1
|
Yan S, Yue Z, Zhang P, Yuan L, Wang H, Yin F, Ju L, Chen L, Cai W, Ni Y, Wu J. Case report: Hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma: a rare case and review of the literature. Front Med (Lausanne) 2023; 10:1192998. [PMID: 37476617 PMCID: PMC10354642 DOI: 10.3389/fmed.2023.1192998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023] Open
Abstract
Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is a rare subtype of follicular dendritic cell sarcoma (FDCS) that primarily occurs in the liver and spleen. The etiology of IPT-like FDCS is unknown, and it has nonspecific clinical manifestations, imaging performance and laboratory test results. Recently, a patient with IPT-like FDCS was admitted to our hospital because of abdominal distension and anemia. Over the past 3 years, the patient has been followed up after a liver mass was found in a physical examination. The lesion gradually enlarged and caused compression symptoms. In November 2022, a tumor with a diameter of approximately 20 cm was found in the right posterior lobe of the liver after abdominal enhanced Magnetic resonance imaging (MRI) in our hospital. Liver tumor biopsy before the operation revealed a large number of hyperplastic plasma cells and a small number of spindle cells, and the spindle cells were atypical. After a complete examination, the patient underwent liver resection. Pathology after surgery confirmed liver IPT-like FDCS.
Collapse
Affiliation(s)
- Shuai Yan
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Zhiqiang Yue
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Peng Zhang
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Liuxia Yuan
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Huixuan Wang
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Fei Yin
- Department of Nail and Breast Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Linglin Ju
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Lin Chen
- Institute of Liver Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Weihua Cai
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Yi Ni
- Department of Nail and Breast Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Jinzhu Wu
- Department of Hepatobiliary Surgery, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
2
|
Auerbach A, Girton M, Aguilera N. Controversies in the Spleen: Histiocytic, Dendritic, and Stromal Cell Lesions. Surg Pathol Clin 2023; 16:385-400. [PMID: 37149364 DOI: 10.1016/j.path.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Histiocytic, dendritic, and stromal cell lesions that occur in the spleen are challenging diagnostically, not well studied due to their rarity, and therefore somewhat controversial. New techniques for obtaining tissue samples also create challenges as splenectomy is no longer common and needle biopsy does not afford the same opportunity for examination of tissue. Characteristic primary splenic histiocytic, dendritic, and stromal cell lesions are presented in this paper with new molecular genetic findings in some entities that help differentiate these lesions from those occurring in non-splenic sites, such as soft tissue, and identify possible molecular markers for diagnosis.
Collapse
Affiliation(s)
| | - Mark Girton
- University of Virginia Health System, Charlottesville, VA, USA
| | - Nadine Aguilera
- University of Virginia Health System, Charlottesville, VA, USA.
| |
Collapse
|
3
|
Tregnago AC, Morbeck DL, D’Almeida Costa F, Campos AHJFM, Soares FA, Vassallo J. Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41241-017-0051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
4
|
Wang X, Wang Z, Chen Y, Qian M. Inflammatory myofibroblastic tumor of the right frontal lobe. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
5
|
Sun Z, Wang H, Guo X, Jiang S, Jing C. Inflammatory myofibroblastic tumor of kidney together with ipsilateral perinephric and periureteric fibrosis: A case report and literature review. Medicine (Baltimore) 2017; 96:e8807. [PMID: 29245241 PMCID: PMC5728856 DOI: 10.1097/md.0000000000008807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RATIONALE Both inflammatory myofibroblastic tumor (IMT) and retroperitoneal fibrosis are rare lesions, but kidney involvement is more rare. It is the first study about IMT of the kidney in a patient with perinephric and periureteric fibrosis and we hold that fibroblast proliferation may be an intermediate status in oncogenesis of IMT. But further investigation is necessary in order to better clarify the relationship between fibroblast proliferation and IMT. PATIENT CONCERNS A 54-year-old female presented no positive signs except dull back pain after overwork. DIAGNOSES On the basis of the urinary ultrasonography and computed tomography (CT) scan, we strongly suspected a renal cell carcinoma. INTERVENTIONS Considering the little remaining function of the right kidney and the possibility of malignancy, we performed a laparoscopic right radical nephrectomy. OUTCOMES According to the analysis of the postoperative paraffin section and immunohistochemistry assay, a final diagnosis of IMT and retroperitoneal fibrosis nodules was made. LESSONS Both IMTs are rare lesions and its etiology and pathogeny are unclear. It is the first study about IMT of the kidney in a patient with perinephric and periureteric fibrosis. This report suggested that fibroblast proliferation may be an intermediate status in oncogenesis of IMT, but further investigation is necessary in order to better clarify the relationship between fibroblast proliferation and IMT. The preoperative diagnosis of renal IMT remains difficult. Preoperative fine-needle aspiration or percutaneous biopsy and intraoperative frozen section were applied to confirm the diagnosis to avoid unnecessary nephrectomy, especially in patients with renal insufficiency, bilateral masses, or a solitary kidney.
