1
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Mishra S, Suh CH, Bergmark RW, Jo VY, Miyawaki EK, Schoenfeld JD, Uppaluri R, Guenette JP. Imaging features, therapies, and outcomes of fibrosing inflammatory pseudotumor of the nasopharynx: A systematic review. J Neuroimaging 2021; 32:223-229. [PMID: 34879175 DOI: 10.1111/jon.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Fibrosing inflammatory pseudotumor (FIP) of the nasopharynx is a rare nonneoplastic inflammatory lesion that is frequently mistaken for malignancy or infection. It is often misdiagnosed by radiologists as nasopharyngeal carcinoma or lymphoma, resulting in multiple biopsies and delays in diagnosis. The purpose is to understand trends in clinical presentation, imaging findings, treatment modalities, and patient outcomes of nasopharyngeal FIP. METHODS MEDLINE and EMBASE databases were queried for articles related to FIP of the nasopharynx. Articles that described cases of FIP involving the nasopharynx were selected. Studies that described inflammatory pseudotumor of the nasopharynx associated with known distinct pathologic entities were excluded. RESULTS A total of 19 articles describing 37 patients were included. MRI findings were reported in 32 patients. All cases demonstrated avid gadolinium enhancement. T2-weighted imaging characteristics were described or displayed for 21 patients: 95% demonstrated hypointensity compared to surrounding mucosa. Fluorodeoxyglucose (FDG) PET/CT findings were reported for 6 patients, all demonstrating mild FDG avidity. CONCLUSIONS Nasopharyngeal FIP is a histological diagnosis of exclusion that presents with facial pain and, often, cranial neuropathies. Relatively low T2-weighted MRI signal should inform the interpreting neuroradiologist to include FIP as a differential consideration for both the ordering provider and pathologist. Corticosteroid therapy is the most frequently employed therapy and results in partial or complete response in most patients. Radiation therapy and anti-inflammatory medications have also been reported to have potential therapeutic roles.
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Affiliation(s)
- Shruti Mishra
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Regan W Bergmark
- Division of Otolaryngology-Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edison K Miyawaki
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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2
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Kourtidis S, Saravakos P, Fiehn C, Preyer S. Inflammatory Pseudotumor in the Parapharyngeal Space: Is It Possible to Diagnose by Exclusion? Cureus 2021; 13:e18907. [PMID: 34804740 PMCID: PMC8599394 DOI: 10.7759/cureus.18907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammatory pseudotumor (IP) is a rare pathologic condition that easily can be confounded with malignancy. The clinical presentation depends on the site of occurrence and the radiological or laboratory findings are not specific. Diagnosis can be established only with histology. We report a case of a 64-year-old woman with IP in an uncommon localization, the parapharyngeal space extending to skull base. Although the diagnosis was not certain after histopathological examination, broad diagnostic workup helped to exclude malignancy or bacterial infection and led to diagnosis of an IP by exclusion. We observed a good clinical and radiological regression of symptoms after administration of oral immunosuppressants, confirming the immunological mechanism of the disease.
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Affiliation(s)
- Savvas Kourtidis
- Otorhinolaryngology and Head and Neck Surgery, Charité Universitätsmedizin, Berlin, DEU
| | | | - Christoph Fiehn
- Rheumatology and Clinical Immunology, Medical Centre Baden-Baden, Baden-Baden, DEU
| | - Serena Preyer
- Otorhinolaryngology and Head and Neck Surgery, ViDia Kliniken, Karlsruhe, DEU
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3
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Wang X, Li Y, Wang S, Wang S, Sun S. A rare case of inflammatory pseudotumor located in the ventral of medullocervical junction. A case report and review of literature. Br J Neurosurg 2021; 37:1-3. [PMID: 33688755 DOI: 10.1080/02688697.2021.1895970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
Inflammatory pseudotumor is a benign lesion of unknown etiology, which mimics neoplasms clinically and radiographically. It most commonly involves the lungs and orbits and is rarely reported in the central nervous system. We report a rare case of inflammatory pseudotumor located in the ventral junction of the medulla oblangta and cervical cistern, which has not been reported before as far as we know. A 61-year-old male presented with right arm weakness. MRI showed a mass located in the ventral junction of the medulla oblongata and cervical cisten. The patient was diagnosed as inflammatory pseudotumor(IPT) after surgical excision and histopathology. This tumor-like lesion was surrounding the bilateral intracranial segment of the vertebral arteries. No evidence of vascular invasion was observed. Complete surgical resection was achieved.
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Affiliation(s)
- Xiaochen Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingying Li
- Department of Radiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sihui Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Affiliated Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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4
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Miyawaki EK, Hsu L, Bhattacharyya S, O'Hare MJ, Roy A, Kett L, Caplan RA, Dattilo LW, Jo VY, Guenette JP. Fibrosing Inflammatory Pseudotumor Presenting as Cranial Neuropathy. Case Rep Neurol 2020; 12:247-254. [PMID: 32774282 PMCID: PMC7383149 DOI: 10.1159/000507920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 12/27/2022] Open
Abstract
We report two cases of biopsy-corroborated “fibrosing inflammatory pseudotumor” to illustrate that the entity, rarely described in the neurological literature, should be included in the differential diagnosis of either a cranial mononeuropathy or, certainly, in the case of progressive cranial neuropathies. A broad differential diagnosis arises in certain contexts. Early steroid treatment can be effective, and perhaps later-generation immune-modulating agents may confer further options, although there is no known definitive treatment.
