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Mahadev DS, Praveen NVS, Suryadevara A, Naga Kishore MG. Inflammatory myofibroblastic disease of right petrous apex: A rare case with review of literature. J Cancer Res Ther 2024; 20:1077-1080. [PMID: 38261452 DOI: 10.4103/jcrt.jcrt_1451_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/12/2023] [Indexed: 01/25/2024]
Abstract
ABSTRACT Inflammatory myofibroblastic tumor (IMFT) is a rare tumor of unknown etiology. It can involve any part of the body. The IMFT involving the base of skull is rare with only 36 cases reported in the literature. We report a rare case of IMFT of temporal bone with review of literature. A 42 year old male presented with complaints of headache and double vision and MRI brain showed lesion in the right petrous apex region suggestive of a neurogenic mass. He had excision of lesion and histopathology was suggestive of IMFT with IgG4 and ALK positive. He had complete clinical response but a month later he presented with right eyelid ptosis and decreased rotation of eye medially with recurrent lesion on MRI. Patient received radiation by SRT technique and then started on Ceretinib with partial response. The IMFT is rare tumor of unknown etiology and tumors of temporal bone are more aggressive. It is benign but locally invasive tumor. Treatment of IMFT is controversial. Extensive surgery with complete excision has about 80% response rates and with intracranial extension, adjuvant radiation is need. In head and neck IMFT response rates are lower (30 to 40%). Monoclonal antibodies and steroids are used in IMFT at recurrence. In advanced or metastatic ALK positive tumors, Crizotinib is used with a response rate of 50%. Radiotherapy (25 to 30 Gy) induces remission and helps to taper the steroids. Temporal bone IMFT is a rare tumor with multimodality approach and variable response to treatment.
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Affiliation(s)
- Doddala Sankara Mahadev
- Nuclear Medicine, King George Hospital, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | - N V S Praveen
- Consultant Radiation Oncologist, Omega Hospital, Guntur, Andhra Pradesh, India
| | - Aparna Suryadevara
- Department of Radiation Oncology, Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - M G Naga Kishore
- Consultant Surgical Oncologist, Omega Hospital, Guntur, Andhra Pradesh, India
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Huang SH, Chuang CC, Huang CC, Jung SM, Lee CC. Diagnosis and Treatment of Inflammatory Pseudotumor with Lower Cranial Nerve Neuropathy by Endoscopic Endonasal Approach: A Systematic Review. Diagnostics (Basel) 2022; 12:2145. [PMID: 36140546 PMCID: PMC9497500 DOI: 10.3390/diagnostics12092145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory pseudotumor (IPT) is a non-neoplastic condition of unknown etiology. IPT with lower cranial nerve (CN IX, X, XI, XII) neuropathies is extremely rare. In this study, we systematically reviewed all previously reported cases regarding the management of IPT with lower cranial nerve neuropathies. We searched the PubMed/MEDLINE database for reports related to IPT with lower cranial nerve neuropathies. A total of six papers with 10 cases met the inclusion criteria (mean age 51.6 years, 70% male). The mean follow-up period was 15.4 months (range: 1-60 months). The most frequent treatment was corticosteroids alone (60%), followed by surgery alone (20%), and multimodal treatment (20%). Corticosteroid therapy was associated with an excellent (100%) response rate at 6 months of follow-up, and half of the patients were in complete remission after 9 months. Both cases who received surgery had persistent neurological deficits. Immediate complete remission of neurological symptoms and resolution on imaging after decompression surgery via an endoscopic endonasal approach (EEA) with corticosteroids was demonstrated in our representative case. This review suggests that EEA is a preferred method for diagnosis and treatment, a promising approach associated with favorable outcomes, and a viable first-line treatment for selected cases, followed by multimodal therapy.
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Affiliation(s)
- Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan 33382, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33301, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33301, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan 33382, Taiwan
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan
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Imamura K, Hosoya M, Kasuya K, Shimanuki MN, Shinden S, Ogawa K, Oishi N. Labyrinthine destruction caused by inflammatory pseudotumor of the temporal bone: A report of three cases and review of the literature. Laryngoscope Investig Otolaryngol 2021; 6:857-865. [PMID: 34401513 PMCID: PMC8356880 DOI: 10.1002/lio2.609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumors (IPTs) are rare, idiopathic, and inflammatory lesions that are histopathologically benign. Here, we present three cases of labyrinthine destruction caused by an IPT. METHODS The first patient was a 74-year-old male with a mass lesion extending from the inner ear to the external ear canal. The second patient was a 62-year-old female with a foliated polycystic lesion in the petrous bone on the dorsal side of the left internal auditory canal. The third patient was a 68-year-old female with a mass extending from the inner ear to the middle ear, destroying the semicircular canal and cochlea. RESULTS In two cases, we performed surgical resection successfully with no recurrence. In the other case, the lesion showed shrinkage after chemotherapy for colorectal cancer incidentally found during the examination process. CONCLUSION Surgical technique and indication for IPT should be based on the location and function of the lesion. In addition, there is room to consider pharmacotherapy as a treatment option for IPT of the temporal bone. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Kanako Imamura
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Makoto Hosoya
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Kento Kasuya
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Marie N. Shimanuki
- Department of OtolaryngologySaiseikai Utsunomiya HospitalUtsunomiya‐shiJapan
| | - Seiichi Shinden
- Department of OtolaryngologySaiseikai Utsunomiya HospitalUtsunomiya‐shiJapan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
| | - Naoki Oishi