Collapse
Affiliation(s)
- Zhuolun Sun
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital affiliated to Shandong University
| | - Hanbo Wang
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital affiliated to Shandong University
| | - Xudong Guo
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital affiliated to Shandong University
| | - Shaobo Jiang
- Department of Minimally Invasive Urology Center, Shandong Provincial Hospital affiliated to Shandong University
| | - Changying Jing
- The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| |
Collapse
|
6
|
Abstract
Biliary strictures frequently present a diagnostic challenge during pre-operative evaluation to determine their benign or malignant nature. A variety of benign conditions, such as primary sclerosing cholangitis (PSC) and IgG4-related sclerosing cholangitis, frequently mimic malignancies. In addition, PSC and other chronic biliary diseases increase the risk of cholangiocarcinoma and so require ongoing vigilance. Although traditional methods of evaluation including imaging, detection of circulating tumour markers, and sampling by endoscopic ultrasound and endoscopic retrograde cholangiopancreatography have a high specificity, they suffer from low sensitivity. Currently, up to 20% of biliary strictures remain indeterminate after pre-operative evaluation and necessitate surgical intervention for a definitive diagnosis. The discovery of novel biomarkers, new imaging modalities and advanced endoscopic techniques suggests that a multimodality approach might lead to better diagnostic accuracy.
Collapse
|
7
|
Mance M, Romić I, Majerović M. Detection of Epstein-Barr virus in inflammatory pseudotumour of the spleen: a case report. Wien Klin Wochenschr 2015; 128:442-6. [PMID: 26109554 DOI: 10.1007/s00508-015-0807-6] [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: 02/17/2015] [Accepted: 05/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Various types of benign and malignant splenic tumours including hemangiomas, lymphagiomas, hamartomas, hemangiosarcomas, malignant lymphomas and metastatic carcinomas share radiological characteristics making it impossible for a physician to determine the definite aetiology of splenic masses noninvasively without histopathological evaluation. It is important that physicians recognize the importance of a careful and continuous follow-up since inflammatory pseudotumours (IPT) are considered to be tumours with an intermediate malignant potential based on their behaviour when they arise in other locations. METHODS Our patient, a 60-year-old woman was evaluated using laboratory, gastroscopy, computed tomography and surgical methods. The resected tumour was evaluated using immunohistochemical methods. RESULTS The patient presented with weight loss, nausea and vomiting, symptoms lasting over a course of a few months. The splenic mass was found incidentally at the time of work up for gastritis and cholelithiasis. Histologically, the tumour differed from typical splenic architecture being composed of atypical spindle cells with inflammatory elements; numerous plasma cells, macrophages, eosinophils and lymphocytes. CONCLUSIONS Although very difficult to diagnose at initial presentation, it is very important for the physician to be aware of the importance of a careful diagnosis since IPT of the spleen are rare and considered to be tumours with an intermediate malignant potential.
