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Karibe J, Teranishi J, Kawahara T, Noguchi T, Takeshima T, Osaka K, Kumagai E, Sawazumi T, Fujii S, Uemura H. A diagnostically challenging case of inflammatory myofibroblastic tumor primary to the peritoneum. IJU Case Rep 2024; 7:206-209. [PMID: 38686080 PMCID: PMC11056253 DOI: 10.1002/iju5.12701] [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] [Received: 09/12/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Inflammatory myofibroblastic tumors are difficult to diagnose because of the lack of specific indicators. We describe a diagnostically challenging case of an inflammatory myofibroblastic tumor primary to the peritoneum. Case presentation The patient was a 25-year-old male who presented at our hospital with lower abdominal pain. Computed tomography revealed a mass lesion 80 mm in diameter just above the bladder. This was suspected to be a bleeding tumor of the urachus. Since malignancy could not be ruled out, surgery was planned. This revealed a fragile tumor arising from the peritoneum. Following its removal, the tumor was diagnosed by histopathological analysis as an inflammatory myofibroblastic tumor. Conclusion We describe a case of inflammatory myofibroblastic tumor primary to the peritoneum diagnosed by histopathology. Inflammatory myofibroblastic tumor should be considered in the differential diagnosis of abdominal wall and anterior bladder tumors.
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Affiliation(s)
- Jurii Karibe
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Jun‐ichi Teranishi
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Takashi Kawahara
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Takeaki Noguchi
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Teppei Takeshima
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Kimito Osaka
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
| | - Eita Kumagai
- Department of PathologyYokohama City University Medical CenterYokohamaJapan
| | - Tomoe Sawazumi
- Department of PathologyYokohama City University Medical CenterYokohamaJapan
| | - Satoshi Fujii
- Department of PathologyYokohama City University Medical CenterYokohamaJapan
- Department of PathologyYokohama City University HospitalYokohamaJapan
- Department of Molecular PathologyYokohama City University Graduate School of MedicineYokohamaJapan
| | - Hiroji Uemura
- Department of Urology and Renal TransplantationYokohama City University Medical CenterYokohamaJapan
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Hage L, O’Donnell MA, Abou Chakra M, Kime A, Sibony M, Peyromaure M, Duquesne I. Inflammatory myofibroblastic tumor of the urinary bladder: A systematic review of the literature and report of a case. Indian J Urol 2024; 40:88-95. [PMID: 38725889 PMCID: PMC11078447 DOI: 10.4103/iju.iju_50_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Inflammatory myofibroblastic tumors (IMTs) are intermediate-grade lesions that frequently recur and rarely metastasize. There are currently no guidelines on the management of bladder IMTs. This systematic review aims to describe the clinical presentation and compare the management options for bladder IMTs. Methods A PubMed/Medline search was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the following Mesh terms: ("inflammatory myofibroblastic") AND ("tumor") OR ("tumor") AND ("bladder") AND ("case report"). A total of 75 case reports were included in the analysis. Results The mean age of the patients was 36 years. 65% of the cases initially presented with hematuria. 68% of the tumors stained positive for anaplastic lymphoma kinase, and 20% invaded the muscularis. Patients underwent either transurethral resection of the bladder tumor (TURBT) only (34%), TURBT followed by complementary partial cystectomy (16%), or TURBT followed by radical cystectomy (4%). 36% and 9% of the cases underwent partial and radical cystectomy after the initial diagnosis, respectively. Cystectomies were performed using an open (74%), laparoscopic (14%), robotic-assisted (10%), or unknown (2%) approach. At a mean follow-up of 14 months, the recurrence and metastasis rates were about 9% and 4%, respectively. In addition, we present the case of a 49-year-old woman with a bladder IMT who underwent TURBT followed by laparoscopic partial cystectomy. The patient remains tumor free postoperatively (follow-up period of 12 months). Conclusion A complete surgical excision of the bladder IMT is crucial for the optimal management of these cases. Proper differentiation of this tumor from sarcoma or leiomyosarcoma leads to the best outcomes.
