Pediatric inflammatory myofibroblastic tumor of the trachea: a case report and review of the literature

Mediastinal Myofibroblastic Inflammatory Tumor Compressing the Airway: An Unusual Cause of Dyspnea in a 12-Year-Old

A healthy 12-year-old presented with wheezing and progressive dyspnea over a 10-month period. He had several general physician consultations and emergency visits during this time and was treated as an asthma exacerbation with no clinical response. He was referred to the pediatric pulmonologist and a tracheal deviation in his previous two chest X-rays was noted, therefore further studies were performed. A severe extrinsic tracheal compression due to a mediastinal mass was documented. He was taken into surgery where a partial resection of the tumor was made. The biopsy of the tumor reported an inflammatory myofibroblastic tumor (IMT), a rare tumor with an atypical presentation, which made this case a diagnostic challenge.

Endotracheal inflammatory myofibroblastic tumour: A rare cause of central airway occlusion in adults

Inflammatory myofibroblastic tumour (IMT) is an unusual myofibroblastic spindle cell neoplasm that is rarely discovered in the airway of adults. Previously, it was regarded as a reactive lesion and was infamously known as inflammatory pseudotumour before recent insights revealed that significant majority of cases harboured neoplastic genes. Diagnosis is difficult as clinical presentation and imaging findings are non‐specific. Diagnosis and a favourable prognosis require the complete resection of the tumour. Detection of the anaplastic lymphoma kinase expression via immunohistochemistry expedites diagnosis. We report a young adult with an endotracheal mass occluding the central airway. The patient successfully underwent bronchoscopic resection using interventional techniques. IMT was diagnosed. No recurrence was seen after a year of surveillance. Due to the rarity of the disease, the recurrence rates for large airway disease is unknown. Recurrence rates for pulmonary lesions is reported to be lower compared to extrapulmonary IMTs and recurrence is unlikely if compete surgical excision is achieved.

Mini-invasive endoscopic approach to tracheal inflammatory myofibroblastic tumor in a young woman: A case report

INTRODUCTION

Inflammatory myofibroblastic tumor (IMT) of the trachea is rare tumor mostly found in children and young adults.

CASE REPORT

We report a case of a 28 year-old woman who presented chronic isolated coughing. Chest CT scan showed a tracheal tumor. Rigid bronchoscopy allowed the complete removal of the tumor, and histology confirmed the diagnosis of IMT. 12 months follow-up found no recurrence.

DISCUSSION

IMT is a rare tumor exhibiting both benign and aggressive behaviour. The endoscopic approach of tracheal should be considered when there is a minimal tracheal wall invasion.

CONCLUSION

Through this case, we want to emphasise the role of rigid bronchoscopy in the complete removal of endotracheal IMT.

Inflammatory Myofibroblastic Tumor of the Upper Airways Harboring a New TRAF3-ALK Fusion Transcript

Inflammatory myofibroblastic tumor (IMT) is a rare disease that mainly involves the lung and the abdomen with an intermediate clinical course but a recurrence rate between 15–30%. Radical surgery represents the gold standard of treatment, while chemotherapy and radiotherapy are considered for unresectable lesions. The identification of ALK translocations in IMT opened the option for the use of target therapies. Indeed, the ALK inhibitors have changed the treatment approach for aggressive lesions, improving the prognosis. Intraluminal upper-way IMT is extremely rare and represents a medical challenge. We reported an endotracheal IMT case presenting a previously unknown TRAF3-ALK fusion transcript.

Pediatric inflammatory myofibroblastic tumor of the trachea: Imaging spectrum and review of literature

Inflammatory myofibroblastic tumor of the airway is a very uncommon benign primary neoplasm in pediatric age group with increased local recurrence rate and potential metastatic spread. We describe a case of a 6-year boy who was brought to the pediatric emergency with severe respiratory distress, dry cough, and stridor. Contrast-enhanced computed tomography and magnetic resonance imaging (MRI) of the neck showed a polypoidal mass lesion in the right anterolateral trachea causing significant airway narrowing. Bronchoscopic findings correlated with the imaging. The lesion was confirmed at surgery and was completely removed by surgical excision. Histopathology revealed an inflammatory myofibroblastic tumor. MRI findings of this entity in a child have not been reported before.