Collapse
Affiliation(s)
- Marko Mance
- Majerović, University of Zagreb, Zagreb University Hospital Center, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Ivan Romić
- Majerović, University of Zagreb, Zagreb University Hospital Center, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Matea Majerović
- Department of Internal Medicine, University of Zagreb, Zagreb University Hospital Center, Zagreb, Croatia
| |
Collapse
|
8
|
Kitamura Y, Takayama Y, Nishie A, Asayama Y, Ushijima Y, Fujita N, Morita K, Baba S, Kubo Y, Shirabe K, Honda H. Inflammatory Pseudotumor-like Follicular Dendritic Cell Tumor of the Spleen: Case Report and Review of the Literature. Magn Reson Med Sci 2015; 14:347-54. [PMID: 25740238 DOI: 10.2463/mrms.2014-0052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A 74-year-old woman underwent contrast-enhanced (CE) computed tomography (CT) that revealed an enlarging splenic lesion. This splenic tumor was suspected as metastasis because the patient had been diagnosed with right breast cancer with lung and right axillary lymph node metastases 4 years earlier and had undergone surgery and hormone therapy at another hospital. T2-weighted imaging of magnetic resonance (MR) imaging demonstrated the tumor with slightly high intensity with a rim of low intensity at the margin. On dynamic contrast-enhanced (DCE)-MR imaging after intravenous administration of gadolinium diethylenetriamine pentaacetic acid, delayed enhancement was observed in the center and margin of the tumor. On positron emission tomography with 2-deoxy-2-[18F] fluoro-D-glucose (FDG) integrated with CT, the tumor showed high FDG uptake. Splenic metastasis was considered based on the imaging findings, lack of inflammation on laboratory data, and clinical course, so she underwent splenectomy. Histopathologically, the tumor was encapsulated by a fibrous structure, which was depicted as the rim at the tumor margin on T2-weighted imaging and DCE-MR imaging. Immunohistochemical study allowed the diagnosis of inflammatory pseudotumor (IPT)-like follicular dendritic cell tumor (FDCT). FDCT is a primary neoplasm of lymph nodes that shows features of follicular dendritic cell differentiation, and it is rare at the spleen. Differential diagnosis is difficult between IPT-like FDCT and similar splenic tumors, such as IPT, splenic metastases, hamartoma and hemangioma. However, in addition to the enhancement pattern within a tumor on DCE-MR imaging, detection of the capsular-like rim on MR imaging might aid the diagnosis of splenic IPT-like FDCT.
Collapse
Affiliation(s)
- Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Bui PL, Vicens RA, Westin JR, Jensen CT. Multimodality imaging of Epstein-Barr virus-associated inflammatory pseudotumor-like follicular dendritic cell tumor of the spleen: case report and literature review. Clin Imaging 2015; 39:525-8. [PMID: 25725946 DOI: 10.1016/j.clinimag.2014.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/05/2014] [Accepted: 12/24/2014] [Indexed: 01/27/2023]
Abstract
Inflammatory pseudotumors (IPTs) are rare tumors of unknown etiology; however, there is a strong association with the Epstein-Barr virus (EBV). EBV-positive IPTs are typically found in the liver and spleen. While many EBV-positive splenic IPTs contain follicular dendritic cell (FDC) proliferations, they are not aggressive such as with conventional FDC tumors. EBV-positive splenic IPTs have been reported with low malignant potential. We present a case with multimodality imaging of an EBV-positive IPT-like tumor with FDC features.
Collapse
Affiliation(s)
- Pauline L Bui
- Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
| | - Rafael A Vicens
- Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.
| | - Jason R Westin
- Department of Lymphoma/Myeloma, Unit 0429, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009
| | - Corey T Jensen
- Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.
| |
Collapse
|
10
|
Prieto-Nieto MI, Pérez-Robledo JP, Díaz-San Andrés B, Nistal M, Rodríguez-Montes JA. Inflammatory pseudotumour of the spleen associated with splenic tuberculosis. World J Gastrointest Surg 2014; 6:248-252. [PMID: 25548610 PMCID: PMC4278147 DOI: 10.4240/wjgs.v6.i12.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/18/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirty-seven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.
Collapse
|
11
|
Tepeoğlu M, Atılgan AO, Ozdemir BH, Haberal M. Synchronous posttransplant lymphoproliferative disorder and inflammatory myofibroblastic tumor of the lung in a 2-year-old liver transplanted boy: a case report. EXP CLIN TRANSPLANT 2014; 13:92-5. [PMID: 25184247 DOI: 10.6002/ect.2013.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inflammatory myofibroblastic tumor is a rare benign lesion found mostly in children and young adults. It originates from the lung, abdominopelvic region, and retroperitoneum. The tumor is composed of myofibroblasts and inflammatory cell infiltration in the tissue. The cause and pathogenesis of this tumor are not completely understood. Epstein-Barr virus has been held responsible in some reported cases of inflammatory myofibroblastic tumors. Another tumor (which is known to be related to the Epstein-Barr virus) is posttransplant lymphoproliferative disorder. We report the case of a 2-year-old boy who underwent a liver transplant at the age of 9 months (the donor was his mother) because of biliary atresia. At 11 months after transplant, we detected posttransplant lymphoproliferative disorder and inflammatory myofibroblastic tumor concurrently. This entity is presented to highlight possible Epstein-Barr virus involvement in inflammatory myofibroblastic tumor of lung.
