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Tumors of the cardiovascular system: heart and blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Uccheddu A, Faa G, Cois A, Ambu R. Inflammatory pseudotumor of the Liver. A Report of Two Cases with Unusual Histologic Picture. TUMORI JOURNAL 2018; 81:151-6. [PMID: 7778221 DOI: 10.1177/030089169508100217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two cases of inflammatory pseudotumor (IPT) of the liver are reported. Clinical presentation was vague and aspecific. Laboratory tests and data from imaging techniques provided no specific information on the actual nature of the lesions and were misleading, suggesting a malignant lesion in one patient and a complicated hydatid cyst in the other. On gross examination, the tumors appeared yellowish ore grey-yellow in color, with a firm cut surface and well circumscribed from the surrounding parenchyma, although a true capsule was not evident. Variability in the histological pattern was also observed, even though the major finding was in both cases an admixture of lymphocytes, plasmacells, granulocytes and monocytes. Lymphocytes were immunohistochemically heterogeneous; monocytes showed in one case large hyperchromic atypical nuclei, confirming the previously, reported possibility that some cases of IPT may be mistaken for sarcomas. Further evidence is added in support of the hypothesis that some liver IPT may result from the evolution of cholangitic abscesses.
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Affiliation(s)
- A Uccheddu
- Istituto di Chirurgia, University of Cagliari, Italy
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Abstract
Primary heart tumors are extremely rare, constituting approximately 0.02% of all malignancies. Inflammatory myofibroblastic tumor (IMT) constitutes <5% of primary heart tumors. Until now, IMT of the heart has been described in 21 infants below 1 year of age. Its etiology remains unknown. IMT usually develops within the right atrial and ventricular endocardium. The main clinical symptoms reported in the affected infants involved increasing respiratory failure, cyanosis, and heart murmurs. Histopathologically, IMT is characterized by the myofibroblast proliferation with inflammatory infiltrates composed of plasmocytes, lymphocytes, and histiocytes. Tumor resection is the treatment of choice in IMT. Such tumor location is associated with the high risk of perioperative failure. Steroid therapy and chemotherapy is reported in the literature as a nonsurgical treatment alternative. Here, we present a review of clinical symptoms, diagnostic and treatment options, based on published case reports of IMT in infants, including our 11-month-old patient with IMT located within the pericardium.
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Eilers AL, Nazarullah AN, Shipper ES, Jagirdar JS, Calhoon JH, Husain SA. Cardiac Inflammatory Myofibroblastic Tumor. World J Pediatr Congenit Heart Surg 2014; 5:556-64. [DOI: 10.1177/2150135114546203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although inflammatory myofibroblastic tumors (IMTs) can be found in virtually every major organ, cardiac origin is rare. After recently providing care to a child who presented with a significant myocardial infarction, interest in this rare tumor was piqued. We describe a comprehensive review of cardiac IMT, including information on nomenclature, epidemiology, clinical features, pathogenesis, gross/histological features, immunohistochemical profile, diagnosis, treatment, and prognosis. Fifty-seven cases were identified in the literature. Interestingly, our case represents the seventh case of coronary artery involvement reported. Moreover, it was found that an initial presentation of sudden death most commonly involves the coronary arteries.
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Affiliation(s)
- Amanda L. Eilers
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alia N. Nazarullah
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Edward S. Shipper
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jaishree S. Jagirdar
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John H. Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - S. Adil Husain
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Xu B, Fraser RS, Renaud C, Youssef S, Gottesman RD, Bernard C. Inflammatory myofibroblastic tumor of the aortic valves causing sudden cardiac death: a case report and review of the literature. Pediatr Dev Pathol 2014; 17:231-9. [PMID: 24649800 DOI: 10.2350/13-12-1414-cr.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity affecting predominantly infants, children, and young adults. Although most tumors have a benign clinical course after complete surgical resection, some have significant clinical effects. We report the case of a 9-year-old girl who had sudden cardiac death as a result of occlusion of the left circumflex coronary artery. A review of 57 cases of cardiac IMTs reported in the literature in terms of epidemiology, clinical presentation, histologic and immunohistologic features, and outcome is presented. Recognition of this rare abnormality is important in order to initiate prompt surgical intervention.
