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Serret Miralles P, Nebot Muro L, Carrera Salas R, Blázquez Mañá C. [Inflammatory myofibroblastic tumour of the vocal cord. A case report and revision of the literature]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2021; 54:182-187. [PMID: 34175030 DOI: 10.1016/j.patol.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/22/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
Inflammatory myofibroblastic tumour (IMT) is a rare entity that can occur in practically any location. Although it has an increased incidence in infancy and adolescence, cases of IMT in the head and neck are more frequent in adults. We report the case of a 74-year-old male who presented with a two month history of dysphonia. Laryngoscopy and cervical TAC revealed a nodular lesion affecting the anterior half of the left vocal cord. He underwent endoscopic laser cordectomy. Histopathology concluded that the lesion was an IMT. Cases of IMT in the head and neck are infrequent and in the vocal cord extremely rare, with only a few previously reported cases.
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Affiliation(s)
- Paula Serret Miralles
- Servicio de Patologia, Parc Taulí Hospital Universitari, Institut d'Investigació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
| | - Laura Nebot Muro
- Servicio de Patologia, Parc Taulí Hospital Universitari, Institut d'Investigació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Rubén Carrera Salas
- Servicio de Patologia, Parc Taulí Hospital Universitari, Institut d'Investigació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Carmen Blázquez Mañá
- Servicio de Patologia, Parc Taulí Hospital Universitari, Institut d'Investigació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
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Smaily H, Cherfane P, Matar N. Pediatric laryngeal inflammatory myofibroblastic tumour: Case report and systematic review of the literature. Auris Nasus Larynx 2020; 48:1047-1053. [PMID: 32878712 DOI: 10.1016/j.anl.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/12/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Inflammatory myofibroblastic tumours (IMT) are rare benign neoplasms in the pediatric population, found most frequently in the lungs with rare reports of laryngeal involvement. The aim of this paper is to present a clinical case of laryngeal IMT followed by a systematic review on pediatric laryngeal IMT. CASE REPORT We present the case and the management of a 13-year-old boy with a laryngeal IMT MATERIAL AND METHODS: A comprehensive review of literature was conducted in September 2019 using Pubmed and Scopus. Included articles were reviewed for mean age at presentation, gender, main symptoms, treatment modality, histopathological features and follow-up RESULTS: Sixteen cases of pediatric laryngeal IMT were reported in the literature. The mean age of presentation was 7 years; endoscopic surgical resection was used in 87% of procedures, and the mean number of interventions needed to achieve remission was 1.6. CONCLUSIONS Pediatric laryngeal IMT are rare benign proliferations with only 16 reported case in the medical literature. The diagnosis of this entity remains a challenge and the standard of care is surgery with clear margins.
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Affiliation(s)
- Hussein Smaily
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
| | - Patrick Cherfane
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Nayla Matar
- Otolaryngology Head and Neck Surgery Department, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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Inflammatory myofibroblastic tumour of the jaw: A rare presentation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:90-94. [PMID: 30825659 DOI: 10.1016/j.jormas.2019.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022]
Abstract
Inflammatory Myofibroblastic Tumour (IMT) is a rare entity of unknown aetiology and pathogenesis. It was initially described in the lung, although there have been reported cases affecting extra-pulmonary sites. The aetiology of IMT remains unclear, with current evidence suggesting that IMTs are neoplastic processes resulting from chromosomal translocations that often cause an overexpression of ALK tyrosine kinase. Histologically, a variably cellular myxoid morphology is common in these tumours, with the presence of inflammatory cell infiltrate. Clinically, symptoms are non-specific, although the presence of a swelling is frequently reported. Imaging studies are not very useful in the diagnosis, as they only describe the presence of a mass, and do not provide a definitive diagnosis. This article presents a case, of Inflammatory Myofibroblastic Tumour of the jaw, in a male patient aged 16 years.