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Affiliation(s)
- Lory Hage
- Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Michael A O’Donnell
- Department of Urology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohamad Abou Chakra
- Department of Urology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Amel Kime
- Department of Pathology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Mathilde Sibony
- Department of Pathology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Michaël Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
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Nakano K. Inflammatory myofibroblastic tumors: recent progress and future of targeted therapy. Jpn J Clin Oncol 2023; 53:885-892. [PMID: 37394916 DOI: 10.1093/jjco/hyad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
An inflammatory myofibroblastic tumor is a rare component of bone and soft-tissue sarcomas that has distinct pathological features as a lymphoplasmacytic inflammatory infiltrate. As is the case for other non-small round cell sarcomas, surgical resection remains the standard treatment strategy for inflammatory myofibroblastic tumors, but recurrence is possible. Concerning systemic therapy, the available data for conventional chemotherapy (such as those of doxorubicin-based regimens) are limited, and case reports of anti-inflammatory inflammatory myofibroblastic tumor treatments describe some degree of symptom relief and efficacy against tumor progression. However, as more information about cancer genomics accumulates, the potential for molecularly targeted therapies for inflammatory myofibroblastic tumors has become more promising. Approximately half of inflammatory myofibroblastic tumors harbor anaplastic lymphoma kinase (ALK) fusion genes, and the other half could have potentially targetable fusion genes or mutations such as ROS1, NTRK and RET; case reports demonstrating the clinical efficacy of treatments targeted to inflammatory myofibroblastic tumor have been published, as have several prospective clinical trials. Few drugs are approved for the treatment of inflammatory myofibroblastic tumor, and most of them were approved for tumor-agnostic indications. Drugs that could be used for pediatric indications and dosing in inflammatory myofibroblastic tumor have also not been established. To provide effective targeted therapy for rare diseases such as inflammatory myofibroblastic tumor, it is necessary to obtain clinical evidence by designing and performing clinical trials and to find a path toward regulatory approval.
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Affiliation(s)
- Kenji Nakano
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Kawakita Y, Anan K, Kurata K, Koga K, Saimura M, Tamiya S, Nishihara K, Mitsuyama S, Nakano T. Anaplastic lymphoma kinase-positive inflammatory myofibroblastic tumor of the breast: a case report and review of the literature. Surg Case Rep 2023; 9:152. [PMID: 37656266 PMCID: PMC10474000 DOI: 10.1186/s40792-023-01732-6] [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: 04/11/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Few reports of inflammatory myofibroblastic tumor (IMT) of the breast have been published worldwide. Furthermore, primary anaplastic lymphoma kinase (ALK)-positive IMT of the breast is extremely rare. To date, only six patients with ALK-positive IMT have been reported in the literature. CASE PRESENTATION A 52-year-old woman underwent a medical examination, and a left breast mass was detected. She did not feel a mass in her chest. Mammography showed a focal asymmetric density at the lower outer portion of the left breast. Breast ultrasonography showed a 1.2-cm hypoechoic lesion with relatively clear boundaries and poor blood flow. Magnetic resonance imaging and computed tomography revealed a solitary heterogeneous mass in the left breast. Pathologic examination revealed a fibrosing lesion with proliferation of fibroblastic cells arranged in a storiform pattern and admixed inflammatory cells. Immunohistochemical examination showed that the tumor cells were positive for ALK. Under the preoperative diagnosis of IMT, we performed partial mastectomy with adequate margins. The postoperative diagnosis was pathologically confirmed as IMT. Immunohistochemical staining also showed overexpression of ALK-1 in the tumor. The patient had a good clinical course for 24 months postoperatively, without recurrence or metastasis. CONCLUSIONS IMT of the breast shows nonspecific imaging findings, making preoperative diagnosis difficult. Nevertheless, IMT has the characteristics of low-grade neoplasms with recurrence, invasion, and metastatic potential. Our report emphasizes the importance of determining a treatment plan as soon as possible based on an accurate diagnosis to improve the prognosis of this disease.
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Affiliation(s)
- Yasutaka Kawakita
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan.