Collapse
Affiliation(s)
- Merih Tepeoğlu
- From the Baskent University, Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | | | | | | |
Collapse
|
12
|
Mid common bile duct inflammatory pseudotumor mimicking cholangiocarcinoma. A case report and literature review. Int J Surg Case Rep 2013; 5:12-5. [PMID: 24394855 PMCID: PMC3907201 DOI: 10.1016/j.ijscr.2013.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Biliary inflammatory pseudotumors (IPTs) represent an exceptional benign cause of obstructive jaundice. These lesions are often mistaken for cholangiocarcinomas and are treated with major resections, because their final diagnosis can be achieved only after formal pathological examination of the resected specimen. Consequently, biliary IPTs are usually managed with unnecessary major resections. PRESENTATION OF CASE A 71-year-old female patient underwent an extra-hepatic bile duct resection en-bloc with the gallbladder and regional lymph nodes for an obstructing intraluminal growing tumor of the mid common bile duct (CBD). Limited resection was decided intraoperatively because of negative for malignancy fast frozen sections analysis in addition to the benign macroscopic features of the lesion. Histologically the tumor proved an IPT, arising from the bile duct epithelium, composed of inflammatory cells and reactive mesenchymal tissues. DISCUSSION The present case underlines the value of intraoperative reassessment of patients undergoing surgical resection for histopathologically undiagnosed biliary occupying lesions, in order to optimize their surgical management. CONCLUSION The probability of benign lesions mimicking cholangiocarcinoma should always be considered to avoid unnecessary major surgical resections, especially in fragile and/or elderly patients.
Collapse
|
13
|
Li Z, Wang W, Wang Y, Zhai X, Tian Y, Fu Y, Zhou H. Inflammatory myofibroblastic tumor of the kidney with viral hepatitis B and trauma: A case report. Oncol Lett 2013; 6:1741-1743. [PMID: 24273608 PMCID: PMC3835164 DOI: 10.3892/ol.2013.1598] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/21/2013] [Indexed: 12/16/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare entity that most commonly involves the lung. However, an IMT of the kidney is extremely rare. The etiology and pathogenesis of IMT remain unknown. The present study describes the case of a 48-year-old female who presented asymptomatically. Imaging investigations revealed a mass in the left kidney and a pathological examination of the nephrectomy specimen revealed an IMT. The patient had a history of trauma in the left hypochondrium 13 years previously and a history of hepatitis B for 20 years. The latter developed into hepatic cirrhosis, hypersplenism and coagulation disorders, which may play have played a significant role in the development of the IMT of the kidney in the present case and also may aid in improving the understanding of the etiology and pathogenesis of IMT of the kidney.
Collapse
Affiliation(s)
- Zeyu Li
- Center of Urology, First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | | | | | | | | | | | | |
Collapse
|
14
|
Ma ZH, Tian XF, Ma J, Zhao YF. Inflammatory pseudotumor of the spleen: A case report and review of published cases. Oncol Lett 2013; 5:1955-1957. [PMID: 23833674 PMCID: PMC3701001 DOI: 10.3892/ol.2013.1286] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/12/2013] [Indexed: 12/28/2022] Open
Abstract
Inflammatory pseudotumor of the spleen (IPTS) is an extremely rare condition. To the best of our knowledge, only ∼113 cases have been reported in the literature since the first 2 cases were reported in 1984. The present study reports the case of an IPTS in a 72-year-old male patient. The splenic tumor was identified incidentally 1 year prior to the patient being admitted to the Second Affiliated Hospital of Dalian Medical University (Dailan, China). There were no specific clinical symptoms. The initial diagnosis was of splenic lymphoma based on the pre-operative radiological findings. However, the patient underwent a splenectomy and the final pathological diagnosis of IPTS was declared. The present study also highlighted the difficulty of forming accurate pre-operative diagnoses, even when using modern imaging techniques. A partial resection of the spleen or splenectomy was considered to be the required treatment to form a definitive diagnosis and exclude malignancy. The prognosis of IPTS is generally considered to be favorable following splenectomy. The clinical and pathological features of previously reported cases are also briefly reviewed in the present study to aid in improving the accuracy of the diagnosis of this rare disease.