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Tay SY, Balakrishnan A. Laryngeal inflammatory myofibroblastic tumor (IMT): a case report and review of the literature. J Med Case Rep 2016; 10:180. [PMID: 27339455 PMCID: PMC4918124 DOI: 10.1186/s13256-016-0967-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This case report is interesting as cases of children with laryngeal inflammatory myofibroblastic tumor are not common and previously had been presented as isolated case reports. This is the first case report in Asia describing a laryngeal inflammatory myofibroblastic tumor and its removal using an endoscopic approach. CASE PRESENTATION Our patient is a 12-year-old Malay girl from Singapore who presented with hoarseness without respiratory distress. The initial impression was that of a granuloma or a papilloma. We did a biopsy, which confirmed the histology to be inflammatory myofibroblastic tumor, and a magnetic resonance imaging scan showed a contrast-enhanced lesion. The lesion was excised completely using an endoscopic approach. The child was discharged well on the first postoperative day and she has been on follow-up for a year in the clinic. CONCLUSIONS This report highlights the importance of understanding the differential diagnosis for a child with hoarseness. It is not uncommon for a pediatrician, a general practitioner, and a pediatric otolaryngologist to see a child presenting with hoarseness. In most cases, the diagnosis made would be screamer's nodules, which is commonly seen in children. In a small group, recurrent respiratory papillomatosis form the diagnosis. Over the past few years, the cases of recurrent respiratory papillomatosis have decreased significantly. Laryngeal tumors are not common in children. However, we must maintain a high index of suspicion when we have a child with hoarseness who does not improve with speech therapy and watchful waiting. In such situations, a stroboscope is usually necessary to diagnose the voice problems and to rule out pathological conditions such as laryngeal tumors. If left untreated, the lesion can grow with time and result in a life-threatening airway condition. We also demonstrate our endoscopic technique in this report, and it has proven to be safe with no increased recurrence and much lower morbidity.
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Affiliation(s)
- Sok Yan Tay
- Department of Otolaryngology Head and Neck Surgery, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Abhilash Balakrishnan
- Department of Otolaryngology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Pierry C, Pérot G, Karanian-Philippe M, Neuville A, Gomez-Brouchet A, Crestani S, Coindre JM. Polypoid laryngeal inflammatory myofibroblastic tumors: misleading lesions: description of six cases showing ALK overexpression. Am J Clin Pathol 2015; 144:511-6. [PMID: 26276782 DOI: 10.1309/ajcpcg8d6jaqbvlg] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Laryngeal inflammatory myofibroblastic tumors (IMTs) are rarely reported in the literature but may be underrecognized. To better characterize their features, we report a series of six cases. METHODS The clinicopathologic findings, including immunohistochemistry, fluorescence in situ hybridization (FISH) analysis, and follow-up, were evaluated and a review of the literature was performed. RESULTS These cases presented as small polypoid vocal cord or ventricular band lesions, with a more advanced mean age at diagnosis (49 years) than typically reported in other localizations. Apart from one secondary revision surgery, no complementary treatment and no recurrences were observed. Histologically, various morphologic features were seen. All tumors were spindle cell proliferations on a myxoid background with more or less atypia and significant inflammatory infiltrate. All six cases showed anaplastic lymphoma kinase (ALK) immunohistochemical expression. FISH rearrangement was present in four of six cases. Only two cases were initially diagnosed as IMT. CONCLUSIONS According to our series, laryngeal IMTs are easily misdiagnosed. They have a good prognosis, and ALK immunohistochemistry should be carried out to assess this diagnosis when spindle cell proliferations are observed in this localization.
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Affiliation(s)
- Clémence Pierry
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - Gaëlle Pérot
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - Marie Karanian-Philippe
- Department of Biopathology, Institut Bergonié, Bordeaux, France
- Université Bordeaux, Bordeaux, France
| | - Agnès Neuville
- Department of Biopathology, Institut Bergonié, Bordeaux, France
- Université Bordeaux, Bordeaux, France
| | - Anne Gomez-Brouchet
- Department of Pathology, Rangueil University Hospital, Toulouse, France; and
| | - Sabine Crestani
- ENT and Maxillofacial Surgery Department, Larrey University Hospital, Toulouse, France
| | - Jean-Michel Coindre
- Department of Biopathology, Institut Bergonié, Bordeaux, France
- Université Bordeaux, Bordeaux, France
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He CY, Dong GH, Liu HG. Recurrent laryngeal inflammatory myofibroblastic tumor with positive anaplastic lymphoma kinase mimicking recurrent respiratory papillomatosis: a case report. World J Surg Oncol 2014; 12:54. [PMID: 24602144 PMCID: PMC3996035 DOI: 10.1186/1477-7819-12-54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/19/2014] [Indexed: 12/24/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) of the larynx is an unusual lesion, particularly in the pediatric age group. Laryngeal IMTs in children follow a benign clinical course with reports of only rare recurrences and no metastases. Although anaplastic lymphoma kinase (ALK) has been associated with IMTs, there is only one pediatric laryngeal IMT reported to be ALK-positive with immunohistochemical staining. Here, we present a case of a 10-year-old boy with a laryngeal IMT that recurred four times and was misdiagnosed as recurrent respiratory papillomatosis after the initial three operations. ALK positivity was demonstrated by both immunohistochemical staining and fluorescence in situ hybridization. To the best of our knowledge, this case report is the first to describe a laryngeal IMT that recurred multiple times and was confirmed to be ALK-positive at the molecular level.
