Multifocal omental mesenteric inflammatory pseudotumor (plasma cell granuloma)

Imaging findings of inflammatory myofibroblastic tumor from the greater omentum: One case report

RATIONALE

Inflammatory myofibroblastic tumors (IMTs) are rare neoplastic lesions with benign tendency. Even more rare are IMTs from the greater omentum (GO-IMT). A GO-IMT is easily misdiagnosed as other malignant tumors before operation; thus, clinicians need to be familiar with its imaging findings. Here, we report the imaging findings of a GO-IMT patient presenting with a pelvic mass.

PATIENT CONCERNS

Ultrasound of the IMT in the pelvic cavity showed a hypoechoic mass. A computed tomography (CT) scan showed a nearly circular soft tissue mass with a clear border and heterogeneous density, and the surrounding tissues were pushed and compressed. Contrast-enhanced CT showed severe persistent enhancement in the lesion edges and mural nodules, but not in the central necrosis.

DIAGNOSES

Histopathology and immunohistochemistry confirmed that the mass was a GO-IMT.

INTERVENTIONS

The tumor was resected after preoperative preparation.

OUTCOMES

No recurrence or metastasis was found during a short-term follow-up.

LESSONS

The GO-IMT is an inferior epigastric mass in the periphery of the bowel, and is usually well-demarcated without calcification or lymphadenopathy. Contrast-enhanced CT showed a heterogeneous hypervascular mass where the center necrosis, the edge of the tumor, and the mural nodules can be partially reinforced.

Mesenteric inflammatory pseudotumor: a case report and comprehensive literature review

PURPOSE

This study aims to provide an overview of the literature on mesenteric/omental inflammatory pseudotumors (IPTs).

METHODOLOGY

We present a new case of mesenteric IPT. We also conducted a systematic search of the English-language medical literature using PubMed, Medline, Google, and Google Scholar related to mesenteric or omental IPTs. The following search terms were used in various combinations: inflammatory myofibroblastic tumor, IPT, mesentery, and omentum. The search included articles published in the English language between January, 1978 and April, 2014. Studies were excluded if the full text was unavailable or missing information prohibited comparisons.

RESULTS

A total of 30 reports concerning 36 patients with inflammatory pseudotumors meeting the aforementioned criteria were included. The patients were aged from 10 months to 68 years (mean, 19.98 ± 20.5 years); 12 were female (16.75 ± 16.97 years; range, 10 months to 68 years) and 24 were male (21.6 ± 21.9 years; range, 18 months to 63 years). Detailed clinical and pathologic characteristics of 36 patients with IPTs are provided in Table 1.

CONCLUSION

IPTs may be definitively diagnosed only by histopathological examination and are most effectively treated by resection with negative surgical borders. No consensus has yet been reached regarding when nonsurgical treatment options are most appropriate in management of these lesions. IPTs often recur locally, while distant metastases are very rare. Postoperative close surveillance is essential to detect recurrences early.