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

Endobronchial Inflammatory Myoblastic Tumor (IMT)-A Sleeve to Solve the Issue

Inflammatory myoblastic tumors of the lung are rare benign lesions. Here we present the case of a 15-year-old boy with postobstructive pneumonia. Computed tomography of the chest revealed a mass in the left mainstem bronchus that was confirmed on bronchoscopy. A rigid bronchoscopy with core resection was performed. Findings on pathologic examination were consistent with an inflammatory myoblastic tumor. The initial core resection relieved his postobstructive pneumonia; however, repeat bronchoscopy a month later demonstrated recurrence of the lesion. The tumor was removed with a parenchymal-sparing sleeve resection. At 80 months of follow-up, the patient is without evidence of recurrence or stenosis.

Inflammatory myofibroblastic tumors in children: clinical characteristics and treatment outcomes with a focus on targeted therapies

BACKGROUND

Inflammatory myofibroblastic tumors (IMTs) are rare neoplasms in children. Traditionally, surgical resection has been the primary treatment modality with limited efficacy reported for conventional chemotherapy and radiation therapy. Recently, targeted therapies have emerged as potential options for selected cases. This study aimed to evaluate the demographic, clinical, laboratory, and radiological characteristics, as well as treatment outcomes, in children diagnosed with IMTs.

METHODS

This study involved a retrospective review of medical records for eight children diagnosed with IMTs between 1990 and 2022. We collected demographic, clinical, laboratory, and radiological data, as well as treatment outcomes. Data on tumor characteristics, surgical procedures, and chemotherapy or targeted therapy treatments were extracted.

RESULTS

The mean age at diagnosis was 9 years. None presented with metastatic disease at the time of diagnosis. Anaplastic lymphoma kinase (ALK) positivity was identified in tumor tissue from five patients. Among the six patients who underwent surgical resection, three achieved negative surgical margins. Of the three patients with positive surgical margins, one underwent re-resection, local and metastatic recurrences were noted in another, and one was started on crizotinib. A patient with an inoperable tumor at diagnosis was initiated on crizotinib and achieved complete remission. Ceritinib was administered to a patient with YWHAE-ROS fusion, resulting in more than 90% reduction in tumor volume. The median follow-up time was 67.5 months. The five-year overall survival and event-free survival rates for the cohort were 85.7% and 72.9%, respectively.

CONCLUSIONS

While surgical resection remains the cornerstone of treatment for IMTs, favorable outcomes can be achieved with chemotherapy and targeted therapies in selected cases. Increasing the utilization of targeted therapies may be beneficial, particularly through molecular studies aimed at minimizing the side effects associated with conventional chemotherapy.

Eight patients with inflammatory myofibroblastic tumor treated with rigid bronchoscopy

BACKGROUND

Pulmonary inflammatory myofibroblastic tumor (IMT) accounts for 0.04-0.7% of all lung tumors, and endobronchial IMT accounts for only 10% of all pulmonary IMTs. Little is known about the therapeutic outcomes of rigid bronchoscopy for endobronchial IMT. Here, we report a case series of eight patients with endobronchial IMT underwent rigid bronchoscopy.

METHODS

We retrospectively analyzed eight patients with endobronchial IMT between January 2004 and December 2023.

RESULTS

The median age of our patients was 36 years, and 62.5% were male. Dyspnea was the predominant symptom in cases where the tumor was centrally located (n = 6), whereas hemoptysis was the predominant symptom in peripherally located tumors (n = 2). Most cases had high contrast enhancement and a tumor stalk without bronchial wall invasion on computed tomography (CT) and bronchoscopy. Complete endoscopic resection and laser cauterization via rigid bronchoscopy were possible in five patients. There were only two cases in which tumors remained after the procedure, requiring additional treatment (chemotherapy and surgical resection, respectively). In one patient, surgical resection was performed three weeks after the procedure, and the surgical specimen was free of residual tumor. There was no mortality during the median follow-up duration of 18.8 months.

CONCLUSIONS

Endoscopic resection and laser cauterization using rigid bronchoscopy may serve as a safe and effective alternative treatment modality to surgery for patients with endobronchial IMT.

Tracheal resection anastomosis for rare tracheal inflammatory lesions mimicking malignancy: report of 2 cases

BACKGROUND

Tumor-like lesions of the trachea are rare and challenging in diagnosis and management. Inflammatory myofibroblastoma, also known as Inflammatory pseudo tumors (IPTs), as well as Rosai Dorfman Disease (RDD) are inflammatory lesions that may involve the central airways with variable non-specific clinical features mimicking tumors.

CASE PRESENTATION

In this study 2 cases with tumor-like lesions are presented. One case with an inflammatory pseudotumor and the other one with Rosai-Dorfman disease affecting the upper trachea. Both cases were successfully managed with tracheal resection anastomosis.