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Affiliation(s)
| | | | - Hong-gang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, No,1 Dongjiaominxiang Street, Dongcheng District, Beijing 100730, China.
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Salehinejad J, Pazouki M, Gerayeli MA. Malignant inflammatory myofibroblastic tumor of the maxillary sinus. J Oral Maxillofac Pathol 2013; 17:306-10. [PMID: 24250100 PMCID: PMC3830248 DOI: 10.4103/0973-029x.119754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are extremely rare neoplasms with a variable natural history and biologic behavior, ranging from completely benign to malignant tumors with fatal outcome. They have no common identifiable cause, although some authors have assumed that any inflammatory stimulus may cause these pseudotumors. They are most commonly found in the lungs. Extrapulmonary sites include abdomen, retroperitoneum and extremities. IMTs rarely affect the head and neck, but the most common subsites in this region include the orbit, larynx, mouth, tonsils, parapharyngeal space, thyroid, parotid and lacrimal glands. There are few reports of inflammatory pseudotumors in the paranasal sinuses. In the maxillary sinus, the initial presenting sign is usually a nonspecific sinonasal mass, which has been growing over a period of weeks or months. On rare occasions, IMT may exhibit malignant transformation. Herein we present a rare case of pathologically proved IMT with malignant transformation which originated in the maxillary sinus of a 29-year-old male.
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Affiliation(s)
- Jahanshah Salehinejad
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry and Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Jung YY, Hong ME, Han J, Kim TS, Kim J, Shim YM, Kim H. Bronchial schwannomas: clinicopathologic analysis of 7 cases. KOREAN JOURNAL OF PATHOLOGY 2013; 47:326-31. [PMID: 24009627 PMCID: PMC3759631 DOI: 10.4132/koreanjpathol.2013.47.4.326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/23/2013] [Accepted: 05/28/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND It has long been recognized that bronchial schwannomas are extremely rare. As such, diagnosing tumors in this extraordinary location can sometimes be problematic. METHODS We reviewed seven cases of bronchoscopically or surgically resected endobronchial schwannomas and evaluated their clinical and pathologic features. RESULTS The present study included five female and two male patients, with ages ranging from 16 to 81 years (mean age, 44.9 years). The clinical presentation varied according to tumor size and location. Patients with more centrally (trachea or main bronchus) located tumors experienced respiratory symptoms (80%) more often than patients with more peripherally (lobar or segmental bronchus) located tumors (0%). Histologically, the tumors were composed of spindle cells that stained with S100 protein. Some of the tumors showed typical Antoni A areas with Verocay body formation. Five of six patients (83.3%) underwent complete tumor removal by rigid bronchoscopy. CONCLUSIONS Pathologists should consider endobronchial schwannoma in the differential diagnosis of a spindle cell tumor involving the bronchus. Additionally, our results showed that rigid bronchoscopy is an effective tool for tumor removal in endobronchial schwannoma patients.