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Affiliation(s)
- Edison K Miyawaki
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liangge Hsu
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meabh J O'Hare
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexis Roy
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Kett
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel A Caplan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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5
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Han MS, Moon KS, Lee KH, Jang WY, Kim SK, Jung S. Intracranial Inflammatory Pseudotumor Associated with Idiopathic Hypertrophic Pachymeningitis Mimicking Malignant Tumor or High-Grade Meningioma. World Neurosurg 2020; 134:372-376. [DOI: 10.1016/j.wneu.2019.10.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
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6
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Thaker R, Lee KC, Peters S, Greenman D, Kings JR. Asymptomatic nodule in the right cheek in a 65-year-old female. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:567-571. [PMID: 31444151 DOI: 10.1016/j.oooo.2019.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Raj Thaker
- Resident, Department of Oral and Maxillofacial Surgery, Harlem Hospital Center, New York, NY, USA
| | - Kevin C Lee
- Resident, Department of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, New York, NY, USA
| | - Scott Peters
- Assistant Professor, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY, USA.
| | - David Greenman
- Attending, Harlem Hospital Center, Department of Oral and Maxillofacial Surgery, New York, NY, USA
| | - James R Kings
- Director of Dentistry and Chief/Program Director Oral and Maxillofacial Surgery Program Harlem Hospital Center, New York, NY, USA
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7
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Wang X, Wang Z, Chen Y, Qian M. Inflammatory myofibroblastic tumor of the right frontal lobe. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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8
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Tong TR, Gil J, Batheja N, Strauchen JA, Kaneko M, Chan OWH, Krellenstein DJ, Gattani A. Inflammatory Pseudotumor of the Mediastinum Associated With Azacytidine Therapy, Acute Myeloid Leukemia, and Previous Chemotherapy for Astrocytoma. Int J Surg Pathol 2016. [DOI: 10.1177/106689699500300108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the rare case of a rapidly growing inflammatory pseudotumor arising in the mediastinum of a 30-year-old man with myelodysplastic syndrome secondary to treatment for grade 3 astrocytoma. The tumor was discovered soon after discontinuation of 5-azacytidine therapy for myelodysplasia. Fine-needle aspiration was suggestive, and thoracoscopic biopsy was diagnostic. The tumor was excised because of rapid growth and encroachment on the left pulmonary artery and lung. Postoperatively, blastemia was discovered. Acute myeloid leukemia was confirmed by bone marrow biopsy. The patient died of aspiration pneumonia before commencement of leukemia chemotherapy. This case illustrates a rare occurrence of inflammatory pseudotumor in the mediastinum complicating or arising in the setting of multiple primary cancers and chemotherapy. A temporal association with azacytidine therapy is noted. Int J Surg Pathol 3(1):49-58, 1995
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Affiliation(s)
| | - Joan Gil
- Department of Pathology, Mount Sinai Medical Center
| | | | | | | | | | | | - Anna Gattani
- Department of Neoplastic Diseases, Mount Sinai Medical Center, New York, New York
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9
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Ceruse P, Ramade A, Vautrin R, Crozes C, Dubreuil C, Disant F. Inflammatory pseudotumor of the neck: A long-term result without surgical approach. Otolaryngol Head Neck Surg 2016; 132:812-3. [PMID: 15886643 DOI: 10.1016/j.otohns.2004.09.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Philippe Ceruse
- Department of Head and Neck Surgery, Pavillon U, Edouard Herriot Hospital, Place d'Arsonval, 69003 Lyon, France.
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10
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Inflammatory myofibroblastic tumor of the pancreatic head - a case report of a 6 months old child and review of the literature. Radiol Oncol 2015; 49:265-70. [PMID: 26401132 PMCID: PMC4577223 DOI: 10.2478/raon-2014-0017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/22/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Inflammatory myofibroblastic tumors are rare in the pediatric population. Most common localizations were reported in the lungs. A localization in the pancreas needs differentiation from other tumors and chronic pancreatitis. Treatment is surgical resection, although there are reports of treatment with oral steroids and radiation therapy. CASE REPORT A 6-month-old child was treated due to a tumor in the head of the pancreas. On admission he was jaundiced with pruritus. US and MRI confirmed pancreatic tumor. Preoperative biopsy wasn't conclusive regarding the nature of the tumor. Duodenopancreatectomy was performed. Postoperative course was uneventful. Histologic examination confirmed the diagnosis of inflammatory myofibroblastic tumor. On follow up, he remained with no evidence of recurrence. CONCLUSIONS A literature review revealed 10 cases of pancreatic inflammatory myofibroblastic tumors in the pediatric age group. Our patient is the youngest reported. Despite major resection, there were no complications. However, management of this child might be possible with steroids, but conservative treatment might be insufficient, especially in aggressive forms of tumors.
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11
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Maxillary sinus inflammatory myofibroblastic tumors: a review and case report. Case Rep Oncol Med 2015; 2015:953857. [PMID: 25763286 PMCID: PMC4339865 DOI: 10.1155/2015/953857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/30/2015] [Indexed: 12/21/2022] Open
Abstract
An inflammatory myofibroblastic tumor (IMT) is an immunohistochemically diverse entity demonstrating neoplastic and nonneoplastic qualities. Although IMTs can arise in any area of the body, lesions arising in certain sites, namely, the nasal cavity, paranasal sinuses, and pterygopalatine fossa, demonstrate a heightened neoplastic and invasive potential. Despite case specific complete tumor regression and disease remission in response to pharmacotherapeutics, a subset of IMTs remain resistant to all forms of therapy. We present such a case, a 34-year-old female patient, with a highly resistant, maxillary sinus IMT. Her refractory, ALK-1 negative IMT has not responded well to novel therapies reported in current literature. This case suggests the role of zonal expressivity within a single lesion as a probable mechanism for its highly resistant nature and should promote determination of each IMT's cytogenetic profile to provide more effective targeted therapy. Paper includes a literature review of all maxillary sinus IMTs from 1985 to 2014 along with their immunohistochemical staining, treatments, and outcomes.