Collapse
Affiliation(s)
- Zhen-Hai Ma
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | | | | | | |
Collapse
|
15
|
Jin R, Zhao P, Ma X, Ma J, Wu Y, Yang X, Zhang J, Zhong R, Zeng Y. Quantification of Epstein-Barr virus DNA in patients with idiopathic orbital inflammatory pseudotumor. PLoS One 2013; 8:e50812. [PMID: 23300945 PMCID: PMC3534710 DOI: 10.1371/journal.pone.0050812] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 10/29/2012] [Indexed: 11/19/2022] Open
Abstract
Inflammatory pseudotumors (IPT) are soft tissue tumors that include a diverse group of lesions characterized by inflammatory cell infiltration and variable fibrotic responses. Idiopathic orbital inflammatory pseudotumors (IOIP) are IPTs of unknown etiology that develop in the orbit. Due to the lack of well-defined pathogenic mechanisms, diagnosis and treatment of this disease remain a significant challenge. Epstein-Barr virus (EBV) infection, which causes significant lymphocyte infiltration, has been proposed to be involved in IOIP. This study tries to validate the relationship between EBV infection and the development of IOIP. Sixteen IOIP tissue samples were obtained from patients during surgical resection of the lesion. One Graves' ophthalmopathy tissue sample and 20 normal donors' plasma serves as controls. The plasma level of five EBV antibodies, including VCA-IgG, VCA-IgA, VCA-IgM, EA-IgG and EBNA1-IgG were examined. All plasma samples were EB-VCA-IgG positive and EB-VCA-IgM negative, suggesting that all people tested had been infected with EBV but not in the acute infection stage. EBV-DNA was detected in 15/16 (94%) of IOIP tissue samples despite different levels of lymphocyte infiltration and 5/16 plasma samples (31%) were detected EBV DNA positive which is higher than the normal controls (10%). Percent of positive plus suspected positive samples with one or more of the three important risk markers (VCA-IgA, EA-IgG, EBV-DNA) is 50% of the patients (8/16) which is much higher compare with the normal controls (20%). The results further reveal the relationship between IOIP and EBV infection.
Collapse
Affiliation(s)
- Rui Jin
- College of Life Science and Bio-Engineering, Beijing University of Technology, Beijing, People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Gupta P, Dhingra KK, Singhal S, Mandal S, Khurana N, Saroha V. Inflammatory myofibroblastic tumour of the kidney with a papillary adenoma. Pathology 2010; 42:193-6. [PMID: 20085528 DOI: 10.3109/00313020903494003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Abstract
INTRODUCTION Inflammatory pseudotumours are benign lesions of unknown aetiology that can appear almost in any organ, sometimes along with infectious agents like Epstein-Barr virus. They are very rare in the spleen, with about 80 cases described in the world literature. The tumour is a single, very rarely multinodal, lesion. Middle-aged patients are mostly affected. Symptoms are either absent or uncharacteristic so that the tumours are discovered by chance or during the investigations for other diseases. Although the tumour may be suspected before surgery, the exact diagnosis is established by the histological and immunohistochemical examination of the spleen removed as lymphoma or some other lymphoproliferative disorder because they cannot be ruled out. OUTLINE OF CASES The authors present 3 female patients 36, 48 and 56 years of age (average age 46.6 years) with the inflammatory pseudotumour of the spleen. Two patients complained of a mild pain in the epigastrium and below the left costal margin, while in the third patient the tumour of the spleen was discovered by chance during the examination after the traffic accident trauma. On examination, only slight epigastric tenderness was found in two patients. Except for the elevated white blood cells in one patient, laboratory data were within normal limits. All 3 patients were submitted to splenectomy as lymphoma of the spleen could not have been ruled out. Two patients developed transient postsplenectomy thrombocytosis which was treated with aspirin. The exact diagnosis of the tumours was established by the histological and immunohistochemical investigation. CONCLUSION Inflammatory pseudotumours of the spleen may not be so rare as it is believed. Thanks to the new diagnostic modalities (US, CT, MRI), an increasing number of reports of these tumours may be expected. They have to be taken into consideration in the differential diagnosis of solitary or multimodal lesions of the spleen. Splenectomy is a treatment of choice.