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Affiliation(s)
- Bin Xu
- 1 Department of Pathology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC H3H 1P3, Canada
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Value of immunohistochemistry in diagnosing a rare case of maxillofacial plasma cell granuloma masquerading as a gingival epulis. J Maxillofac Oral Surg 2013; 14:40-5. [PMID: 25729225 DOI: 10.1007/s12663-013-0587-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Plasma cell granuloma is a non-neoplastic lesion rather uncommonly seen in the maxillofacial region. Its etiology, biological behavior, ideal treatment and prognosis are still unclear and rather controversial. STUDY A detailed histopathological examination and immunohistochemical study of the excised specimen was carried out, both for making a confirmatory diagnosis as well as to determine the etiopathology, biological behavior and prognosis of the lesion. RESULTS Light microscopy revealed a hyperplastic stratified squamous epithelial lining, overlying a densely fibrocellular granulation tissue containing a rich proliferation of mononuclear inflammatory cells, among which there was a predominance of plasma cells with their typical eccentric, cartwheel shaped, "clock-faced" nuclei. Strong immunohistochemical positivity was observed for CD-138 by numerous cells of the connective tissue of the lesion, thus confirming them to indeed be plasma cells. Further, immunohistochemistry (IH) analysis also demonstrated the expression of both, the lambda and kappa light chain immunoglobulins by the plasma cell population, thus confirming them to be polyclonal and of an inflammatory, non-neoplastic origin. SUMMARY AND CONCLUSION As a plasma cell granuloma is rarely encountered in the oral and maxillofacial region, its diagnosis could have been very easily missed, had it not been for the detection of the large numbers of plasma cells by light microscopy, which was further confirmed by IH. IH also helped in establishing the likely etiopathology of the lesion and confirmed it to be of a non-neoplastic reactive/inflammatory origin.
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Rao N, Gajjar T, Ghosal N, Desai N. Inflammatory Pseudotumor Arising from the Right Ventricular Outflow Tract Causing Pulmonary Stenosis. J Card Surg 2012; 27:696-8. [DOI: 10.1111/j.1540-8191.2012.01460.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Manohar B, Bhuvaneshwari S. Plasma cell granuloma of gingiva. J Indian Soc Periodontol 2011; 15:64-6. [PMID: 21772725 PMCID: PMC3134051 DOI: 10.4103/0972-124x.82275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 12/12/2010] [Indexed: 11/25/2022] Open
Abstract
Plasma cell granuloma is a rare benign lesion characterized by the infiltration of plasma cells; primarily occurring in the lungs. It is also seen to occur in the brain, kidney stomach, heart, and so on. In the intraoral region it is seen to involve the tongue, oral mucosa, and gingiva. This case presents a 42-year-old female, with an enlargement in the maxillary anterior region, treated by excisional biopsy. Histological evaluation revealed plasma cell infiltrates in the connective tissue. The immunohistochemistry revealed kappa and lambda light chains with a polyclonal staining pattern, which confirmed the diagnosis of plasma cell granuloma.
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Affiliation(s)
- Balaji Manohar
- Department of Periodontics, Pacific Dental College and Hospital, Debari, Udaipur, Rajasthan, India
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Obikane H, Ariizumi K, Yutani C, Mitsumata M. Inflammatory pseudotumor (inflammatory myofibroblastic tumor) of the mitral valve of the heart. Pathol Int 2010; 60:533-7. [DOI: 10.1111/j.1440-1827.2010.02556.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Burke A, Li L, Kling E, Kutys R, Virmani R, Miettinen M. Cardiac Inflammatory Myofibroblastic Tumor: A “Benign” Neoplasm That May Result in Syncope, Myocardial Infarction, and Sudden Death. Am J Surg Pathol 2007; 31:1115-22. [PMID: 17592279 DOI: 10.1097/pas.0b013e31802d68ff] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac tumors other than myxomas are rare. We report a series of 10 intracavitary polypoid myofibroblastic proliferations in children and young adults emphasizing gross, histologic, and clinical features. There were 6 females and 4 males, with a mean age of 10 years (range 5 wk to 21 y). All lesions were endocardial-based, located in the right atrium (1), right ventricular inflow/tricuspid valve (1), right ventricular outflow (3), mitral valve (3), aortic valve/left coronary sinus (1), and left ventricular free wall (1). Symptoms included shortness of breath or dyspnea (3), syncope (2), chest pain (1), transient ischemic attacks (1), and fever with myalgias (1). All tumors were surgical resections, except 1 tumor that resulted in sudden coronary death and that was diagnosed at autopsy, and 1 tumor that embolized into the coronary artery and was treated by cardiac transplant. Two tumors, present in the aortic and mitral valves, respectively, caused cardiac ischemia. The tumors were polypoid or filiform and histologically resembled inflammatory myofibroblastic tumors of extracardiac sites, with loose spindle cell growth with sparse inflammation. Although there were frequent collagen bundles interspersed among the tumor cells, there were no large areas of dense fibrosis. Surface fibrin was present on the polypoid projections in 7 cases. Symptoms resulted from prolapse into coronary ostia or embolization, but no patient developed metastasis. Long-term follow-up in 2 patients demonstrated no evidence of disease or recurrence. Although metastatic potential was not identified, these tumors may result in serious symptoms, including myocardial infarct, syncope, and sudden death. These cardiac myofibroblastic tumors are readily distinguished from other endocardial-based cardiac tumors, including papillary fibroelastoma and myxoma, which may present clinically in the same manner.