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12
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Segawa Y, Yasumatsu R, Shiratsuchi H, Tamae A, Noda T, Yamamoto H, Komune S. Inflammatory pseudotumor in head and neck. Auris Nasus Larynx 2014; 41:321-4. [DOI: 10.1016/j.anl.2013.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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13
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Affiliation(s)
- Martin G Mack
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
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14
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Hadimeri U, Hultman P, Larsson R, Melander S, Mölne J, Hadimeri H. Membranoproliferative glomerulonephritis and inflammatory pseudotumour of the spleen. Case Rep Oncol 2013; 6:84-9. [PMID: 23569442 PMCID: PMC3618054 DOI: 10.1159/000347229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Inflammatory pseudotumour is a rare condition that can affect various organs. The clinical and histologic appearance of the pseudotumour may mimic haematological, lymphoproliferative, paraneoplastic or malignant processes. A previously healthy 39-year-old man presented with nephrotic syndrome. He had a history of headaches, nausea and swollen ankles. Computed tomography of the abdomen revealed a 6-cm mass in the spleen. Following a renal biopsy, a diagnosis of membranoproliferative glomerulonephritis (MPGN) type I was made. Splenectomy was performed and the examination revealed a mixed population of lymphocytes with predominantly T-cells, B-cells and lymphoplasmacytoid cells. Immunostaining confirmed that the small cells were mostly T-cells positive for all T-cell markers including CD2, CD3, CD4, CD5, CD7 and CD8. A diagnosis of inflammatory pseudotumour was established. The removal of the spleen was followed by remission of glomerulonephritis, but it was complicated by a subphrenic abscess and pneumonia. This association between an inflammatory pseudotumour of the spleen and MPGN has not been previously described. Abnormal immune response due to the inflammation leading to secondary glomerulonephritis might be the main pathogenic mechanism.
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Affiliation(s)
- U Hadimeri
- Department of Radiology, Kärnsjukhuset, Skövde, Linköping University, Linköping, Göteborg, Sweden
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15
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Hoebers FJP, Ordonez BP, Irish J, Simpson RE, Yu E, O'Sullivan B. Progressive tumefactive fibroinflammatory lesion of the infratemporal fossa treated by radiation therapy. Rare Tumors 2012; 4:e12. [PMID: 22532910 PMCID: PMC3325739 DOI: 10.4081/rt.2012.e12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 11/25/2011] [Indexed: 11/22/2022] Open
Abstract
Tumefactive fibroinflammatory lesion (TFIL) is a rare benign tumor in the head and neck region. We present a case of a 40-year-old female with a benign but progressive lesion of the infratemporal fossa, which was diagnosed as TFIL. Patient responded briefly to a course of steroid treatment but eventually showed progression and was unresponsive to further steroids. She was then treated with external beam radiation to a dose of 60 Gy in 30 fractions. After radiation a slow, gradual decrease in tumor size was noted over the course of years and she is free of disease after more than 11 years of follow-up. The major long-term side effect this patient developed was an expected unilateral radiation-induced retinopathy, due to the close proximity of the lesion to the orbit. The dilemma of treatment of benign disease with radiation with potential long-term complications is discussed and a review of the literature on TFIL is presented.
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Affiliation(s)
- Frank J P Hoebers
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network and Radiation Oncology, University of Toronto, Ontario
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17
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Galindo J, Lassaletta L, Garcia E, Gavilan J, Allona M, Royo A, Patrón M. Spontaneous hearing improvement in a patient with an inflammatory myofibroblastic tumor of the temporal bone. Skull Base 2011; 18:411-5. [PMID: 19412412 DOI: 10.1055/s-0028-1087224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare lesion of unknown etiology and difficult diagnosis. The treatment of IMT is controversial. We report a case of IMT of the temporal bone in a young man presenting with a progressive hearing loss. Three years after diagnosis, partial hearing improvement has been documented.
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Affiliation(s)
- Javier Galindo
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain
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18
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Myocbacterium-avium intracellulare associated inflammatory pseudotumor of the anterior nasal cavity. Head Neck Pathol 2011; 5:296-301. [PMID: 21327589 PMCID: PMC3173547 DOI: 10.1007/s12105-011-0248-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
Abstract
In this case report, we describe an unusual case of mycobacterial associated inflammatory pseudotumor that occurred in a patient with a previous history of cocaine abuse. We discuss inflammatory pseudotumor (IPT) in general and emphasize the rare entity where an associated mycobacterial infection is seen. The histogenesis is not yet completely understood. The lesion can pose challenges for practicing pathologists and a misdiagnosis of malignancy can occur at multiple facets. A discussion about the differential diagnosis and clues to make the distinction is presented. In addition to spindle cell proliferation, the presence of a background of mixed inflammatory cell infiltrate and foamy macrophages are clues to make the diagnosis. In the case of mycobacteria associated IPT, Acid Fast Bacilli (AFB) stains will easily highlight the organisms confirming the diagnosis.