- Department of Otorhinolaryngology‐Head and Neck SurgeryKeio University School of MedicineTokyoJapan
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Inflammatory Pseudotumor of the Temporal Bone Leading to Atypical Superior Semicircular Canal Dehiscence Syndrome: A Novel Case Report. Otol Neurotol 2021; 42:e1062-e1066. [PMID: 34149029 DOI: 10.1097/mao.0000000000003218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Inflammatory pseudotumor of the temporal bone is a benign idiopathic inflammatory process that is rarely encountered in clinical practice. We describe a novel case of a patient who developed superior semicircular canal dehiscence syndrome in the setting of active inflammatory pseudotumor of the temporal bone. PATIENT One female patient found to have inflammatory pseudotumor of the temporal bone. After treatment with mastoidectomy and steroids, she subsequently developed superior semicircular canal dehiscence syndrome. INTERVENTIONS The patient initially underwent myringotomy and pressure equalization tube placement for a unilateral effusion. Imaging with computed tomography and magnetic resonance imaging revealed a lytic mastoid mass. A complete mastoidectomy was diagnostic for inflammatory pseudotumor and the patient was treated with adjuvant long-term corticosteroids. After this procedure, she was discovered to have new development of symptomatic superior semicircular canal dehiscence syndrome. She eventually underwent a trans-mastoid repair of her superior semicircular canal dehiscence. MAIN OUTCOME MEASURES The patient's clinical course is described with emphasis on the development of superior semicircular canal dehiscence syndrome in the setting of active inflammatory pseudotumor of the temporal bone. RESULTS The patient's radiographic and clinical history were found to be consistent with inflammatory pseudotumor of the temporal bone. She underwent a therapeutic mastoidectomy with long-term post-operative corticosteroids. During her post-operative course, she developed symptoms of vertigo, hearing loss, and autophony. She was subsequently diagnosed with superior semicircular canal dehiscence and treated with a trans-mastoid repair of the dehiscence. Her symptoms satisfactorily resolved after this surgery. CONCLUSIONS Inflammatory pseudotumor of the temporal bone is a rare benign inflammatory process. We present what is to our knowledge the first description of superior semicircular canal dehiscence syndrome developing in the setting of inflammatory pseudotumor.
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The Clinical and Radiological Characteristics of Inflammatory Myofibroblastic Tumor Occurring at Unusual Sites. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5679634. [PMID: 29888269 PMCID: PMC5977025 DOI: 10.1155/2018/5679634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 12/26/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) can occur rarely in the soft tissue or joint of the limb. We retrospectively collected IMT cases of these rare sites and analyzed their clinical and imaging appearance. Thirteen cases of IMT were clinically diagnosed and underwent surgical procedures, pathological analyses, and postsurgical follow-up in our two hospitals. Other than one case of IMT of the bladder wall that presented with gross hematuria, none presented with local swelling, fever, or weakness. All the cases of IMT occurring at the bone showed destruction and parosteal soft tissue masses. The boundaries between the mass and normal bone were vague, without calcifications or any periosteal reaction. Five cases of IMF showed continuous enhancement on CT; seven cases demonstrated iso- or hyposignal intensity on T1WI; one case showed hypersignal intensity on T1WI, and eight cases demonstrated a hypersignal intensity signal on T2WI. All the masses located in soft tissues showed clear and sharp boundaries with different sizes of the swelling regions surrounding muscle interspaces. Three cases showed homogeneous enhancement, one case demonstrated heterogeneous enhancement, and two cases showed edge enhancement on enhanced MRI scans. On pathology, all the lesions showed an absence of a pseudocapsule, and four cases of ALK were positive. The radiological manifestations of IMT located at the soft tissue and bones were similar to benign tumors in shape; however, peritumoral edema, parosteal soft tissue, and the invasive rim of IMT are similar to the features of malignant tumors. Different radiological methods should be used to obtain an accurate diagnosis.
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Abstract
OBJECTIVE Inflammatory pseudotumor of the temporal bone is a benign, idiopathic inflammatory process that is locally invasive and a cause of significant morbidity. This study reviews our experience with seven patients and is currently the largest series to date. STUDY DESIGN Retrospective review from January 1, 2014 to January 1, 2016. SETTING Single tertiary medical center. PATIENTS There were five male and two female (n = 7) subjects with a diagnosis of temporal bone inflammatory pseudotumor. The mean age at presentation was 41 years old. The most common presenting symptoms were hearing loss (7/7) and headache (4/7). Four patients demonstrated an inflammatory aural polyp. Two patients experienced facial nerve paralysis. INTERVENTION(S) Seven patients underwent computed tomography and six underwent magnetic resonance imaging. Corticosteroids and antibiotics were the initial treatment of choice. Five patients also underwent surgery. As adjuvant therapy, two patients received Rituximab, one patient received radiation, and one received mycophenolate mofetil. MAIN OUTCOME MEASURE(S) Clinical courses were followed with focus on symptoms, disease recurrence, duration, and treatment. Mean follow-up was 17.8 months. RESULTS The primary lesions demonstrated T2 hypo-intensity and enhancement as well as diffuse dural thickening on magnetic resonance imaging in five of six patients. Histopathology demonstrated chronic inflammation in the setting of hyalinized fibrosis (7/7). All the patients are currently symptomatically stable. CONCLUSION Inflammatory pseudotumor of the temporal bone can cause devastating effects on neurological function and quality of life. Recognition of characteristic imaging and histopathology can expedite appropriate treatment. Patients may require chronic steroid therapy. Adjunctive therapy with radiation and immuno-modulation are currently being explored.