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Affiliation(s)
- Allen Burke
- CVPath Institute Inc, Gaithersburg, MD 20878, USA.
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Tian JT, Cheng LC, Yung TC. Multiple Cardiac Inflammatory Myofibroblastic Tumors in the Right Ventricle in an Infant. Ann Thorac Surg 2006; 82:1531-5. [PMID: 16996978 DOI: 10.1016/j.athoracsur.2006.02.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 01/28/2006] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Jin-Tao Tian
- Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing, China
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Ferbend P, Abramson LP, Backer CL, Mavroudis C, Webb CL, Doll JA, Junewick JJ, Crawford SE. Cardiac plasma cell granulomas: response to oral steroid treatment. Pediatr Cardiol 2004; 25:406-10. [PMID: 15054564 DOI: 10.1007/s00246-003-0269-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Plasma cell granulomas are lesions of uncertain histogenesis arising in a variety of locations, most commonly the lung. Treatment for these lesions is complete surgical excision if possible. Unresectable pulmonary lesions respond to oral corticosteroids and radiation therapy. We report the long-term outcome of two unusual pediatric cases of cardiac plasma cell granulomas originating within the right ventricle and posterior aspect of the left ventricle. The limited literature reports advocate surgical resection for this entity, with no discussion of alternative treatment strategies for unresectable lesions. We prospectively evaluated the response to postoperative oral steroid therapy, as complete surgical excision was not possible in either case. Sequential echocardiography demonstrated additional significant reduction in the size of the masses and the patients remain asymptomatic at 9 and 5.5 years follow-up, without evidence of obstruction or recurrence. Oral corticosteroids should be considered as a treatment option for any unresectable plasma cell granuloma.
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Affiliation(s)
- P Ferbend
- Dept of Pathology, Roger Williams Medical Center, Providence, RI 02908, USA
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Abstract
Inflammatory pseudotumor is a quasineoplastic lesion that most commonly involves the lung and the orbit, but it has been reported to occur in nearly every site in the body. The pathogenesis, natural history, clinical presentation, imaging findings, and treatment options for inflammatory pseudotumor in the lung, heart, gastrointestinal tract, adrenal gland, iliopsoas muscle, orbit, and central nervous system are discussed. Because inflammatory pseudotumors mimic malignant tumors both clinically and radiologically, the radiologist should be familiar with this entity and help avoid unnecessary radical surgery when possible.
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Affiliation(s)
- Lakshmana Das Narla
- Department of Radiology, Medical College of Virginia VCU Health System, Main Hospital 3rd Fl, 1250 E Marshall St, Richmond, VA 23298, USA.
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Abstract
Inflammatory pseudotumor is a tumor-like reactive lesion of unknown etiology that rarely affects the heart. We describe an unusual case of a cardiac inflammatory pseudotumor that involved the aortic valve and caused regurgitation in a 62-year-old man. The lesion was excised and the aortic valve was replaced, resulting in a favorable outcome for the patient.
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Affiliation(s)
- L Krishna
- Cardiac Department, National University Hospital, Singapore.
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Abstract
Plasma cell granuloma of the lung has been reported often but extrapulmonary cases are rare. A case of plasma cell granuloma of the bladder involving the omentum is reported. Transurethral biopsy of the bladder did not aid in diagnosis because the lesion was deeply seated, and differential diagnosis with hematoxylin and eosin staining was difficult due to atypical plasma cells. Immunohistochemistry established the final diagnosis.