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19
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Yoon SH, Kim KJ, Chung SK, Kim HJ, Choe G, Chung SB, Jin YJ. Inflammatory myofibroblastic tumor in the intradural extramedullary space of the lumbar spine with spondylolisthesis: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19 Suppl 2:S153-7. [PMID: 19941012 PMCID: PMC2899620 DOI: 10.1007/s00586-009-1212-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 07/23/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs but still thought to be a neoplastic or reactive inflammatory condition controversially. The author reports an extremely rare case of intradural extramedullary IMT of lumbar spine which was presenting radiculopathy and neurogenic intermittent claudication due to concomitant spondylolisthesis.
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Affiliation(s)
- Sang Hoon Yoon
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Sang Ki Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Gyeonggi-do Korea
| | - Sang Bong Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
| | - Yong Jun Jin
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seoul, Gyeonggi-do 463-707 Korea
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20
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Maruya SI, Miura K, Tada YI, Masubuchi T, Nakamura N, Fushimi C, Sakashita T, Monma T, Kamata SE. Inflammatory pseudotumor of the parapharyngeal space: A case report. Auris Nasus Larynx 2010; 37:397-400. [DOI: 10.1016/j.anl.2009.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 08/17/2009] [Accepted: 08/28/2009] [Indexed: 01/22/2023]
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21
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Abstract
Pseudoneoplastic lesions ("pseudotumors") can be seen in virtually all anatomic locations. Some organ sites, such as the lungs and skin, are overrepresented for unknown reasons, and the histologic images seen in pseudoneoplastic lesions are partially overlapping in disparate locations. More than occasionally, the degree of histologic likeness to true neoplasms-often malignant ones-is striking. This overview outlines the spectrum of pseudoneoplastic lesions and divides them into etiologic categories, including reparative, developmental, functional (usually endocrine), iatrogenic, infectious, and idiopathic. Side-by-side pictorial comparisons of selected pseudoneoplastic lesions and their neoplastic mimics are included.
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Affiliation(s)
- Mark R Wick
- Department of Pathology, University of Virginia Medical Health Sciences Center, Charlottesville, 22908-0214, USA.
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22
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Das-Purkayastha PK, Hartley B, Sebire N. Airway obstruction due to a retro-tracheal inflammatory myofibroblastic tumour in a 19-month-old boy. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.pedex.2008.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Choi SY, Yu IK, Han MH, Lee BH, Song CJ, Kim KS. Fibrosing inflammatory pseudotumor of the nasopharynx: MR features and histopathologic correlation. Eur J Radiol 2008; 72:274-7. [PMID: 18778906 DOI: 10.1016/j.ejrad.2008.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 06/24/2008] [Accepted: 07/28/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the magnetic resonance (MR) imaging features of six cases of pathologically proven fibrosing inflammatory pseudotumor involving the nasopharynx, and to compare the MR signal intensities of the lesions with histopathologic findings. METHODS We reviewed the MR finding of six patients with pathologically proved fibrosing inflammatory pseudotumor at the nasopharyngeal wall with respect to the following points: extent, margins, signal intensity and enhancement degree of the lesion; cervical lymphadenopathy and response to steroid therapy. MR findings were correlated with histopathologic findings. RESULTS All lesions showed ill-defined margins and looked less-likely contour bulging features. The signal intensity of the lesions was hypointense or slightly heterogeneous relative to brain cortex on both T1- and T2-weighted images, and enhancement was weakly homogeneous in all cases. There was no demonstrable cervical lymphadenopathy in all cases. After steroid therapy, the lesions showed decreased extent and weaker enhancement in three patients. Histopathologic findings showed high degree of polymorphous inflammatory cellular infiltration with underlying significant reactive fibrosis. CONCLUSION Fibrotic inflammatory pseudotumors involving nasopharynx are very rare, and can mimic malignancy. MR imaging showed ill-defined margins, hypointensity or slightly heterogenous signal intensity on T2-weighted image and weak enhancement. There was no significant cervical lymphadenopathy.
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Affiliation(s)
- So-Young Choi
- Department of Radiology, Eulji University Hospital, 1306 Dunsan-dong, Seo-gu, Daejeon, South Korea
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Abstract
Inflammatory pseudotumors (IPTs) are a clinically and histologically diverse group of lesions characterized by a tumor mass of acute and chronic inflammatory cells with a variable fibrous response. IPTs most commonly involve the lung and orbit, but rarely the sinonasal tract. We report a 68-year-old male with an IPT of the sinonasal tract presenting as nasal obstruction and postnasal dripping for several years. A gray-white soft mass was noted in the right nasal cavity. Computed tomography revealed a solid mass filling the right nasal cavity and maxillary sinus. Caldwell-Luc operation with ethmoidectomy (right) was conducted to resect the mass en bloc. Pathology revealed admixture of plasma cells, lymphocytes and eosinophils, confirming the diagnosis of IPT. The patient remained symptom-free over 4 years of follow-up. Awareness of the clinical presentations, histopathologic features and treatment of choice of this rare disease entity is necessary to distinguish it from malignancy and avoid unnecessary management.
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Affiliation(s)
- Chih-Chieh Chuang
- Department of Otolaryngology, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.