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Mehta RP, Cueva RA, Brown JD, Fliss DM, Gil Z, Kassam AB, Rassekh CH, Schlosser RJ, Snyderman CH, Har-El G. What's New in Skull Base Medicine and Surgery? Skull Base Committee Report. Otolaryngol Head Neck Surg 2016; 135:620-30. [PMID: 17011428 DOI: 10.1016/j.otohns.2006.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 04/27/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Ritvik P Mehta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Abstract
OBJECTIVE To describe the presentation, treatment, and outcome of inflammatory pseudotumors (IPs) of the skull base. DATA SOURCES English-language articles in PubMed, Web of Science, and EMBASE from earliest available through April 2014. STUDY SELECTION Articles were identified using a keyword search for "inflammatory pseudotumor," "inflammatory myofibroblastoma," or "plasma cell granuloma," including a keyword localizing to the skull base. DATA EXTRACTION One hundred papers with 157 cases met inclusion criteria. History, tumor site, initial and subsequent treatment, outcomes, and complications were extracted. Student t test, z test, and analysis of variance were used to analyze demographics, symptoms, sites involved, and outcomes. Odds ratios for site versus initial treatment were calculated. DATA SYNTHESIS At diagnosis, average patient age was 41 years. Approximately 70% of lesions primarily involved the anterior skull base, 29% the lateral skull base, and 1.2% the occiput. The most common initial treatments were steroids (44%), surgery (28%), and surgery with steroids (16%). Anterior lesions were 55.8 times more likely than lateral lesions to be treated initially with steroids (CI, 14.7-212). Seventy-six percent of patients had stable or resolved symptoms after a single course of treatment. CONCLUSION Diagnosis of skull base IP requires ruling out other aggressive pathologies, such as malignancy and infection, and maintaining a high index of suspicion. Surgery is favored for lesions that can be removed in toto with minimal morbidity, as well as steroids for those sites where anatomy limits complete resection, such as within the orbit, cavernous sinus, or brain. An option for larger lesions involving vital anatomy is debulking, followed by postoperative steroids.
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Rodgers B, Bhalla V, Zhang D, El Atrouni W, Wang F, Sundararajan J, Lin J. Bilateral inflammatory myofibroblastic tumor mastoiditis. Head Neck 2015; 37:E142-5. [PMID: 25546323 DOI: 10.1002/hed.23978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Inflammatory myoblastic tumors (IMTs) are rare, mesenchymal neoplasms most commonly located in areas of previous inflammation. In the temporal bone, these tumors typically present as solitary, space-occupying lesions that clinically resemble chronic otitis media. METHODS We present a case of bilateral IMTs with facial nerve involvement, sigmoid sinus thrombosis, leptomeningeal enhancement, and seizures. RESULTS/CONCLUSION This case demonstrates the need for a high index of suspicion of IMT when imaging reveals bilateral mastoid opacification. These tumors are more aggressive than their orbital counterparts and require multimodality therapy to prevent recurrence and alleviate severe neurotologic symptoms.
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Affiliation(s)
- Brian Rodgers
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Hospital, Kansas City, Kansas
| | - Vidur Bhalla
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Hospital, Kansas City, Kansas
| | - Da Zhang
- Department of Pathology and Laboratory Medicine, University of Kansas Hospital, Kansas City, Kansas
| | - Wissam El Atrouni
- Department of Infectious Diseases, University of Kansas Hospital, Kansas City, Kansas
| | - Fen Wang
- Department of Radiation Oncology, University of Kansas Hospital, Kansas City, Kansas
| | | | - James Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Hospital, Kansas City, Kansas
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Inarejos Clemente EJ, Vilanova JC, Riaza Martin L, Guirao-Marín S. A primary inflammatory myofibroblastic tumor of the scapula in a child: imaging findings. Skeletal Radiol 2015; 44:733-7. [PMID: 25307049 DOI: 10.1007/s00256-014-2023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/18/2014] [Accepted: 09/28/2014] [Indexed: 02/02/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor characterized by inflammatory cell infiltration and differentiated myofibroblastic spindle cells. IMT was first described in the lung and retroperitoneum. Occurrence in bone has been well described in the maxilla and occasionally in the long bones in the adult population. We present a unique case of IMT arising primarily from the scapula in an 8-year-old patient, not described previously in the pediatric or adult literature. Imaging demonstrated an ill-defined and aggressive osteolytic lesion with cortical bone destruction associated with an important soft tissue component that extended into the adjacent muscles. Histologically, the tumor was composed of spindle and polygonal cells distributed in an inflammatory background with different proportions of plasma cells, lymphocytes, eosinophils and neutrophils. The absence of cellular atypia helped to differentiate this entity from malignant spindle cell tumors, and imaging could differentiate the tumor from the nontumoral inflammatory reaction.