CONCLUSION

Tracheal Inflammatory myofibroblastoma, and Rosai-Dorfman diseases are rare tumor like lesions that present with upper airway obstruction. Despite being benign, these lesions may have features suggestive of malignancy, requiring prompt management. Complete surgical excision by segmental resection and primary anastomosis (if feasible) is the treatment of choice with an optimum outcome.

Inflammatory myofibroblastic tumour of the central airways: treatment and molecular analysis

Inflammatory myofibroblastic tumours (IMT) are a rare cause of endobronchial masses in adults. Surgery has been the mainstay of treatment of endobronchial IMTs, based on the potential for recurrence. Interventional pulmonology has emerged as a minimally invasive and lung function preserving modality in management of airway obstruction due to tumours. We present a series of three adult patients with IMT treated endobronchially with a short discussion on its potential role. We also discuss how molecular analysis of IMTs for mutations in genes such as ALK and ROS1 might provide insights into clinical behaviour and potential targetable therapy in advanced, unresectable and metastatic cases.

Bronchoscopic Treatment of Endobronchial Inflammatory Myofibroblastic Tumors

Endobronchial localizations of inflammatory myofibroblastic tumors are very unusual. We report the multimodal, bronchoscopic management of 3 cases, offering durable local control in all cases (including 2 patients who were definitively cured). Although surgery is usually considered the gold standard, therapeutic bronchoscopy should probably be considered as a frontline option for proximal lesions with limited base (< 10 mm²) because of uncommon metastatic spread and delayed local recurrence. Of note, 1 of our cases is a rare airway case after allograft hematopoietic stem cell transplant.

Pediatric airway tumors: A report from the International Network of Pediatric Airway Teams (INPAT)

OBJECTIVE

Primary tracheobronchial tumors (PTTs) are rare heterogeneous lesions arising from any part of the tracheobronchial tree. Nonspecific symptoms may lead to delayed diagnosis that requires more aggressive surgical treatment. An analysis of cases collected by the International Network of Pediatric Airway Team was undertaken to ensure proper insight into the behavior and management of PTTs.

METHODS

Patients <18 years of age with a histological confirmation of PTT diagnosed from 2000 to 2015 were included in this multicenter international retrospective study. Medical records, treatment modalities, and outcomes were analyzed. The patient presentation, tumor management, and clinical course were compared between malignant and benign histotypes. Clinical and surgical variables that might influence event-free survival were considered.

RESULTS

Among the 78 children identified, PTTs were more likely to be malignant than benign; bronchial carcinoid tumor (n = 31; 40%) was the most common histological subtype, followed by inflammatory myofibroblastic tumor (n = 19; 25%) and mucoepidermoid carcinoma (n = 15; 19%). Regarding symptoms at presentation, wheezing (P = 0.001) and dyspnea (P = 0.03) were more often associated with benign growth, whereas hemoptysis was more frequently associated with malignancy (P = 0.042). Factors that significantly worsened event-free survival were age at diagnosis earlier than 112 months (P = 0.0035) and duration of symptoms lasting more than 2 months (P = 0.0029).

CONCLUSION

The results of this international study provide important information regarding the clinical presentation, diagnostic workup, and treatment of PTTs in children, casting new light on the biological behavior of PTTs to ensure appropriate treatments.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:E243-E251, 2020.

Primary tracheobronchial tumors in children

Primary tracheobronchial tumors are rare lesions that can be benign or malignant, with different location along the airway tree. Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis, and weight loss. Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction. Due to the rarity of primary tracheobronchial tumors in children, there are not any oncological guidelines on pre-operative work-up, treatment, and follow-up. Only few reports and multicentric studies are reported. In most cases, surgical resection seems to be the treatment of choice. Brachytherapy, endoscopic treatment, and chemotherapy are rarely described. In this article we present an overview on these rare tumors, including pathological aspects, clinical presentation, imaging assessment, and endoscopic or open surgical treatments. We discuss different surgical approaches, according with tumor location.

Inflammatory myofibroblastic tumor of the lung in pregnancy mimicking carcinoid tumor

Inflammatory myofibroblastic tumors (IMT) are uncommon neoplasms of the lung in adults. They constitute less than 1% of all lung neoplasms and usually present as parenchymal masses. Diagnosis requires a high index of suspicion. They are characterized by spindle-shaped tumor cells (fibroblasts/myofibroblasts) in a background of lymphoplasmacytic infiltrate. About 50% of the tumors harbor an ALK gene rearrangement. They have to be differentiated from inflammatory pseudotumors (IPT), which show increased number of IgG4 plasma cells on immunostaining and are negative for anaplastic lymphoma kinase (ALK) protein. Herein, we present a case of a 28-year old female who presented with hemoptysis and was diagnosed with an IMT of lung in the first trimester of pregnancy. We have not only reviewed the occurrence of IMT during pregnancy but also discuss the management options for IMT during pregnancy.