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Boutarbouch M, Arkha Y, Rifi L, Derraz S, El Ouahabi A, El Khamlichi A. Intradural cervical inflammatory pseudotumor mimicking epidural hematoma in a pregnant woman: case report and review of the literature. ACTA ACUST UNITED AC 2007; 69:302-5. [PMID: 17765955 DOI: 10.1016/j.surneu.2006.12.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 12/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inflammatory pseudotumors usually affect the lung and the orbit. They occur extremely rarely in the spine. We encountered a case of intradural extramedullary IPT of the cervical spine in a pregnant woman that initially presented as an epidural hematoma in MRI. CASE DESCRIPTION This is a case of a 30-year-old, HIV-negative, full-term pregnant lady presenting with 2-month history of progressive quadriparesis with rapid worsening of power in all 4 limbs for 3 days. Magnetic resonance imaging scanning revealed cervical extramedullary compressive lesion likely to be epidural bleed from its imaging characteristics. Intraoperatively, intradural extramedullary granulomatous lesion was found with dural thickening. Gross total excision was accomplished; histopathologic study assessed an IPT. The patient improved after surgery excision and is doing well at 6-month follow-up with remarkable neurological recovery. CONCLUSION Cervical intradural IPT is a very rare issue in the spine. Diagnosis can be confused with a neoplastic lesion like an "en plaque meningioma" or as epidural bleed like in the present case.
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Affiliation(s)
- Mahjouba Boutarbouch
- Department of Neurosurgery, Mohamed Vth University School of Medicine, Hôpital des Spécialités ONO, Rabat 10100, Morocco.
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Lee DH, Lee SH, Sung JK. Inflammatory myofibroblastic tumor on intercostal nerve presenting as paraneoplastic pemphigus with fatal pulmonary involvement. J Korean Med Sci 2007; 22:735-9. [PMID: 17728520 PMCID: PMC2693830 DOI: 10.3346/jkms.2007.22.4.735] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Dong-Hyun Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joo-Kyung Sung
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
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27
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Abstract
OBJECTIVES/HYPOTHESIS The term idiopathic pseudotumor (IP) refers to a nonspecific, nonneoplastic inflammatory process without identifiable local or systemic causes, which is one of the most common causes of intraorbital space-occupying lesions. Occasionally, orbital pseudotumors may extend to other areas of the skull base. Rarely, pseudotumors may present as a skull base mass with no involvement of the orbit. The ophthalmology literature has detailed reviews of IP as an intraorbital space-occupying lesion, but lesions involving only the skull base and sparing the orbit are rare in the literature. We present a review of our experience with six patients with extraorbital skull base pseudotumor and a review of the relevant literature. METHOD Retrospective case study. RESULTS We treated six patients with extraorbital skull base pseudotumor between 1996 and 2004. Four patients had lesions in the pterygopalatine and/or infratemporal fossae, and two patients had lesions in the superior aspect of the parapharyngeal space. Five patients had excellent initial response to steroids. Two of the pseudotumors recurred. One patient partially responded to steroids and is currently stable with limited disease. Our literature review demonstrated 16 previously published reports of IP of the skull base sparing the orbit. CONCLUSIONS A well-documented intraorbital lesion, inflammatory pseudotumor may present outside the orbit. Treatment of IP of the skull base is controversial and may involve corticosteroids or surgical resection, or both. Other chemotherapeutic agents and radiotherapy may be considered in steroid-resistant patients. Pathological subtype, ease and safety of resection, safety of high-dose corticosteroid use, the surgeon's comfort, and the patient's preference must be included in the decision-making process for treatment.
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Affiliation(s)
- Jason R Mangiardi
- Division of Head and Neck Surgical Oncology-Department of Otolaryngology, State University of New York Downstate Medical Center and the Long Island College Hospital, Brooklyn, NY, USA.
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Ushio M, Takeuchi N, Kikuchi S, Kaga K. Inflammatory pseudotumour of the paranasal sinuses--a case report. Auris Nasus Larynx 2007; 34:533-6. [PMID: 17331689 DOI: 10.1016/j.anl.2007.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 01/25/2007] [Accepted: 01/26/2007] [Indexed: 11/17/2022]
Abstract
Inflammatory pseudotumour represents benign non-specific granulation, and is uncommon in the head-and-neck region, particularly in the paranasal sinuses. We present herein the case of a 63-year-old woman with inflammatory pseudotumour of the paranasal sinuses. Physical examination and computed tomography revealed a mass in the bilateral nasal cavity and paranasal sinuses with extension to bilateral orbits. Multiple intranasal biopsies revealed marked lymphoplasmatic infiltration and myofibroblastic proliferation with hyalinisation. Systemic steroid therapy was selected and was very effective. The lesion has shown no evidence of enlargement for more than 1 year. The difficulties in establishing the clinico-pathological diagnosis and treatment are discussed.
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Affiliation(s)
- Munetaka Ushio
- Department of Otorhinolaryngology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Lee DK, Cho YS, Hong SH, Chung WH, Ahn YC. Inflammatory pseudotumor involving the skull base: response to steroid and radiation therapy. Otolaryngol Head Neck Surg 2006; 135:144-8. [PMID: 16815200 DOI: 10.1016/j.otohns.2006.01.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 01/25/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the response to steroid and radiation therapy in inflammatory pseudotumor (IPT) involving the skull base. STUDY DESIGN AND SETTING Eight patients with IPT of the skull base were evaluated. Six patients were diabetic. All patients underwent initial high-dose steroid therapy. Seven of 8 patients underwent subsequent low-dose steroid maintenance. Additional low-dose radiation therapy was performed in 6 patients. We reviewed the medical records and radiologic findings of the patients to evaluate their responses to the steroid and radiation therapy. RESULTS In all patients, the initial response to steroid therapy was fair. However, 7 patients showed symptom recurrence after cessation of steroid therapy. In 5 of 6 patients, low-dose radiation therapy resulted in recurrence. On follow-up MRI, none of the patients showed complete remission of the disease. CONCLUSION This study shows aggressive clinical behavior of IPT involving the skull base and its poor response to steroid therapy and low-dose radiation therapy. For improving control, more aggressive initial efforts including high-dose radiation therapy with or without concurrent steroid therapy might play a role. EBM RATING C-4.