Collapse
|
18
|
Kiryu S, Takeuchi K, Shibahara J, Uozaki H, Fukayama M, Tanaka H, Maeda E, Akahane M, Ohtomo K. Epstein-Barr virus-positive inflammatory pseudotumour and inflammatory pseudotumour-like follicular dendritic cell tumour. Br J Radiol 2009; 82:e67-71. [PMID: 19325041 DOI: 10.1259/bjr/66918927] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Various splenic inflammatory pseudotumours are reported to be infected with Epstein-Barr virus (EBV), which is thought to be associated with the pathogenesis of the lesion. The term "inflammatory pseudotumour (IPT)-like follicular dendritic cell tumour", all cases of which are also EBV positive, has recently been proposed. Here, we describe the imaging findings of these splenic tumours and present the cases of an IPT-like follicular dendritic cell tumour and two EBV-positive inflammatory pseudotumours in two female patients and one male patient. These splenic lesions were found incidentally on pre-operative or post-operative screening or at medical check-up. CT performed on all three patients revealed low-density solitary masses in the spleen. MRI was performed on one patient; the solitary mass demonstrated isointensity on T(1) weighted images and low intensity on T(2) weighted images relative to the surrounding splenic parenchyma. Dynamic MRI study revealed that the mass did not enhance on the early phase but enhanced to the same degree as the surrounding splenic parenchyma on the delayed phase. The imaging findings are almost identical to those found in conventional IPT because the morphology is similar in both cases; however, attention should be paid to this new entity in the diagnosis of splenic lesions because of its neoplastic nature. Longer follow-up is also necessary for these patients compared with those with conventional IPT.
Collapse
Affiliation(s)
- S Kiryu
- Department of Radiology, Graduate School and Faculty of Medicine, University of Tokyo, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Rosenbaum L, Fekrazad MH, Rabinowitz I, Vasef MA. Epstein-Barr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature. J Hematop 2009; 2:127-31. [PMID: 19669195 PMCID: PMC2725282 DOI: 10.1007/s12308-009-0030-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 03/04/2009] [Indexed: 02/07/2023] Open
Abstract
We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.
Collapse
Affiliation(s)
- Lizabeth Rosenbaum
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - M. Houman Fekrazad
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Ian Rabinowitz
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Mohammad A. Vasef
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
- Department of Pathology MSC08 4640, 1 University of New Mexico, Albuquerque, NM 87131 USA
| |
Collapse
|
20
|
Chorianopoulos D, Samitas K, Vittorakis S, Makrygianni V, Tassidou A, Vadala C, Skoutelis A. Indolent fever, weight loss and spleen infiltrate. Scand J Gastroenterol 2009; 43:1275-8. [PMID: 18609151 DOI: 10.1080/00365520801917663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This is a case of a young female who was admitted to our department with fever of one month in duration, without a specific pattern, anemia, lymphadenopathy and weight loss. The initial clinical and radiological evaluation and laboratory tests, although extensive, were unrevealing. The patient's general situation was temporarily improved and she was dismissed, but she revisited our hospital 2, 5 months later because of fever recurrence and a new pain at the upper left abdomen. This time the pathological findings were more prominent. The abdomen CT scan revealed a splenic mass. The evidence was suggestive of lymphoma, granulomatous or unusual infectious disease. However, it was not possible to establish a certain diagnosis, so we proceeded to open splenectomy and histological analysis that disclosed an inflammatory pseudotumor of the spleen. This procedure apart from diagnostic proved to be also therapeutic. The patient was cured and at six-month follow up she was in perfect health. Our case suggests that a high index of suspicion regarding this entity is needed, particularly if the disease course is variable and protracted.