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Kanako Kurata
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Kenichiro Koga
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Michiyo Saimura
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shoshu Mitsuyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
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Fujiki T, Sakai Y, Ikawa Y, Takenaka M, Noguchi K, Kuroda R, Abe T, Nomura K, Sakai S, Wada T. Pediatric inflammatory myofibroblastic tumor of the bladder with ALK-FN1 fusion successfully treated by alectinib. Pediatr Blood Cancer 2023; 70:e30172. [PMID: 36635892 DOI: 10.1002/pbc.30172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/05/2022] [Accepted: 12/04/2022] [Indexed: 01/14/2023]
Abstract
An inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm characterized by the proliferation of myofibroblasts and inflammatory cell infiltration. Although radical resection is the only established treatment strategy for IMT, it can cause functional disorders when vital organs are affected. We describe a case of pediatric IMT of the bladder with FN1-ALK (fibronectin 1-anaplastic lymphoma kinase) fusion. Radical resection might lead to urinary disturbance due to the large tumor size at diagnosis. However, the tumor was successfully treated with alectinib, a second-generation ALK inhibitor, followed by transurethral resection of the bladder tumor without any complications.
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Affiliation(s)
- Toshihiro Fujiki
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yuta Sakai
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mika Takenaka
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuhiro Noguchi
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Rie Kuroda
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takatoshi Abe
- Department of Pediatric Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kozo Nomura
- Department of Pediatric Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Seisho Sakai
- Department of Pediatric Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Taizo Wada
- Department of Pediatrics, Kanazawa University, Kanazawa, Ishikawa, Japan
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6
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Durham C, Clemons M, Alias A, Konduri K. Locally Advanced Inflammatory Myofibroblastic Tumor Treated With Targeted Therapy: A Case Report and Literature Review. Cureus 2022; 14:e27223. [PMID: 36035049 PMCID: PMC9400374 DOI: 10.7759/cureus.27223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are known to be associated with anaplastic lymphoma kinase (ALK) gene rearrangements. Other molecular alterations such as ROS proto-oncogene 1, receptor tyrosine kinase (ROS1), neurotrophic tyrosine receptor kinase (NTRK), and platelet-derived growth factor receptor (PDGFR) have also been identified in IMTs. Although there are no randomized controlled clinical trials comparing chemotherapy, tyrosine kinase inhibitors (TKIs), or other systemic therapies, the literature demonstrates the use of ALK-targeted TKIs as an effective strategy for the treatment of locally advanced or metastatic ALK-rearranged IMTs. This case report describes a patient with an ALK-rearranged locally advanced pulmonary IMT who was treated with neoadjuvant-intent crizotinib. The patient had a very favorable response to therapy, and surgery was declined. It is difficult to determine the duration and sequencing of TKI use in these settings as there is little published data to guide decisions. This report also includes a comprehensive compilation of published IMT cases with molecular alterations treated with systemic therapy, which also highlighted the duration of therapies and clinical outcomes.
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7
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Gross Hematuria in an Adolescent Secondary to a Rare Bladder Tumor: A Case Report and Review of Inflammatory Myofibroblastic Tumors of the Urinary Bladder. Urology 2022; 165:e39-e45. [DOI: 10.1016/j.urology.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/13/2022] [Accepted: 01/23/2022] [Indexed: 11/19/2022]
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8
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Craig E, Wiltsie LM, Beaupin LK, Baig A, Kozielski R, Rothstein DH, Li V, Twist CJ, Barth M. Anaplastic lymphoma kinase inhibitor therapy in the treatment of inflammatory myofibroblastic tumors in pediatric patients: Case reports and literature review. J Pediatr Surg 2021; 56:2364-2371. [PMID: 33676744 DOI: 10.1016/j.jpedsurg.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Inflammatory myofibroblastic tumors (IMTs) are a rare subtype of inflammatory pseudotumor frequently associated with rearrangement of the anaplastic lymphoma kinase (ALK) gene. Their treatment has historically relied on at-times challenging and morbid surgical excision. Recent studies have shown that neo/adjuvant therapy with ALK inhibitors can significantly enhance outcomes in select patients. METHODS A systematic literature review was performed to characterize comprehensive treatment of ALK-positive IMTs in the pediatric population. This report also includes two patients from our home institutions not previously reported in the literature. RESULTS We identified a total of 27 patients in 12 studies in addition to 2 patients from the senior authors' institution for a total of 29 patients (median age, 7 years; 52% male). The IMTs comprised a wide range of anatomic locations. Almost half (12, 41.3%) were treated with ALK-inhibitors alone and felt to be in remission. The remainder was treated with ALK-inhibitors either before or after surgery and had a curative response. CONCLUSIONS ALK-positive IMTs can be successfully treated with ALK-inhibition alone or in combination with surgical resection. Further genetic characterization may be helpful in determining more precise treatment and defining needed durations thereof.