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Affiliation(s)
- Dong Kyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-Ku, Seoul, Korea
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30
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Abstract
Inflammatory pseudotumor is usually found in the orbits and lungs, but rarely in the sinonasal area. We present a 59-year-old woman with a right nasal mass. This lesion caused nasal bleeding and blockage. Image study showed that the solid mass eroded the bony structure and pushed the nasal septum toward the left side. Wide excision was done via lateral rhinotomy. Although its clinical picture mimicked a malignant tumor, histological examination showed an inflammatory process composed of a mixture of lymphoplasmacytic infiltrate, histiocytic cells, and spindled fibroblastic/myofibroblastic cells. Both culture and pathology identified no microorganism. No evidence of recurrence was found after follow-up for more than 2.5 years. The clinical behavior of inflammatory pseudotumor was confusing and tended to be mistaken as malignancy. Its diagnosis and management could be a great challenge for clinicians.
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Affiliation(s)
- Wei-Hsiung Huang
- Department of Otolaryngology, Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
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31
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Newlin HE, Werning JW, Mendenhall WM. Plasma cell granuloma of the maxillary sinus: a case report and literature review. Head Neck 2006; 27:722-8. [PMID: 15880393 DOI: 10.1002/hed.20196] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Heather E Newlin
- Department of Radiation Oncology, University of Florida College of Medicine, University of Florida Health Science Center, P. O. Box 100385, Gainesville, FL 32610-0385, USA
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Maruya SI, Kurotaki H, Hashimoto T, Ohta S, Shinkawa H, Yagihashi S. Inflammatory pseudotumour (plasma cell granuloma) arising in the maxillary sinus. Acta Otolaryngol 2005; 125:322-7. [PMID: 15966706 DOI: 10.1080/00016480410022994] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSIONS Inflammatory pseudotumours in the maxillary sinus may present as malignant tumours and manifest locally aggressive features characteristic of such tumours. Despite their locally destructive features, they pursue a benign course after local excision. OBJECTIVE Inflammatory pseudotumour (plasma cell granuloma) is an uncommon non-neoplastic lesion comprising a proliferation of spindle myofibroblasts and chronic inflammatory cells. Despite its benign histopathological nature, it may exhibit aggressive behaviour that is yet to be characterized in the head and neck area. MATERIAL AND METHODS We present the cases of two adult patients with inflammatory pseudotumour arising from the maxillary sinus. Immunohistochemistry and polymerase chain reaction for immunoglobulin from tissue sections were performed to confirm the polyclonality of the infiltrating plasma cells. RESULTS CT and MRI disclosed expansive soft masses eroding surrounding soft and bony tissues. Histopathologically, the lesions were unencapsulated and composed of numerous plasma cells, histiocytes and spindle cells with minimal nuclear pleomorphism.
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33
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Browne M, Abramson LP, Chou PM, Acton R, Holinger LD, Reynolds M. Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the neck infiltrating the trachea. J Pediatr Surg 2004; 39:e1-4. [PMID: 15486877 DOI: 10.1016/j.jpedsurg.2004.06.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Marybeth Browne
- Department of Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA
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34
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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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35
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Cruz AAV, Akaishi PMS, Chahud F, Elias JJ. Sclerosing inflammation in the orbit and in the pterygopalatine and infratemporal fossae. Ophthalmic Plast Reconstr Surg 2003; 19:201-6. [PMID: 12918555 DOI: 10.1097/01.iop.0000062849.02508.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe two cases with sclerosing inflammation in the orbit and in the pterygopalatine and infratemporal fossae and to review the literature of head and neck idiopathic inflammation. METHODS Interventional case series. Two clinical case reports of sclerosing inflammation in the orbits and in the pterygopalatine and infratemporal fossae are presented. A review of the literature and discussion was performed. RESULTS Both patients had histologic findings typical of chronic orbital sclerosing inflammation, including mature lymphocytes associated with dense collagen deposition and occasional lymphoid follicles. Bone erosion was present in one patient. CONCLUSIONS The clinical findings of this case series concur with the literature that idiopathic inflammation can be found simultaneously in the orbit and in the infratemporal and pterygopalatine fossae. These cases of idiopathic inflammation are often clinically indistinguishable from malignant neoplasms.
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Affiliation(s)
- Antonio A V Cruz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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36
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Amir R, Danahey D, Ferrer K, Maffee M. Inflammatory myofibroblastic tumor presenting with tracheal obstruction in a pregnant woman. Am J Otolaryngol 2002; 23:362-7. [PMID: 12430129 DOI: 10.1053/ajot.2002.128041] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT), also known as inflammatory pseudotumor, is a benign lesion predominantly found in the lung and abdomen. Sporadic cases have been reported in the trunk, genitourinary tract, and extremities as well as in the head and neck. Of critical importance is this entity's correct histopathologic diagnosis that differentiate it from malignant neoplasms such as spindle cell carcinoma and fibrosarcoma, benign tumors such as neurofibroma, and other pseudoneoplastic lesions such as nodular fasciitis. Correct diagnosis is followed by wide local excision to prevent recurrence; however, treatment must be tailored to the location of tumor and the condition of the patient. We present a unique case of IMT of the trachea presenting with acute upper airway obstruction in a pregnant woman. Diagnostic considerations as well as the anesthetic and surgical approach are discussed.