Collapse
|
21
|
Detection of Epstein–Barr virus-encoded small RNA-expressed myofibroblasts and IgG4-producing plasma cells in sclerosing angiomatoid nodular transformation of the spleen. Virchows Arch 2008; 453:275-82. [DOI: 10.1007/s00428-008-0648-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 04/23/2008] [Accepted: 07/23/2008] [Indexed: 02/06/2023]
|
22
|
|
23
|
Inflammatory pseudotumor of the liver successfully treated with nonsteroidal anti-inflammatory drugs: a challenge diagnosis for one not so rare entity. Eur J Gastroenterol Hepatol 2007; 19:1016-20. [PMID: 18049174 DOI: 10.1097/meg.0b013e32821acdd2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Inflammatory pseudotumor of the liver is a rare, benign lesion characterized by a well-circumscribed mass of chronic inflammatory cell infiltration and proliferating fibrous tissue. Its etiology remains unclear, although inflammatory processes have been proposed. It is often misdiagnosed as a malignant tumor, and the management has been traditionally surgical. We report the case of a 16-year-old boy who was referred from another hospital with a fever of >38 degrees C with rigor and right upper quadrant pain which he had suffered from for 5 days. The ultrasonographic computed tomography and MRI findings were not diagnostic, and we performed a needle biopsy from the lesion that was consistent with inflammatory pseudotumor (of liver, mixed fibrous tissue and chronic inflammatory cell infiltration). The patient was treated with nonsteroidal anti-inflammatory drugs and had an uneventful clinical course. During follow-up, the lesion subsequently shrank to completely vanish 1 year later.
Collapse
|
24
|
Akatsu T, Kameyama K, Tanabe M, Endo T, Kitajima M. Epstein-Barr virus-positive inflammatory pseudotumor of the spleen with concomitant rectal cancer: a case report and review of the literature. Dig Dis Sci 2007; 52:2806-12. [PMID: 17406818 DOI: 10.1007/s10620-007-9773-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 01/18/2007] [Indexed: 12/09/2022]
Affiliation(s)
- Tomotaka Akatsu
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | |
Collapse
|
25
|
Weinreb I, Bailey D, Battaglia D, Kennedy M, Perez-Ordoñez B. CD30 and Epstein-Barr virus RNA expression in sclerosing angiomatoid nodular transformation of spleen. Virchows Arch 2007; 451:73-9. [PMID: 17492312 DOI: 10.1007/s00428-007-0422-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 04/16/2007] [Indexed: 02/08/2023]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a splenic lesion composed of angiomatoid/vascular nodules surrounded by hyalinized/sclerotic stroma, fibroblasts, myofibroblasts, and inflammatory cells. The endothelium within the nodules has a phenotype resembling splenic sinusoids, capillaries, and small veins. Martel et al. (Am J Surg Pathol 28:1268-1279, 2004) suggested that SANT may represent the final pathway of a variety of splenic lesions including inflammatory pseudotumors (IPTs). Epstein-Barr virus (EBV) has a role in the genesis of some splenic IPTs, but its presence in SANT has not been investigated. Six cases of SANT are reported. All were stained for CD31, CD34, CD8, CD68, smooth muscle actin, muscle-specific actin, and CD30 and were tested for EBV by in situ hybridization (EBER). All cases showed angiomatoid nodules with complex expression of CD31, CD34, and CD8, with focal CD68. Expression of CD30 by endothelial cells was also seen. One case had small diffuse areas lacking nodules resembling an IPT and was positive for EBV. The inflammatory cells and the normal spleen were negative for CD30 and EBER. In conclusion, SANT shows upregulation of CD30 with respect to normal spleen. The presence of EBV in the stromal cells of a case supports the notion that a subset of SANT may be related to IPT.
Collapse
Affiliation(s)
- Ilan Weinreb
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, Ontario M5G 2C4, Canada
| | | | | | | | | |
Collapse
|
26
|
Uchida H, Ohta M, Shibata K, Endo Y, Iwaki K, Tominaga M, Ishio T, Kitano S. Laparoscopic splenectomy in patients with inflammatory pseudotumor of the spleen: Report of 2 cases and review of the literature. Surg Laparosc Endosc Percutan Tech 2006; 16:182-6. [PMID: 16804466 DOI: 10.1097/00129689-200606000-00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report 2 cases of splenic inflammatory pseudotumor treated by laparoscopic splenectomy. The first patient was a 58-year-old woman who complained of constipation. Computed tomography (CT) showed a well-demarcated mass that measured 4 cm in diameter and was not enhanced. She underwent laparoscopic splenectomy under a preoperative diagnosis of hemangioma. The final histopathologic diagnosis was inflammatory pseudotumor. The second patient was a 29-year-old man who complained of abdominal pain. Computed tomography revealed a demarcated splenic tumor that measured 3 cm in diameter and was not enhanced. Laparoscopic splenectomy was performed. The pathologic and operative diagnoses were both inflammatory pseudotumor. In both cases, the postoperative course was uneventful, and the postoperative hospital stays were 10 and 11 days. Preoperative diagnosis of a splenic inflammatory pseudotumor is very difficult. However, laparoscopic splenectomy is safe and beneficial treatment for this tumor and should be performed in cases in which it is diagnosed.