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Affiliation(s)
- Ethan Craig
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Laura M Wiltsie
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Lynda K Beaupin
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences and Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ayesha Baig
- Division of Pediatric Gastroenterology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Rafal Kozielski
- Department of Pathology, John R. Oishei Children's Hospital, Buffalo, NY, United States
| | - David H Rothstein
- Department of Pediatric Surgery John R. Oishei Children's Hospital and Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.
| | - Veetai Li
- Department of Pediatric Neurosurgery, John R. Oishei Children's Hospital and Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Clare J Twist
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences and Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Matthew Barth
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences and Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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9
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Hensley PJ, Bree KK, Guo CC, Lobo N, Campbell MT, Pettaway CA, Kamat AM. Clinicopathological analysis and outcomes of inflammatory myofibroblastic tumours of the urinary bladder. BJU Int 2021; 130:604-610. [PMID: 34773684 DOI: 10.1111/bju.15638] [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: 05/04/2021] [Revised: 08/28/2021] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe clinical, imaging, and histopathological characteristics of inflammatory myofibroblastic tumour (IMT) of the urinary bladder and provide initial management and surveillance recommendations. PATIENTS AND METHODS We identified patients with IMT of the bladder treated at our facility from 1998 to 2020. Categorical variables were analysed with chi-square and Fisher's exact tests and continuous variables with the Mann-Whitney U-test. Kaplan-Meier analysis was performed for recurrence-free survival. RESULTS IMT was diagnosed in 35 patients with median (interquartile range [IQR]) follow-up of 20 (11.5-68.5) months. At initial diagnosis 86% were clinically organ-confined, 9% locally advanced, and 5% metastatic. Majority of patients (92%) had residual disease on re-staging transurethral resection (TUR). Of the 15 patients with organ-confined disease managed initially with TUR alone, five (33%) recurred at a median (IQR) of 5 (3.0-5.5) months from initial diagnosis. Presentation with visible haematuria was associated with recurrence (100% in recurrence vs 40% in non-recurrence groups, P = 0.044). There were no patients who developed a recurrence beyond 6 months after diagnosis. Partial or radical cystectomy was required in 23% and 9% of patients, respectively. One patient presented with metastatic disease associated with anaplastic lymphoma kinase (ALK) translocation and achieved a durable complete remission with 7 months of crizotinib therapy. CONCLUSIONS No patient with IMT treated with aggressive endoscopic management developed recurrences beyond 6 months. There were additionally no recurrences noted after definitive radical or partial cystectomy. These data support organ sparing therapy with aggressive endoscopic management and short-term surveillance in patients with localised IMT, with extirpative surgery reserved for refractory cases.
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Affiliation(s)
| | - Kelly K Bree
- Department of Urology, MD Anderson Cancer Center, H, TX, USA
| | - Charles C Guo
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Niyati Lobo
- Department of Urology, MD Anderson Cancer Center, H, TX, USA
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, H, TX, USA
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10
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Malnik SL, Moor RF, Shin D, Laurent D, Trejo-Lopez J, Dodd W, Yachnis A, Ghiaseddin AP, Fox WC, Roper S. Inflammatory myofibroblastic tumor masquerading as an anterior choroidal artery fusiform aneurysm. Surg Neurol Int 2021; 12:297. [PMID: 34221627 PMCID: PMC8247755 DOI: 10.25259/sni_113_2021] [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] [Received: 02/06/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Inflammatory myofibroblastic tumor is a rare, poorly understood tumor that has been found to occur in almost every organ tissue. Its location within the central nervous system is uncommon, and patients tend to present with nonspecific symptoms. Case Description: A female in her eighth decade presented to neurosurgery clinic with complaints of headache and dizziness. Initial imaging was consistent with a low-grade, benign brain lesion in the region of the left choroidal fissure. She was recommended for observation but returned 1 month later with progressive symptoms and doubling of the lesion size. She underwent surgical resection and was found to have an IMT arising from the wall of the left anterior choroidal artery. Conclusion: Intracranial IMT remains a rare and poorly understood entity. The present case demonstrates a novel presentation of IMT in an adult patient and exemplifies the heterogeneity of the disease presentation.