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Affiliation(s)
- Roy Amir
- Departments of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
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37
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Abstract
Eighty-one patients suffering from follicular pharyngitis were treated for 7 days in a double-blind, multicentre controlled study of fusafungine versus placebo. Evaluations were performed at inclusion, after 7 days of treatment, and 3 weeks after the end of the treatment. The effects of the pharyngitis on day-to-day life, changes in symptoms, morphological changes of lesions, and general changes observed by the investigator and expressed by the patient were the parameters evaluated at each visit. Results confirmed the efficacy of fusafungine in the treatment of local and symptomatic manifestations of follicular pharyngitis. Effects of follicular pharyngitis on day-to-day life decreased after 7 days of treatment and the differences between the treatment group and the placebo group was close to significance in favour of fusafungine. For the majority of symptoms, the percentage of patients who did not display the symptoms at D7 was greater in the fusafungine group. Postnasal drip decreased significantly in the fusafungine group. The investigators' and patients' judgement was also in favour of the fusafungine treatment. These improvements were confirmed at least 3 weeks after the end of the treatment.
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Affiliation(s)
- L Pandraud
- Centre Hospitalier de Saint-Cloud, France.
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38
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Soysal V, Yigitbasi OG, Kontas O, Kahya HA, Guney E. Inflammatory myofibroblastic tumor of the nasal cavity: a case report and review of the literature. Int J Pediatr Otorhinolaryngol 2001; 61:161-5. [PMID: 11589984 DOI: 10.1016/s0165-5876(01)00561-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Our aim is to describe clinicopathological, histochemical, and immunohistochemical findings of one case of inflammatory myofibroblastic tumor of the nasal cavity. A 10-year-old female presented with a short history of nasal obstruction, epistaxis, nasal discharge and headache. Computerized tomography (CT) scans showed a space-occupying lesion in the right nasal cavity. Histological examination of initial biopsy showed fascicles of spindle cells in a mixed inflammatory background with a predominance of plasma cells, typical of inflammatory pseudotumor. The spindle cells were positive for vimentin and actin. The mass was completely excised without any difficulty under generalized anesthesia. Inflammatory myofibroblastic tumor of the nasal cavity is a localized and completely benign lesion. Simple complete excision is curative.
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Affiliation(s)
- V Soysal
- ENT Clinic of Amasya State Hospital, Turkey
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39
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Abstract
An unusual pseudosarcomatous lesion of the oral mucosa is described in a 43-year-old woman. It presented as an aggressive ulcerative mass in the mandibular retromolar gingiva of one month's duration. The lesion was composed of florid myofibroblastic and fibrohistiocytic proliferations with infiltrative margins in an inflammatory background and was considered to be an inflammatory pseudotumor. Although the tumor appeared to have been incompletely excised, the patient remains free of disease at 1 year follow-up.
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Affiliation(s)
- F Ide
- Department of Oral Surgery, Saitama Medical Center, Saitama Medical School, Kawagoe, Japan
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40
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Gangopadhyay K, Mahasin ZZ, Kfoury H, Ashraf Ali M. Inflammatory myofibroblastic tumour of the tonsil. J Laryngol Otol 1997; 111:880-2. [PMID: 9373561 DOI: 10.1017/s0022215100138885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inflammatory myofibroblastic tumours are aetiologically enigmatic, nosologically confusing and biologically unpredictable lesions. The lungs are the organs of apparent predilection. These tumours have also been documented in a number of extrapulmonary sites including the head and neck. So far only two cases of inflammatory myofibroblastic tumour of the tonsil have been reported in the English literature. We document another case, occurring in a 41-year-old man with history of cadaveric renal transplant nine years ago. A comprehensive review of the literature is also presented.
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Affiliation(s)
- K Gangopadhyay
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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41
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Okamoto M, Takahashi H, Yamanaka J, Nemoto S, Kuno K, Ishii T. Sclerosing inflammatory pseudotumor arising from the carotid artery region. Auris Nasus Larynx 1997; 24:315-20. [PMID: 9251862 DOI: 10.1016/s0385-8146(96)00030-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a 42-year-old female patient with sclerosing inflammatory pseudotumor. She had found a mass in her left neck after she caught a cold. An elastic hard mass (25 x 15 mm), unaccompanied by any other symptoms, was palpated adjacent to the left carotid bifurcation. The mass extended vertically along the common carotid artery, partially adhering to the pulsating artery. Under ultrasonography, the mass was characterized by a homogenized low echoic shadow surrounding the left common carotid artery. Angiography revealed a slight narrowing of the common carotid artery with a surrounding hypovascular mass. Computerized tomography (CT) and magnetic resonance imaging (MRI) both showed a mass enclosing the carotid artery; a Ga scintigram also showed a highly concentrated mass. Surgical removal of the mass included removing part of the carotid artery, internal and external carotid arteries and sympathetic trunk. The left internal jugular vein was transplanted to connect the common carotid artery to the internal carotid artery. Although the hypoglossal and vagus nerves adhered to the mass, they were preserved by sharp dissection with the scalpel. Although hypoglossal and vagus nerve dysfunction were observed temporarily after the surgery, Horner's syndrome appeared and persisted. Histological examination revealed markedly fibrotic tissues surrounding the carotid artery with extensive lymphocyte and plasmacyte infiltration and a diagnosis of sclerosing inflammatory pseudotumor was made.