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Affiliation(s)
- Yoon Yang Jung
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Muthialu N. Inflammatory myofibroblastic tumour occluding left main bronchus in a young boy. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gutiérrez-Jodas J, Ruiz-Molina I, Jurado-Ramos A, Navarro JCP, Ramirez-Ponferrada R, Solis-Garcia E, Baños EC. Inflammatory myofibroblastic tumor of the subglottis in children—Report of a single case with positive anaplastic lymphoma kinase. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pedex.2010.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ni C, Xu YY, Zhou SH, Wang SQ. Differential diagnosis of inflammatory myofibroblastic tumour and low-grade myofibroblastic sarcoma: two case reports with a literature review. J Int Med Res 2011; 39:311-20. [PMID: 21672335 DOI: 10.1177/147323001103900134] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) and low-grade myofibroblastic sarcoma (LGMS) have similar morpho logical and immunophenotypic features, but LGMS is more malignant than IMT and the treatment requires a wider surgical margin plus post-operative chemotherapy or radiotherapy. To date, only 28 cases of IMT and two cases of LGMS have been reported in the laryngopharynx. Recent studies have suggested that anaplastic lymphoma kinase (ALK) and cytokeratin are important markers for differentiating between the two tumours. Here, two cases involving different myofibroblastic tumours of the larynx are reported. Based on the histological and immunohistochemical results, case 1 was diagnosed as IMT involving the right arytenoepiglottic fold, while case 2 was diagnosed as LGMS involving the epiglottic-glossal surface. There was no recurrence or metastasis in either case after post-operative follow-up (12 and 14 months, respectively). It is difficult to distinguish IMT from LGMS; both morphological and immunohistological analyses are required.
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Affiliation(s)
- C Ni
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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12
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Airway obstruction due to inflammatory myofibroblastic tumour of the posterior pharyngeal wall. The Journal of Laryngology & Otology 2011; 125:655-9. [DOI: 10.1017/s0022215110003002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a unique case of inflammatory myofibroblastic tumour of the posterior wall of the hypopharynx.Method:We present the patient's case history, management and histopathological findings. A literature review of all cases localised to the larynx or pharynx is provided and discussed.Results:A 67-year-old man presented with airway obstruction due to a spherical mass in the hypopharynx originating from the posterior pharyngeal wall. The tumour was resected. Histopathological examination revealed an inflammatory myofibroblastic tumour. We found only five previously reported cases with pharyngeal localisation. Further treatment of the patient is described.Conclusion:Inflammatory myofibroblastic tumour of the pharynx is extremely rare. It is regarded as a neoplastic tumour of intermediate biological potential. In cases with extrapulmonary localisation, the incidence of local recurrence can be as high as 25 per cent. Radical surgery is the treatment of choice; no adjuvant therapy is necessary.
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Völker HU, Scheich M, Zettl A, Hagen R, Müller-Hermelink HK, Gattenlöhner S. Laryngeal inflammatory myofibroblastic tumors: Different clinical appearance and histomorphologic presentation of one entity. Head Neck 2009; 32:1573-8. [DOI: 10.1002/hed.21232] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Tumeur pseudo-inflammatoire du larynx chez l’enfant. ACTA ACUST UNITED AC 2009; 126:14-7. [DOI: 10.1016/j.aorl.2008.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 11/21/2008] [Indexed: 11/20/2022]
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Is radical surgery necessary to head and neck inflammatory myofibroblastic tumor (IMT) in children? Childs Nerv Syst 2009; 25:285-91. [PMID: 18830608 DOI: 10.1007/s00381-008-0718-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Indexed: 02/05/2023]
Abstract
PURPOSE We report a case of head and neck inflammatory myofibroblastic tumor (IMT) in an infant. Reviewing the literature, we discuss the etiology, diagnosis, treatment, and prognosis of the head and neck IMT in children. MATERIALS AND METHODS A 52-day-old infant was admitted with an enlarging lesion in the right head and neck region. Following total excision, the lesion recurred and progressed to terminal stage. We performed a review of the literature on head and neck IMTs in children up to the age of 18 years and assessed the treatments and related prognosis of IMT in the head and neck region. RESULTS AND CONCLUSIONS The children's prognosis of head and neck IMT is diverse with different treatments. Combined treatment of surgical and corticosteroid is recommended for younger children, especially infants.