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Affiliation(s)
- Samuel Louis Malnik
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Rachel Freedman Moor
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - David Shin
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Dimitri Laurent
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Jorge Trejo-Lopez
- Department of Neuropathology, Mayo Clinic, Rochester, Minnesota, United States
| | - William Dodd
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Anthony Yachnis
- Department of Pathology, University of Florida, Gainesville, United States
| | - Ashley P Ghiaseddin
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - W Christopher Fox
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Steven Roper
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
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11
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Inflammatory Myofibroblastic Tumor of the Upper Airways Harboring a New TRAF3-ALK Fusion Transcript. CHILDREN-BASEL 2021; 8:children8060505. [PMID: 34203606 PMCID: PMC8232338 DOI: 10.3390/children8060505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
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.
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12
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Comandini D, Catalano F, Grassi M, Pesola G, Bertulli R, Guadagno A, Spina B, Mascherini M, De Cian F, Pistoia F, Rebuzzi SE. Outstanding Response in a Patient With ROS1-Rearranged Inflammatory Myofibroblastic Tumor of Soft Tissues Treated With Crizotinib: Case Report. Front Oncol 2021; 11:658327. [PMID: 34211840 PMCID: PMC8239351 DOI: 10.3389/fonc.2021.658327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a very rare subtype of sarcoma, which frequently harbor chromosomal rearrangements, including anaplastic lymphoma kinase (ALK) rearrangements (almost 50% of the IMTs) and other kinase fusions such as ROS1. ROS1 fusions are present in about 10% of IMT, almost half of the ALK-negative IMT patients. Apart from radical surgery for resectable tumors, there is no standard-of-care therapy for advanced IMTs. Nonetheless, the use of tyrosine kinase inhibitors has shown promising efficacy in IMT patients with targetable genomic alterations. We report the case of a 24-year-old patient with chemotherapy-refractory metastatic IMT harboring ROS1 kinase fusion, who experienced a significant clinical and pathological response to crizotinib. This clinical case highlights the need to assess all patients with unresectable IMTs for chromosomal abnormalities and gene mutations and address them to targeted agents as well as clinical trials.
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Affiliation(s)
- Danila Comandini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Catalano
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Massimiliano Grassi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Pesola
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Rossella Bertulli
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Antonio Guadagno
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Bruno Spina
- Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Franco De Cian
- Surgical Clinic Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Federico Pistoia
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
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Takeyasu Y, Okuma HS, Kojima Y, Nishikawa T, Tanioka M, Sudo K, Shimoi T, Noguchi E, Arakawa A, Mori T, Sunami K, Kubo T, Kohno T, Akihiko Y, Yamamoto N, Yonemori K. Impact of ALK Inhibitors in Patients With ALK-Rearranged Nonlung Solid Tumors. JCO Precis Oncol 2021; 5:PO.20.00383. [PMID: 34036223 PMCID: PMC8140781 DOI: 10.1200/po.20.00383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/30/2021] [Accepted: 02/22/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) rearrangement is a well-known driver oncogene in non–small-cell lung cancer and has also been identified in other types of tumors. However, there is limited evidence on the clinical response to ALK tyrosine kinase inhibitors (TKIs), such as alectinib and crizotinib, in rare tumors with ALK fusion. We evaluated the therapeutic effect of ALK-TKIs in rare ALK-rearranged tumors. PATIENTS AND METHODS Between April 2012 and April 2019, clinical outcomes and characteristics of patients with ALK-rearranged nonlung solid tumors who received ALK-TKIs (alectinib and/or crizotinib) outside of clinical trials were reviewed. Expression and/or rearrangement of ALK was evaluated by immunohistochemistry, fluorescence in situ hybridization, and next-generation sequencing. The tumor response was assessed according to RECIST (version 1.1). Progression-free survival was estimated from initial ALK-TKI initiation until progression. RESULTS We identified seven patients (inflammatory myofibroblastic tumors, n = 3; ALK-positive histiocytosis, n = 1; histiocytic sarcoma, n = 1; osteosarcoma, n = 1; and parotid adenocarcinoma, n = 1), with a median age of 17 years. Two rare ALK fusions, namely, CTNNA1-ALK and ITSN2-ALK, were identified. As initial ALK-TKI therapy, five patients received alectinib and two received crizotinib. The objective response rate for the initial ALK-TKI therapy was 85.7% (95% CI, 44 to 97), including two patients who received alectinib and achieved complete response. The median progression-free survival was 8.1 months (range, 1.7 to not estimable). There were no treatment interruptions or dose reductions because of adverse events caused by alectinib. CONCLUSION This study highlights the potential benefit of ALK-TKIs, especially alectinib, in patients with ALK-rearranged nonlung solid tumors.