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Affiliation(s)
- M Okamoto
- Department of Otolaryngology, Kitasato University, School of Medicine, Kanagawa, Japan
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Abstract
OBJECTIVE The purpose of this study was to evaluate our experience with the diagnosis and management of tumors of the parapharyngeal space (PPS), with particular emphasis on the evolving role of magnetic resonance imaging (MRI). METHODS A case series review of 51 patients with parapharyngeal tumors who underwent surgical excision between 1980 and 1992 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique (computed tomography [CT] versus MRI), surgical approach, and outcome. RESULTS Fifty-one patients underwent surgical excision of a parapharyngeal tumor of which the vast majority (78%) were benign neoplasms. Compared with benign neoplasms, the malignant tumors were much more likely to be associated with pain, trismus, and a cranial nerve deficit. MRI was able to locate the tumor in 20 of 21 patients (95%), while CT was able to localize the tumor in 32 of 38 patients (84%). CONCLUSIONS MRI, because of its superior soft-tissue resolution and ability to provide imaging in multiple planes, is the imaging modality of choice to diagnose neoplasms of the parapharyngeal space. Because most of these tumors are benign, MRI allows the surgeon to select the surgical approach with the least morbidity.
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Affiliation(s)
- F R Miller
- Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Ohio, 44195, USA
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43
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Wenig BM, Devaney K, Bisceglia M. Inflammatory myofibroblastic tumor of the larynx. A clinicopathologic study of eight cases simulating a malignant spindle cell neoplasm. Cancer 1995; 76:2217-29. [PMID: 8635024 DOI: 10.1002/1097-0142(19951201)76:11<2217::aid-cncr2820761107>3.0.co;2-n] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors of the larynx are uncommon lesions that easily may be misinterpreted as malignant epithelial or mesenchymal spindle cell neoplasms. METHODS Eight cases of laryngeal inflammatory myofibroblastic tumors were identified from the files of the Otolaryngic Tumor Registry--Armed Forces Institute of Pathology. Clinical records and follow-up were available in all cases. The light microscopic features (hematoxylin and eosin and special histochemical stains) were evaluated in all cases; immunohistochemical analysis was performed in the seven cases with available paraffin blocks; in four cases ultrastructural analysis was done. RESULTS The patients included five males and three females ranging in age from 19-69 years (median, 59 years). Presenting symptoms included hoarseness, dysphonia, or rapidly progressive stridor with the duration of symptoms ranging from 10 days to 4 months. The most common site of involvement was the true vocal cord. The lesions appeared as polypoid or pedunculated masses. Histologically, the cellularity of the lesions varied, consisting of spindle-shaped to stellate cells with no consistently discernible growth pattern, in a fibromyxoid stroma that included a mixed inflammatory cell infiltrate. Features suggesting a malignant cellular infiltrate were not present. The spindle-shaped cells had consistent immunoreactivity with vimentin, muscle specific actin, and smooth muscle actin. Ultrastructurally, intracytoplasmic microfilaments were identified. In seven of the patients, conservative but complete excision of the lesion was curative; these patients have been free of disease over periods ranging from 12 to 36 months. In one patient, the lesion recurred twice over a 2-year period and ultimately required a total laryngectomy. This patient died of unrelated causes. CONCLUSIONS Inflammatory myofibroblastic tumors of the larynx are unusual benign proliferative lesions. Conservative surgical management is advocated and is curative. Recurrence is rare, but metastases disease or death attributable to these lesions is not.
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Affiliation(s)
- B M Wenig
- Department of Otolaryngic and Endocrine Pathology, Armed Forces Institute of Pathology, Washington, District of Columbia, USA
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Affiliation(s)
- J P Newman
- Stanford University, Division of Otolaryngology-Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, California, USA
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Batsakis JG, el-Naggar AK, Luna MA, Goepfert H. "Inflammatory pseudotumor": what is it? How does it behave? Ann Otol Rhinol Laryngol 1995; 104:329-31. [PMID: 7717628 DOI: 10.1177/000348949510400415] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inflammatory pseudotumor, as a histologic diagnosis and carrying with it the prospect of a benign clinical course, is rather firmly entrenched as a pulmonary lesion. Extrapulmonic forms, however, are farraginous and, as reported, have included lesions having few, or even none, of the histologic features of those in the lungs. For those more closely aligned with the fibroblastic or myofibroblastic phase of the lung lesions, their biologic behavior can belie their histology in that they can be locally aggressive and metastasize as sarcomas. For those tumors in the upper airway, and especially in the abdomen, pathologists should be very circumspect in the use of inflammatory pseudotumor as a diagnosis, and clinicians should not be lulled into denying the extrapulmonic forms their due respect.
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Affiliation(s)
- J G Batsakis
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, USA
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Abstract
BACKGROUND Plasma cell granuloma is a rare benign lesion which is found most frequently in the lungs, and a few cases have been described in the head and neck. In the middle ear and mastoid, a case of plasma cell granuloma was reported by Benton et al. METHODS AND RESULTS A 24-year-old woman was seen with a 7-month history of otalgia and decreased hearing. A computed tomographic (CT) scan showed a soft tissue mass occupying most of the mastoid bone. The mass and the contiguous dura were enhanced homogeneously on magnetic resonance imaging (MRI) scan. Microscopic examination showed plasma cell aggregates mixed with other inflammatory cells and Russell's bodies in a fibrous stroma. Immunoperoxidase studies revealed intracytoplasmic kappa and lambda light chains, and the lesion was confirmed as non-neoplastic and of polyclonal origin (ie, plasma cell granuloma). The patient was treated with conservative surgical excision (a canal-down mastoidectomy) and postoperative radiotherapy (5,040 cGy in 28 fractions) and remains free of disease 1 year after treatment. CONCLUSIONS A case of plasma cell granuloma is reported, and we believe this is the second case report of plasma cell granuloma affecting the temporal bone.
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Affiliation(s)
- B H Nam
- Department of Otolaryngology, College of Medicine, Chungnam National University, Daejeon, South Korea
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