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Opacification of the middle ear and mastoid: imaging findings and clues to differential diagnosis. Clin Radiol 2015; 70:e1-e13. [DOI: 10.1016/j.crad.2014.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
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Spinazzi EF, Desai SV, Fang CH, Jyung RW, Liu JK, Baredes S, Eloy JA. Lateral skull base Inflammatory pseudotumor: A systematic review. Laryngoscope 2015; 125:2593-600. [DOI: 10.1002/lary.25308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/30/2014] [Accepted: 03/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Eleonora F. Spinazzi
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Stuti V. Desai
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Christina H. Fang
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Robert W. Jyung
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - James K. Liu
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey U.S.A
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
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Inflammatory Pseudotumor of the Infratemporal Fossa Leading to Orbital Apex Syndrome. J Craniofac Surg 2014; 25:1324-6. [DOI: 10.1097/scs.0000000000000789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Wallace ZS, Deshpande V, Stone JH. Ophthalmic manifestations of IgG4-related disease: single-center experience and literature review. Semin Arthritis Rheum 2013; 43:806-17. [PMID: 24513111 DOI: 10.1016/j.semarthrit.2013.11.008] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/07/2013] [Accepted: 11/11/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES IgG4-related disease (IgG4-RD) is an inflammatory disorder responsible for fibrosing, tumefactive lesions that can involve the lacrimal gland as well as the extraocular muscles, orbital soft tissues, sclera, and local nerves. We reviewed IgG4-related ophthalmic disease (IgG4-ROD), including the natural history, pathology, and treatment, based on our center's experience and that reported in the literature. METHODS We identified 27 patients with orbital manifestations from our IgG4-RD registry; six were excluded because no pathology was available for review. All 21 cases included had histopathologically confirmed diagnoses of IgG4-RD, 11 of which were of the orbital tissue. Other data were obtained by a retrospective medical records review. MEDLINE and PubMed literature searches in English were conducted to identify articles for a literature review on the topic. RESULTS Patients with IgG4-ROD were predominantly male (57%) and had an average age at symptom onset of 50 years (range: 21-79 years). The lacrimal gland was the most commonly involved structure (62%). Most patients (71%) had bilateral disease and extra-orbital involvement (71%); these patients also had elevated serum IgG4 concentrations compared to those with unilateral disease and no extra-orbital disease. Ten patients improved following rituximab treatment. CONCLUSIONS Ophthalmic involvement is a common manifestation of IgG4-RD and can affect nearly every orbital structure. Consideration of IgG4-RD and accurate diagnosis by biopsy have important implications for prognosis and treatment following the distinction of this condition from the Sjögren syndrome (SjS), granulomatosis with polyangiitis (GPA, formerly Wegener's), sarcoidosis, lymphoma, infection, and other disorders. Rituximab holds promise as an effective steroid-sparing agent or therapy for steroid-resistant cases.
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Affiliation(s)
- Zachary S Wallace
- Division of Allergy, Immunology, and Rheumatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - John H Stone
- Division of Allergy, Immunology, and Rheumatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
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Bag AK, Chapman PR. Neuroimaging: Intrinsic Lesions of the Central Skull Base Region. Semin Ultrasound CT MR 2013; 34:412-35. [DOI: 10.1053/j.sult.2013.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tan B, Loh A, Yong TT, Rangabashyam M, Kein LW. Inflammatory pseudotumor of the endolymphatic sac: a case report. Am J Otolaryngol 2013; 34:574-8. [PMID: 23806875 DOI: 10.1016/j.amjoto.2013.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
The authors present a case of Endolymphatic Sac Inflammatory Pseudotumour treated at our institution and reviewed the relevant literature. This is a benign lesion which arises due to chronic inflammation. It has similar clinical and radiological features as endolymphatic sac tumors and is diagnosed through histopathological examination. To date, there have been over 200 case reports of ELSTs but only 2 case reports of endolymphatic sac pseudotumour. This report highlights the clinical presentation, radiological features, histological characteristics, treatment, and clinical outcomes of endolymphatic sac inflammatory pseudotumours and explores their likely etiology and discusses possible treatment options. Endolymphatic sac inflammatory pseudotumour may represent the end of a spectrum of immune-mediated inflammatory disease of the endolymphatic sac. Based on the experience of managing inflammatory pseudo-tumours elsewhere in the body, there may be a role for high dose steroids in its management.
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Zhou X, Liu T, Chen Z, Zhang Z, Xing G. Inflammatory myofibroblastic tumor of the temporal bone presenting with pulsatile tinnitus: a case report. J Med Case Rep 2013; 7:157. [PMID: 23787119 PMCID: PMC3702445 DOI: 10.1186/1752-1947-7-157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/15/2013] [Indexed: 11/26/2022] Open
Abstract
Introduction Inflammatory myofibroblastic tumor of the temporal bone is an unusual but distinct disease entity. The most common presenting symptoms are otalgia, otorrhea, hearing loss, facial palsy, and vertigo. We describe here what we believe to be the first reported case of a patient presenting with persistent pulsatile tinnitus. The clinical features, radiological and histopathologic findings, and treatment outcomes of the patient are presented. Case presentation A 59-year-old woman of Chinese Han origin presented with complaints of left-sided pulsatile tinnitus and progressive hearing loss for several years. Clinical evaluations revealed a reddish mass behind the intact tympanic membrane, and a moderately severe conductive hearing loss in the left ear. The computed tomographic imaging of the temporal bone demonstrated a slightly ill-defined left middle ear soft tissue mass involving the posterior portion of the mesotympanum and epitympanum, and the mastoid antrum. The patient underwent surgical excision of the lesion which subsequently resolved her symptoms. Postoperative pathology was consistent with an inflammatory myofibroblastic tumor. Conclusions An inflammatory myofibroblastic tumor of the temporal bone can present clinically with pulsatile tinnitus and masquerade as venous hum or vascular tumors of the middle ear; therefore, it should be included in the differential diagnosis of pulsatile tinnitus.