Collapse
Affiliation(s)
- Hiroki Uchida
- Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Colović N, Colović R, Grubor N, Micev M, Radak V, Stojković M. [Inflammatory pseudotumor of the spleen]. VOJNOSANIT PREGL 2006; 63:757-60. [PMID: 16918163 DOI: 10.2298/vsp0608757c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Inflammatory pseudotumors are benign tumor lesions of an unknown etiology that can appear almost at any organ, sometimes along with infectious agens, like Epstein-Barr virus. They are extremely rare in the spleen, with less than 80 cases described in the world literature. It is a single, very rarely multinodal lesion. Middle aged patients are mostly affected. Symptoms are either absent or uncharacteristic, so that the tumors are discovered by chance or during investigations of other diseases. CASE REPORT We presented a 56-year-old woman in whom a nodal lesion of 2 cm in diameter had been discovered in the spleen during a routine check-up after a mild traffic accident. The lesion had grown up to 6 cm in diameter during a 5-year follow-up causing a mild pain over the upper left abdomen and left shoulder. Fine needle biopsy failed to show the exact nature of the lesion. Splenectomy was performed due to a suspected lymphoproliferative disorder. Histology and immunohistochemistry of the lesion of the upper pole of the spleen showed inflammatory pseudotumor. Epstein-Barr virus was not present. The patient developed postsplenectomy thrombocytosis (up to 850 x 10(9)/1) which settled down within 10 weeks. CONCLUSION . Inflammatory pseudotumors of the spleen are extremely rare. The exact diagnosis can be established only by histology and/or immunohistochemistry of the spleen removed for a suspected lymphoproliferative disorder, most frequently lymphoma. The patient was cured with splenectomy.
Collapse
Affiliation(s)
- Natasa Colović
- Klinicki centar Srbije, Institut za hematologiju, Beograd
| | | | | | | | | | | |
Collapse
|
28
|
Celebi A, Kayacan SM, Keskin S, Temeloglu E, Koç D, Ercan V, Esin D, Ekizoglu I, Vatansever S, Gulluoglu MG, Erk O. A case of inflammatory pseudotumor in the spleen. South Med J 2006; 99:774-6. [PMID: 16866066 DOI: 10.1097/01.smj.0000217486.13651.f6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case of an inflammatory pseudotumor of the spleen is presented. A 43-year-old woman was hospitalized for a detailed examination due to pancytopenia, which was diagnosed during an examination related to left upper quadrant abdominal pain. Physical examination revealed a 2 to 3 cm splenomegaly. Reticulocyte count was 4% and erythrocyte sedimentation rate was 55 mm/h. No other important findings were noted, except for an evident increase in myeloid series and megakaryocytes (more evident in erythroid series) on bone marrow aspiration and biopsy. Computed tomography (CT) scan revealed splenomegaly and a centrally located hypodense lesion with a 92 X 86 mm axial diameter in the spleen. With a hematologic malignancy prediagnosis, a splenectomy was performed on the patient because of pancytopenia and splenomegaly. An intrasplenic, centrally located, well-limited, capsulated lesion (9.5 x 11 x 10 cm in diameter) was discovered on macroscopic examination of the material. A cellular infiltration area was seen on microscopic examination. The spleen capsule was mildly fibrotically thickened. The lesion that separated from the spleen tissue consisted of diffusely proliferated fusiform fibroblasts, heterogenous inflammatory cells consisting mainly of plasma cells, lymphocytes, sparse neutrophils and vascular elements. No granuloma or multinuclear giant cells were detected. Pancytopenia improved on follow-up. The patient followed up for two years, is now healthy and has no complaints.
Collapse
Affiliation(s)
- Aslan Celebi
- Department of Internal Medicine, Taksim Education and Research Hospital, and the Department of Internal Medicine, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Hatsuse M, Murakami S, Haruyama H, Inaba T, Shimazaki C. Inflammatory pseudotumor of the spleen complicated by idiopathic thrombocytopenic purpura. Ann Hematol 2005; 84:619-20. [PMID: 15841410 DOI: 10.1007/s00277-005-1021-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 02/08/2005] [Indexed: 11/26/2022]
|