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Affiliation(s)
- Yuki Takeyasu
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitomi S Okuma
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.,Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Kojima
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tadaaki Nishikawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Maki Tanioka
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuki Sudo
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsunori Shimoi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Emi Noguchi
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumu Arakawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Kuniko Sunami
- Department of Laboratory Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Kubo
- Division of Translational Genomics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan.,Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Takashi Kohno
- Division of Translational Genomics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan.,Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yoshida Akihiko
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan.,Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Kan Yonemori
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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14
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Dao Thi TA. Characteristic Of Inflammatory Myofibrinoblastic Tumor: Retrospective Analysis Of 4 Cases In Children Hospital Number 2. J Clin Med 2020. [DOI: 10.38103/jcmhch.2020.64.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor that involves various organs. Surgery is the mainstay of therapy for this tumor. Approximately half of all IMT cases have anaplastic lymphoma kinase (ALK) rearrangements; therefore, the ALK inhibitor crizotinib is suggested as a promising treatment for unresectable cases with ALK rearrangements. In cases withoutALK rearrangement, chemotherapy is an alternative treatment for unresectable tumors.
Cases report: We report 4 cases of IMT treated in Children Hospital Number 2 since 2018. There was one case with mesenteric tumor, one with perineal tumor detected at birth, one with inferior mediastinal tumor and one with intestinal tumor. We evaluated ALK expression by immunohistochemistry and ALK rearrangement by fluorescence in situ hybridization (FISH) in 3 cases and all negative. Treatments included tumor resection or biopsy and chemotherapy with methotrexate (30mg/m2) day 1 and vincristine (1.5mg/m2) day 1 and 7 in a 3 week cycle together with NSAID or steroid for inflammatory control. There was one case with complete response to surgery and chemotherapy; the other 3 cases ended in death due to tumor recurrence (3 cases) and metastasis (1 case).
Conclusions: IMT has a diverse clinical presentation, appears in many different locations, and the clinical course can progress quickly with high rate of recurrence after incomplete surgical resection. Surgery is the optimal approach, but in those without complete resection and in those with tumor progression, tyrosine kinase inhibition should be considered if there is ALK rearrangement. In the absence of ALK rearrangement, additional tyrosine kinase rearrangements and other potentially efficacious chemotherapy regimens need to be studied for these patients.
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15
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Fan J, Yang M, Huang B, Wang Z, Luo D, Zhang J, Zhang P, Shi H, Li Y, Nie X. ALK expressed in a gastrointestinal stromal tumor harboring PDGFRA p. D842V mutation:a case report. Diagn Pathol 2020; 15:8. [PMID: 32005261 PMCID: PMC6993420 DOI: 10.1186/s13000-020-0926-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common type of adult mesenchymal neoplasms. The events that drive GIST oncogenesis are primarily KIT or PDGFRA mutations, which lead to the susceptibility of these tumors to small-molecule tyrosine kinase inhibitors such as imatinib and sunitinib. However, previous studies have shown that patients with a PDGFRA D842V mutation in GISTs have a very low rate of response to imatinib treatment. Therefore, novel tyrosine kinase inhibitors (TKIs) are currently being evaluated in clinical trials to treat GISTs harboring a PDGFRA D842V mutation. Anaplastic lymphoma kinase (ALK) overexpression was not expected to be present in the GIST, and it has been used as a biomarker to distinguish GISTs from other types of mesenchymal tumors. CASE PRESENTATION Here, we report a 37-year-old male patient who presented with a large mass in the right upper abdomen and was subsequently diagnosed with a GIST harboring a PDGFRA D842V mutation. We unexpectedly found that the GIST in this patient exhibited simultaneous ALK expression. CONCLUSIONS This is the first case reported of a GIST with ALK expression. This rare phenomenon suggests that the diagnosis of a GIST cannot be excluded absolutely if a tumor exhibits ALK expression. In addition, ALK may be a potential therapeutic target for patients with imatinib-resistant stromal tumors.