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Affiliation(s)
- H Maeda
- Department of Urology, Saiseikai Noe Hospital, Osaka, Japan
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Stringer MD, Ramani P, Yeung CK, Capps SN, Kiely EM, Spitz L. Abdominal inflammatory myofibroblastic tumours in children. Br J Surg 1992; 79:1357-60. [PMID: 1486440 DOI: 10.1002/bjs.1800791239] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Inflammatory myofibroblastic tumours (inflammatory pseudotumours) occurring at intra-abdominal sites in children have rarely been described. This paper reports three patients with this tumour, two of whom presented with fever, anaemia and an abdominal mass, the third with chronic duodenal obstruction. All had experienced significant weight loss. At operation, each had a large fibrous tumour (7-18 cm in diameter) originating from the transverse mesocolon, small bowel mesentery and duodenum respectively. Intraoperative frozen section histological examination in one patient was misinterpreted as a sarcoma. All the lesions were judged to have been completely excised, but one was ruptured during operation and the patient subsequently developed recurrent tumour nodules. Abdominal inflammatory myofibroblastic tumours are rare. They may be suspected before operation but their clinical, radiological and pathological features may be confused with those of malignancy. Complete excision is necessary to avoid local recurrence.
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Affiliation(s)
- M D Stringer
- Department of Paediatric Surgery, Hospitals for Sick Children, London, UK
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Vujanić GM, Milovanović D, Aleksandrović S. Aggressive inflammatory pseudotumor of the abdomen 9 years after therapy for Wilms tumor. A complication, coincidence, or association? Cancer 1992; 70:2362-6. [PMID: 1327498 DOI: 10.1002/1097-0142(19921101)70:9<2362::aid-cncr2820700926>3.0.co;2-t] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) is a benign lesion that occurs in various organs and tissues. It is usually sharply demarcated from the surrounding tissue and surgery is considered to be the best treatment. METHODS This article discusses a 15-year-old boy with an aggressive IPT of the abdomen occurring 9 years after therapy for Wilms tumor. RESULTS IPT widely involved the esophagus, stomach, and liver, producing severe dysphagia. Histologically, it showed classic features of IPT and, also, areas of metaplastic bone, a new feature recently described in the same lesion of the kidney. It mimicked malignant tumor clinically and led to extensive surgery, but early follow-up has shown no recurrence. CONCLUSION Although many complications of surgery and chemotherapy are well known, the authors believe that it is unlikely to be the cause of IPT in the case presented. Therefore, the possibility of coincidence or association of Wilms tumor and IPT remains open.
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Affiliation(s)
- G M Vujanić
- Department of Pediatric Pathology, Mother and Child Health Institute, Belgrade, Serbia, Yugoslavia
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MacLeod CB, Wakely PE, Frable WJ. Extrapulmonary inflammatory myofibroblastic pseudotumor: a potential cytologic trap in childhood. Diagn Cytopathol 1991; 7:633-6. [PMID: 1769295 DOI: 10.1002/dc.2840070619] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A previously healthy 20-mo-old infant presented with a right leg limp and was discovered to have a palpable intra-abdominal mass. Radiographic studies showed the mass arising from the right psoas muscle. Preoperative clinical diagnosis was probable sarcoma. Percutaneous fine-needle aspiration biopsy of the mass was interpreted as a sarcoma based on the abundant cellularity of spindled shaped mesenchymal cells. Exploratory laparotomy showed the mass to be unresectable. Histologic and ultrastructural examination of biopsy fragments, however, revealed an inflammatory myofibroblastic pseudotumor. Radiographic follow-up showed a gradual disappearance of the mass. The infant was clinically well at a clinic visit one year following surgery. This case serves to illustrate the aspiration cytology of an uncommon benign tumor-like proliferation that, when located in an unusual anatomic site, has the potential to mislead the cytopathologist into a malignant interpretation.
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Affiliation(s)
- C B MacLeod
- Department of Pathology, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298
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Abstract
Two children with inflammatory pseudotumor (IPT) of the lung are reported. Symptomless "cystic" lesions were present on routine chest x ray. Morphological study of these peculiar lesions included light microscopic, immunohistochemical, and ultrastructural analysis. Histologic appearance of the lesion varied from the features of granulation tissue on the periphery to bundles of spindle-shaped cells in the central area. Immunohistochemical findings had no diagnostic value but were helpful in excluding other tumors. Ultrastructural analysis confirmed the mixed cellular composition and benign nature of the lesion. Etiopathogenesis of this process is unknown. IPT can be differentiated from similar lesions and must not be mistaken for malignant tumor. Proper treatment by complete surgical removal of the lesion usually cures the patient.
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Affiliation(s)
- G M Vujanić
- Department of Paediatric Pathology, Mother and Child Health Institute, Belgrade, Yugoslavia
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Abstract
We report a case of cardiac inflammatory pseudotumour which we believe caused sudden death in a previously healthy 55-year-old Chinese female. The features of inflammatory pseudotumours are briefly reviewed. Cardiac lesions are very rare, have only been reported in children before, and have not been associated with sudden death.
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Affiliation(s)
- P Dickens
- Department of Pathology, University of Hong Kong
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