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Affiliation(s)
- Xiaoli Zhou
- Department of Otolaryngology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Hato N, Tsujimura M, Takagi T, Okada M, Gyo K, Tohyama M, Tauchi H. Infantile inflammatory pseudotumor of the facial nerve as a complication of epidermal nevus syndrome with cholesteatoma. Auris Nasus Larynx 2013; 40:569-72. [PMID: 23433476 DOI: 10.1016/j.anl.2012.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 11/21/2012] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
Abstract
The first reported case of facial paralysis due to an inflammatory pseudotumor (IPT) of the facial nerve as a complication of epidermal nevus syndrome (ENS) is herein presented. A 10-month-old female patient was diagnosed with ENS at 3 months of age. She was referred to us because of moderate left facial paralysis. Epidermal nevi of her left auricle extended deep into the external ear canal. Otoscopy revealed polypous nevi and cholesteatoma debris filling the left ear. Computed tomography showed a soft mass filling the ear canal, including the middle ear, and an enormously enlarged facial nerve. Surgical exploration revealed numerous polypous nevi, external ear cholesteatoma, and tumorous swelling of the facial nerve. The middle ear ossicles were completely lost. The facial paralysis was improved after decompression surgery, but recurred 5 months later. A second operation was conducted 10 months after the first. During this operation, facial nerve decompression was completed from the geniculate ganglion to near the stylomastoid foramen. Histological diagnosis of the facial nerve tumor was IPT probably caused by chronic external ear inflammation induced by epidermal nevi. The facial paralysis gradually improved to House-Blackmann grade III 5 years after the second operation.
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Affiliation(s)
- Naohito Hato
- Department of Otolaryngology, Ehime University School of Medicine, Ehime, Japan.
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Inflammatory pseudotumor of the temporal bone: three cases and a review of the literature. Case Rep Med 2013; 2013:480476. [PMID: 23424593 PMCID: PMC3568886 DOI: 10.1155/2013/480476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/07/2012] [Accepted: 12/21/2012] [Indexed: 12/03/2022] Open
Abstract
Inflammatory pseudotumor (IP) is a clinically aggressive but histologically benign condition of unknown cause. Its appearance in the temporal bone is uncommon. We present clinical, radiological, and histopathologic findings of three cases originating in the temporal bone. In the first case, a simultaneous IP of the temporal bone and parotid gland was found with histopathologic confirmation. In the second case, an enlarged cervical node, which was also believed to be related to IP, was observed accompanied with the temporal lesion. While the third case presented with chronic suppurative otitis media. Two of them were treated by surgery alone with complete resolve of the diseases. Another one underwent tympanomastoidectomy in combination with oral steroids, radiation, and chemotherapy, but the IP still recurred. A comprehensive review of the literature on clinical features of the temporal pseudotumor was conducted.
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Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics 2012; 32:151-73. [PMID: 22236899 DOI: 10.1148/rg.321105758] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The petrous apex is a complex region of the central skull base that is surrounded by a number of important vascular and neural structures and can be home to a wide range of disease processes. Lesions arising in or spreading to the petrous apex cause varied and occasionally severe clinical sequelae, which typically result from mass effect or direct invasion of the cranial nerves, brainstem, or internal carotid artery. Because the petrous apex is not amenable to direct examination, cross-sectional imaging with computed tomography and magnetic resonance (MR) imaging plays an important role in diagnosis and characterization of lesions occurring there. Petrous apex lesions can be classified on the basis of their origin into the following categories: developmental lesions, inflammatory lesions, benign tumors, malignant tumors, vascular lesions, and osseous dysplasias. The most common lesions arising in the petrous apex are cholesterol granulomas, which can be reliably diagnosed with MR imaging due to their high signal intensity on both T1-weighted images and T2-weighted images. In addition, one should also be familiar with anatomic variants or pseudolesions in the petrous apex that can be mistaken for pathologic conditions.
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Affiliation(s)
- Ahmed Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Jung KH, Kim YW, So YK, Choi SI, Baek MJ. Inflammatory myofibroblastic tumor involving ear lobule. Auris Nasus Larynx 2012; 39:631-3. [PMID: 22341335 DOI: 10.1016/j.anl.2012.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/20/2012] [Accepted: 01/20/2012] [Indexed: 11/18/2022]
Abstract
We present herein an extremely rare case of an inflammatory myofibroblastic tumor (IMT) of the ear lobule with its management. A 50-year-old woman presented with a wart-like mass between the ear lobule and the facial skin. She had been accidentally lacerated her left ear lobule and visited our clinic. The mass had been incidentally found by the patient 1 year before the trauma and growing slowly without pain. Surgical excision and primary closure was performed. Histopathologic examination demonstrated ill-defined margined nodular proliferation of spindle cells in deep dermis with focal stromal hyalinization and lymphoplasmacytic infiltration compatible with the IMT. The patient showed no evidence of recurrence 6 months after surgery. To our knowledge, this is the first report of an IMT occurred in the external ear. Auricular IMT of our case was not aggressive in clinical nature and treated optimally with surgical excision.