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Affiliation(s)
- Jun Fan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Ming Yang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Bo Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Zhenkao Wang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Danju Luo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Jiwei Zhang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Peng Zhang
- Department of Gastrointestinal surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yan Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China.
| | - Xiu Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China.
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17
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Targeted Treatment of a Rare Vaginal Sarcoma With an Anaplastic Lymphoma Kinase Inhibitor. Obstet Gynecol 2019; 134:424. [DOI: 10.1097/aog.0000000000003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Tsuboi I, Maruyama Y, Sadahira T, Wada K, Ando N, Mitsui Y, Nishiyama Y, Arata R, Araki M, Nasu Y, Ono N. Inflammatory myofibroblastic bladder tumor with divergent behavior in a patient with spinal cord injury. IJU Case Rep 2019; 2:212-214. [PMID: 32743416 PMCID: PMC7292174 DOI: 10.1002/iju5.12085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction An inflammatory myofibroblastic tumor of the bladder is rare. Some urothelial carcinoma with sarcomatoid changes may mimic an inflammatory myofibroblastic tumor. Case presentation A 76‐year‐old man with indwelling urinary catheters because of a spinal cord injury presented with gross hematuria. Transurethral electrocoagulation and a resection were performed. A T2‐weighted magnetic resonance imaging showed a tumor and hematoma in the bladder diverticulum that pathologically resembled an inflammatory myofibroblastic tumor. This lesion was then removed en bloc by partial cystectomy. Histology showed a squamous cell carcinoma with sarcomatoid changes. After 4 months, a computed tomography showed the lesion had expanded outside the skin adjacent to the bladder. Conclusion Some cases of inflammatory myofibroblastic tumors have a malignant course. Urologists therefore need to be aware of the possibility of rare cases of malignant bladder myofibroblasts.
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Affiliation(s)
- Ichiro Tsuboi
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Department of Urology Kochi Health Sciences Center Kochi City Kochi Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Yuki Maruyama
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Takuya Sadahira
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Koichiro Wada
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Nobuyoshi Ando
- Department of Urology Kochi Health Sciences Center Kochi City Kochi Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Yosuke Mitsui
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Yasuhiro Nishiyama
- Department of Urology Kochi Health Sciences Center Kochi City Kochi Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Ryoji Arata
- Department of Urology Kochi Health Sciences Center Kochi City Kochi Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Motoo Araki
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Yasutomo Nasu
- Department of Urology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Kita-ku Okayama Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
| | - Noriaki Ono
- Department of Urology Kochi Health Sciences Center Kochi City Kochi Japan.,Okayama Urological Research Group (OURG) Kita-ku Okayama Japan
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19
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Brivio E, Zwaan CM. ALK inhibition in two emblematic cases of pediatric inflammatory myofibroblastic tumor: Efficacy and side effects. Pediatr Blood Cancer 2019; 66:e27645. [PMID: 30697903 DOI: 10.1002/pbc.27645] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/07/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
There is an increasing interest for anaplastic lymphoma kinase (ALK) inhibitors in pediatric oncology for specific entities such as ALK-driven inflammatory myofibroblastic tumor (IMT). IMT treatment can be challenging due to localization of the tumor and in rare cases of metastasis. When standard surgical treatment is not feasible, ALK inhibitors may play an important role, as recently reported for the first-generation ALK inhibitors (crizotinib). However, data on the second-generation ALK inhibitors are limited. We report two emblematic cases of IMT in pediatric patients, treated with the second-generation ALK inhibitor ceritinib in the context of a clinical trial (NCT01742286).
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Affiliation(s)
- Erica Brivio
- Prinses Maxima Centrum, Center for Pediatric Oncology, Utrecht, the Netherlands
| | - C Michel Zwaan
- Prinses Maxima Centrum, Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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