Pulmonary Inflammatory Myofibroblastic Tumor in Children: A Case Report and Brief Review of Literature

The inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear etiology and variable clinical course, consisting of a proliferation of fibroblasts and myofibroblasts, mixed with inflammatory cells. Synonyms of IMT are inflammatory pseudotumor and plasma cell granuloma reflecting the alleged inflammatory nature attributed to this lesion, even though this heterogeneity in the disease denomination is probably involved in a dispersion of the literature data. Among primary pulmonary neoplasms, it represents the most frequent endobronchial tumor of childhood and beyond the lung it has been described mainly in the bladder, mediastinum and mesentery. Despite having a tendency for local recurrence, the risk of distant metastasis is low. Clinical presentation depends on localization therefore lung peripheral lesions are often asymptomatic resulting in a delayed diagnosis. Radiological findings can suggest the diagnosis that must be confirmed by histopathology assessment. The tumor has been characterized by the application of immunohistochemical techniques, molecular biology and cytogenetics, which are very precious for the diagnosis. The therapeutic approach consists in the complete surgical excision of the lesion that normally ensures excellent survival. Due to the potential risk of recurrence, close clinical trial is indicated. To date only 24 cases of pulmonary IMT have been described, although the prevalence is probably higher. We present a case report of a 3-year-old girl with pulmonary IMT and a brief review of known literature cases in order to highlight the most common clinical presentations, the most useful diagnostic tools and therapeutic approach.

Inflammatory myofibroblastic tumor of the trachea in the pediatric age group: case report and systematic review of the literature

Inflammatory myofibroblastic tumors are uncommon tumors, which present as solitary masses in the pulmonary parenchyma. Tracheal involvement by these tumors is extremely rare and can be misdiagnosed as asthma. The closest histologic differential diagnoses are IgG4-related sclerosing pseudotumors, which are differentiated by IgG4 positivity. Fifty percent of inflammatory myofibroblastic tumors are positive for anaplastic lymphoma kinase gene rearrangements. The treatment modality of choice is surgical resection with therapeutic bronchoscopy reserved for patients presenting with acute airway obstruction or in those unwilling for surgery. New and upcoming treatments include anaplastic lymphoma kinase inhibitors like crizotinib.

A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment

Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.

Bronchoscopic resection of endobronchial inflammatory myofibroblastic tumor: A case report and systematic review of the literature

Inflammatory myofibroblastic tumour (IMT) is a rare tumour affecting the tracheo-bronchial tree in the adult population. The clinical presentation of this tumour is diverse and diagnosis can be definitively clinched by histopathological examination. Treatment of this tumour usually requires surgical resection with bronchoscopic resection being described in few cases. We describe a 32 year old male presenting with hemoptysis who was diagnosed to have IMT. Resection of the tumour was done with the help of rigid bronchoscopy. Post-resection, hemoptysis stopped and no recurrence of tumour was noted on subsequent follow-up. We also present a systematic review of literature of all the cases of tracheo-bronchial IMT treated with bronchoscopic resection and conclude it to be a useful alternative to surgery in such cases.

Inflammatory myofibroblastic tumours of the respiratory tract: paediatric case series with varying clinical presentations

OBJECTIVES

To highlight the clinical importance of inflammatory myofibroblastic tumours of the respiratory tract in children, and to present a case series of three children which illustrates this tumour's variable clinical presentation.

CASE HISTORY

The series includes: a nine-year-old girl with a diagnosis of juvenile idiopathic arthritis, who presented with finger clubbing and was found to have an inflammatory myofibroblastic tumour in her right upper lobe; a 15-year-old adolescent with a left main stem bronchial inflammatory myofibroblastic tumour, who presented with breathlessness and chest pain; and a 12-year-old girl with a tracheal inflammatory myofibroblastic tumour who presented with stridor. In each case, the tumour was resected surgically.

CONCLUSION

Inflammatory myofibroblastic tumour are a rare but clinically important and pathologically distinct lesion of the respiratory tract in children. The cases in this series highlight some of the varied clinical presentations of inflammatory myofibroblastic tumours, and illustrate some of this tumour's different anatomical locations within the paediatric respiratory tract.

Inflammatory myofibroblastic tumor of the trachea

This report described a 2-year-old boy who was presented with severe respiratory distress and stridor. Bronchoscopy and CT revealed a mass in the left anterolateral tracheal wall and histopathology showed a tracheal inflammatory myofibroblastic tumor. Initial removal by rigid bronchoscopy resulted in prompt recurrence of the tumor. Therefore, he underwent tracheal surgical resection. A bronchoscopy at 12 months after surgery did not show any recurrence sign.