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Affiliation(s)
- Kyu Hwan Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 1435 Jwa dong, Haeudae-gu, Busan, Republic of Korea
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23
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Nasopharyngeal inflammatory pseudotumor showing abducens nerve palsy. Auris Nasus Larynx 2011; 38:543-6. [DOI: 10.1016/j.anl.2010.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 01/22/2023]
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Abstract
Inflammatory pseudotumor is a non-neoplastic inflammatory process. Histologically these lesions appear as an inflammatory infiltrate with a fibrotic background. Clinical presentations vary from slow growth with minimal mass effect, to bony destruction that can mimic malignancy. Although they occur most commonly in the orbit, there are a growing number of case reports of tumors of the temporal bone and skull base. Inflammatory pseudotumors of the temporal bone are best treated by excision, with radiation and steroid therapy reserved for inoperable tumors. The clinical, histologic, and radiographic features of two patients with inflammatory pseudotumor of the temporal bone are presented.
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Affiliation(s)
- Barry Strasnick
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia
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Santaolalla-Montoya F, Ereño C, Zabala A, Carrasco A, Martínez-Ibargüen A, Sánchez-Fernández JM. Inflammatory myofibroblastic tumor of the temporal bone: a histologically nonmalignant lesion with fatal outcome. Skull Base 2011; 18:339-43. [PMID: 19240833 DOI: 10.1055/s-0028-1086060] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMFT) of the temporal bone is an unusual but distinct clinicopathologic entity. CASE REPORT We report the case of a 75-year-old patient with an IMFT located in the temporal bone. Symptoms included VI, X, XI, and XII cranial nerves palsies. Computed tomography and magnetic resonance images are described. The lesion was locally aggressive and outcome was fatal. IMFT was identified by analysis of postmortem specimen with histopathologic and immunohistochemical confirmation. DISCUSSION IMFT can be locally destructive lesions. Involvement of the skull base and cervical spine is indistinguishable from an aggressive infection or a malignant tumor and can be fatal as in our case report. The difficulties in establishing clinicopathologic diagnosis, radiological imaging characteristics, and treatment are discussed.
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Affiliation(s)
- Francisco Santaolalla-Montoya
- Department of Otorhinolaryngology, Basurto Hospital, Bilbao School of Medicine, University of the Basque Country, Bilbao, Spain
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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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Ajibade DV, Tanaka IK, Paghdal KV, Paghda KV, Mirani N, Lee HJ, Jyung RW. Inflammatory pseudotumor (plasma cell granuloma) of the temporal bone. EAR, NOSE & THROAT JOURNAL 2010; 89:E1-13. [PMID: 20628971 DOI: 10.1177/014556131008900701] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We report the case of a 41-year-old man who presented with progressive right-sided ear pressure, otalgia, hearing loss, tinnitus, and intermittent otorrhea. Computed tomography and magnetic resonance imaging detected a soft-tissue mass in the right mastoid with intracranial invasion and erosion through the tegmen tympani and mastoid cortex. Histopathologic examination was consistent with an inflammatory pseudotumor (plasma cell granuloma). These lesions rarely occur in the temporal bone. When they do, they are locally destructive and can erode bone and soft tissues. Aggressive surgery is recommended as a first-line treatment, with adjunctive steroid or radiotherapy reserved for residual or refractory disease. Our patient subsequently experienced multiple recurrences, and his treatment required all of these modalities. At the most recent follow-up, he was disease-free and doing well.
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Affiliation(s)
- Dare V Ajibade
- Division of Otolaryngology, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Curry JM, King N, O'Reilly RC, Corao D. Inflammatory pseudotumor of the inner ear: are computed tomography changes pathognomonic? Laryngoscope 2010; 120:1252-5. [PMID: 20513047 DOI: 10.1002/lary.20902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case study presents a report of inflammatory pseudotumor of the inner ear in a child, discusses radiographic findings and clinical management, and reviews the current literature on this rare disease. A 2.5-year-old presented with otalgia, transient vertigo, and fluctuating facial palsy partially responsive to myringotomy with tube. Work-up for infectious and neoplastic processes was negative. Computed tomography (CT) of the temporal bone showed a very unusual, expansile, erosive appearance to the otic capsule, and magnetic resonance imaging of the temporal bone revealed soft tissue enhancement of the middle ear, mastoid, and inner ear. The patient's symptoms were transiently responsive to tympanomastoidectomy. Inner ear histopathology after labyrinthectomy revealed changes consistent with pseudotumor. Inflammatory pseudotumor of the inner ear is extremely rare but needs to be considered in cases of refractory otitis media with facial palsy, particularly when certain changes appear on CT of the temporal bone.
