows.

Renal and Lymph-Node Inflammatory Pseudotumor

Inflammatory pseudotumor (IP) is a benign uncommon tumour with uncertainly aetiology. Aetiology may be an inflammatory process due to small traumas, surgery, or malignancy. Some studies showed that patients affected by IP were also affected by wide vasculities and genetics abnormalities, strengthening the hypothesis of an aetiology of this disease from an autoimmune pathology or a true tumour respectively. The bladder localization is the most frequently localisation in the genital-urinary apparatus, while the kidney localization is very uncommon. The IP consist of inflammatory and myofibroblastic cells.

Material and Methods

A 69 years old affected with inhomogeneous mass in the right kidney of about 8 cm, calcify lymph-node of the mesentery of about 28 mm.

Results

The patient was undergone to right nephrectomy and removal of mesenteric lymph-node. Histological issue showed a renal cells carcinoma G2 associated to IP. Mesenteric lymph-node with ossification and associated to IP.

Conclusions

This case is interesting for the simultaneous finding of the IP placed to right kidney and mesenteric lymph-node. Similar wide IP have already described in other studies like true tumour with more biological aggressivity. The differential diagnosis of IP with other neoformations is still difficult. We consider an optimal indication to perform a radical surgery therapy in any case, because IP may be associated with a malignancy and because sometime IP may increases progressively its aggressiveness. The histological diagnosis achieved by bioptical sample may be risky because biopsy cannot exclude all doubt about the existence of a mixed neoformations with IP and malignancy like our case.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the neck infiltrating the trachea

Inflammatory myofibroblastic tumor (IMT), popularly known as inflammatory pseudotumor, is a slow growing quasi-neoplastic lesion with a distinct histologic appearance and benign clinical course. A case of a neck IMT with infiltration into the trachea causing asthmalike symptoms in a 12-year-old girl is described. Both tracheal and neck IMT have been described, but no other case has displayed this infiltration. A review of the pertinent literature and the etiology, diagnosis, treatment, and outcomes of this tumor are discussed. It is important to consider IMT in a differential diagnosis because it can be easily misdiagnosed as a malignancy. A surgeon must not perform radical surgery, radiation, or chemotherapy until a final pathologic diagnosis is made because of the nature of this lesion.