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Affiliation(s)
- Joseph M Curry
- Department of Otolaryngology, Head and Neck Surgery, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Immunoglobulin G4 related systemic sclerosing disease involving the temporal bone. The Journal of Laryngology & Otology 2010; 124:1106-10. [DOI: 10.1017/s0022215110001143] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To report a rare condition affecting the temporal bone. Immunoglobulin G4 related systemic sclerosing disease is a recently described autoimmune condition with manifestations typically involving the pancreas, biliary system, salivary glands, lungs, kidneys and prostate. Histologically, it is characterised by T-cell infiltration, fibrosis and numerous immunoglobulin G4-positive plasma cells. This condition previously fell under the umbrella diagnosis of inflammatory pseudotumour and inflammatory myofibroblastic tumour.Case report:We present the case of a 58-year-old woman with multiple inflammatory masses involving the pharynx, gall bladder, lungs, pelvis, omentum, eyes and left temporal bone, over a seven-year period. We describe this patient's unusual clinical course and pathological features, which resulted in a change of diagnosis from metastatic inflammatory myofibroblastic tumour to immunoglobulin G4 related systemic sclerosing disease. We also review the literature regarding the management of inflammatory pseudotumours of the temporal bone, and how this differs from the management of immunoglobulin G4 related systemic sclerosing disease.Conclusion:We would recommend a full review of all histological specimens in patients with a diagnosis of temporal bone inflammatory pseudotumour or inflammatory myofibroblastic tumour. Consideration should be given to immunohistochemical analysis for anaplastic lymphoma kinase and immunoglobulin G4, with measurement of serum levels of the latter. Management of the condition is medical, with corticosteroids and immunosuppression, rather than surgical excision.
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Inflammatory Pseudotumor of the Petrous Apex With Spontaneous Improvement of the Lesion. Otol Neurotol 2009; 30:245-7. [DOI: 10.1097/mao.0b013e318173fc18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Inflammatory pseudotumor in the middle ear cavity. Int J Pediatr Otorhinolaryngol 2008; 72:1569-72. [PMID: 18676029 DOI: 10.1016/j.ijporl.2008.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 06/23/2008] [Accepted: 06/25/2008] [Indexed: 11/22/2022]
Abstract
Inflammatory pseudotumor includes a diverse group of lesions characterized by inflammatory cell infiltration and variable fibrotic responses. It is extremely rare in the middle ear alone. A 7-year-old girl presented right hearing impairment. Because an otitis media with effusion was first suspected, a myringotomy was performed, but it found a mass that was different from a congenital cholesteatoma. Canal wall-down tympanomastoidectomy removed the mass successfully. The pathologic study of the specimen confirmed an inflammatory pseudotumor. We report an extremely rare case of the inflammatory pseudotumor in the middle ear with a review of the poor literature about this subject.
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Kasliwal MK, Suri A, Gupta DK, Suri V, Rishi A, Sharma BS. Sphenoid wing inflammatory pseudotumor mimicking a clinoidal meningioma: case report and review of the literature. ACTA ACUST UNITED AC 2008; 70:509-13; discussion 513. [PMID: 18207558 DOI: 10.1016/j.surneu.2007.07.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 07/21/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Inflammatory pseudotumor is a nonneoplastic process of unknown etiology most frequently involving the lungs and orbits. Primary intracranial inflammatory pseudotumors are exceptionally rare. The authors report a rare case of clinoidal inflammatory pseudotumor mimicking a medial sphenoid wing meningioma. CASE DESCRIPTION A 24-year-old woman presented with visual diminution and proptosis in the left eye for one and a half years. Imaging revealed a medial sphenoid wing mass, which was surgically decompressed. Histopathology confirmed the diagnosis of inflammatory pseudotumor after which she was treated with steroids. The patient is doing well at 3 months' follow-up with resolution of proptosis and no further diminution of vision. CONCLUSION Inflammatory pseudotumors can mimic a malignant tumor both radiologically and clinically. The treatment options consist of surgery, high-dose steroids, irradiation, and chemotherapeutic agents with variable therapeutic response. Intracranial involvement due to inflammatory pseudotumor is exceptionally rare. The importance of recognizing and appropriately diagnosing this rare intracranial pathology lies in prognostication and avoidance of overzealous treatment.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi 110029, India
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Lee RG, Weber DE, Ness AB, Wasman JK, Megerian CA. Inflammatory pseudotumor of the middle ear masquerading as Bell's palsy. Am J Otolaryngol 2007; 28:423-6. [PMID: 17980777 DOI: 10.1016/j.amjoto.2006.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Indexed: 11/17/2022]
Abstract
We describe the case of a 28-year-old woman who presented with an acute dense left facial paralysis. Magnetic resonance imaging demonstrated enhancement of the labyrinthine portion of the facial nerve, and Bell's palsy was the presumed initial diagnosis. After 2 months without recovery despite receiving steroid and antiviral therapy, the patient underwent further workup. Computed tomographic scan demonstrated a mass lesion adjacent to the tympanic portion of the facial nerve, and electromyography showed active denervation and prominent fibrillation potentials. Surgical excision of the tumor was performed with decompression and sparing of the facial nerve. Histologically, the tumor proved to be an inflammatory pseudotumor (IPT). At the 3-year follow-up, the patient had an improvement in her facial nerve function, progressing to a House-Brackman grade III. An IPT can masquerade as Bell's palsy with sudden complete facial paralysis. Failure to obtain even slight recovery in Bell's palsy should prompt further workup, including appropriate imaging, to assess for a mass lesion. Confusion of an IPT with a nerve-based tumor on frozen section and imaging could lead to inappropriate resection and cable grafting of the facial nerve. Therefore, the relationship between an IPT and facial nerve paralysis is vital and must be recognized for treatment and to maximize postoperative facial nerve function.
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Affiliation(s)
- Richard G Lee
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH, USA
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Cho KJ, Lee DH, Jung SH, Kim JH. A case of an inflammatory myofibroblastic tumor of the mastoid presenting with chronic suppurative otitis media. Auris Nasus Larynx 2007; 34:523-6. [PMID: 17467217 DOI: 10.1016/j.anl.2007.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 02/22/2007] [Accepted: 03/02/2007] [Indexed: 10/23/2022]
Abstract
Inflammatory myofibroblastic tumors, also known as inflammatory pseudotumors, include a diverse group of lesions characterized by inflammatory cell infiltration and variable fibrotic responses. Their occurrence in the temporal bone is unusual. We present a case of an inflammatory myofibroblastic tumor of the mastoid bone in a 55-year-old female who complained of repeated otorrhea and a hearing impairment. On an otoscopic exam, her tympanic membrane was perforated. The computed tomographic imaging revealed a soft-tissue density-filled middle ear and mastoid with sclerotic bony change. The initial clinical diagnosis was chronic suppurative otitis media and mastoiditis, and the patient underwent a canal-wall down tympanomastoidectomy through a retroauricular approach. A histopathologic examination showed the presence of myofibroblastic spindle cells with mixed inflammatory infiltrates, and the pathologic diagnosis was inflammatory myofibroblastic tumor.
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MESH Headings
- Chronic Disease
- Diagnosis, Differential
- Ear Neoplasms/diagnosis
- Ear Neoplasms/pathology
- Ear Neoplasms/surgery
- Ear, Middle/pathology
- Ear, Middle/surgery
- Female
- Granuloma, Plasma Cell/diagnosis
- Granuloma, Plasma Cell/pathology
- Granuloma, Plasma Cell/surgery
- Humans
- Mastoid/pathology
- Mastoid/surgery
- Mastoiditis/diagnosis
- Mastoiditis/pathology
- Mastoiditis/surgery
- Middle Aged
- Myofibroma/diagnosis
- Myofibroma/pathology
- Myofibroma/surgery
- Otitis Media, Suppurative/diagnosis
- Otitis Media, Suppurative/pathology
- Otitis Media, Suppurative/surgery
- Otoscopy
- Skull Neoplasms/diagnosis
- Skull Neoplasms/pathology
- Skull Neoplasms/surgery
- Tomography, X-Ray Computed
- Tympanic Membrane Perforation/diagnosis
- Tympanic Membrane Perforation/etiology
- Tympanic Membrane Perforation/surgery
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Affiliation(s)
- Kwang-Jae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Secho-gu, Seoul 137-701, Republic of Korea
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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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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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McCall T, Fassett DR, Lyons G, Couldwell WT. Inflammatory pseudotumor of the cavernous sinus and skull base. Neurosurg Rev 2006; 29:194-200. [PMID: 16565875 DOI: 10.1007/s10143-006-0017-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 11/02/2005] [Accepted: 11/04/2005] [Indexed: 11/29/2022]
Abstract
Inflammatory pseudotumor is a non-neoplastic process of unknown etiology characterized by a proliferation of connective tissue with an inflammatory infiltrate. Intracranial inflammatory pseudotumors classically involve the cavernous sinus but can also occur in the supratentorial or infratentorial compartments and spinal canal. Symptoms are dependent on location, and, when present in the cavernous sinus, typically include cranial nerve palsies of those nerves in the cavernous sinus. These lesions are rapidly responsive to steroid therapy. Surgery is typically indicated for biopsy only, but complete resection may be justified for lesions outside the cavernous sinus.
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Affiliation(s)
- Todd McCall
- Department of Neurosurgery, University of Utah, 30 North 1900 East, Suite 3B409, Salt Lake City, UT, 84132, USA
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Oral inflammatory myofibroblastic tumor demonstrating ALK, p53, MDM2, CDK4, pRb, and Ki-67 immunoreactivity in an elderly patient. ACTA ACUST UNITED AC 2006; 99:716-26. [PMID: 15897859 DOI: 10.1016/j.tripleo.2004.11.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a controversial lesion composed of myofibroblasts, accompanied by varying numbers of inflammatory cells. Various pathogenetic factors have been proposed (ie, reactive, infectious, autoimmune, and neoplastic) but the etiology of most IMTs remains unknown. Here we review the literature of oral IMTs, detailing the demographic profile of these rare lesions. Moreover, we present an unusual case of IMT arising from the mandibular alveolar mucosa of an 82-year-old female. Microscopic examination revealed plump spindle cells set in a myxoid vascular stroma admixed with inflammatory cells. Numerous large ganglion cell-like cells were seen, some exhibiting emperipolesis of neutrophils. Ultrastructurally, prominent myofibroblasts with abundant rough endoplasmic reticulum were noted. Tumor cells were immunoreactive for vimentin, smooth muscle actin, and KP1 (CD68), and negative for desmin, S-100, and EBV-LMP. The lesion was excised without margins and the patient has manifested no evidence of disease at an 18-month recall. In an attempt to further delineate the potential neoplastic nature of this lesion, we assessed the immunohistochemical expression of various markers that have been linked to neoplastic transformation. The recorded positivity for ALK, p53, MDM2, CDK4, pRb, and Ki-67, despite the absence of bcl-2 reactivity, strongly favors the neoplastic origin of the studied tumor.
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