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Fernández-Aceñero >MJ, Larach F, Ortega-Fernández C. Non-epithelial lesions of the larynx: review of the 10-year experience in a tertiary Spanish hospital. Acta Otolaryngol 2009; 129:108-12. [PMID: 18607979 DOI: 10.1080/00016480802008207] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION In this report we review the diagnosis, therapy, and outcome of laryngeal non-epithelial tumors and comment on the literature on these rare lesions. OBJECTIVES Non-epithelial tumors of the larynx are rather rare and most cases have been reported as isolated or short series of cases from different centers all over the world. The aim of the present study was to review the 10-year experience with non-epithelial lesions in a 400-bed tertiary hospital covering a population of almost 250 000 people in Madrid, Spain. PATIENTS AND METHODS We reviewed 2631 laryngeal samples corresponding to this time period. RESULTS In all, 737 corresponded to carcinomas (726 squamous cell carcinomas). We had two cases of chondrosarcoma, one case of liposarcoma, one case of synovial sarcoma, and one neural benign tumor, suggestive of neurinoma. In this period we also had an inflammatory pseudotumor affecting the vocal cord, a case of primary laryngeal extramedullary plasmocytoma, and one case of high grade diffuse malignant lymphoma with exclusive involvement of the larynx. In our series most patients were women (five vs three patients) and ages ranged between 12 and 92 years.
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Kumar S, Gupta A, Kakkar N. Inflammatory myofibroblastic tumor larynx mimicking laryngeal papillomatosis. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.pedex.2008.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Idrees MT, Huan Y, Woo P, Wang BY. Inflammatory myofibroblastic tumor of larynx: a benign lesion with variable morphological spectrum. Ann Diagn Pathol 2007; 11:433-9. [PMID: 18022129 DOI: 10.1016/j.anndiagpath.2007.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Völker HU, Scheich M, Höller S, Ströbel P, Hagen R, Müller-Hermelink HK, Eck M. Differential diagnosis of laryngeal spindle cell carcinoma and inflammatory myofibroblastic tumor--report of two cases with similar morphology. Diagn Pathol 2007; 2:1. [PMID: 17212821 PMCID: PMC1779261 DOI: 10.1186/1746-1596-2-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 01/09/2007] [Indexed: 11/23/2022] Open
Abstract
Background Spindle cell tumors of the larynx are rare. In some cases, the dignity is difficult to determine. We report two cases of laryngeal spindle cell tumors. Case presentation Case 1 is a spindle cell carcinoma (SPC) in a 55 year-old male patient and case 2 an inflammatory myofibroblastic tumor (IMT) in a 34 year-old female patient. A comprehensive morphological and immunohistochemical analysis was done. Both tumors arose at the vocal folds. Magnified laryngoscopy showed polypoid tumors. After resection, conventional histological investigation revealed spindle cell lesions with similar morphology. We found ulceration, mild atypia, and myxoid stroma. Before immunohistochemistry, the dignity was uncertain. Immunohistochemical investigations led to diagnosis of two distinct tumors with different biological behaviour. Both expressed vimentin. Furthermore, the SPC was positive for pan-cytokeratin AE1/3, CK5/6, and smooth-muscle actin, whereas the IMT reacted with antibodies against ALK-1, and EMA. The proliferation (Ki67) was up to 80% in SPC and 10% in IMT. Other stainings with antibodies against p53, p21, Cyclin D1, or Rb did not result in additional information. After resection, the patient with SPC is free of disease for seven months. The IMT recurred three months after first surgery, but no relapses were found eight months after resurgery. Conclusion Differential diagnosis can be difficult without immunohistochemistry. Therefore, a comprehensive morphological and immunohistochemical analysis is necessary, but markers of cell cycle (apart from the assessment of proliferation) do not help.
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Affiliation(s)
- Hans-Ullrich Völker
- Institute of Pathology, University, Josef-Schneider-Str.2, 97080 Würzburg, Germany
| | - Matthias Scheich
- Department of Otorhinolaryngology, University, Josef-Schneider-Str.2, 97080 Würzburg, Germany
| | - Sylvia Höller
- Institute of Pathology, University, Josef-Schneider-Str.2, 97080 Würzburg, Germany
| | - Philipp Ströbel
- Institute of Pathology, University, Josef-Schneider-Str.2, 97080 Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, University, Josef-Schneider-Str.2, 97080 Würzburg, Germany
| | | | - Matthias Eck
- Institute of Pathology, University, Josef-Schneider-Str.2, 97080 Würzburg, Germany
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Montgomery EA, Shuster DD, Burkart AL, Esteban JM, Sgrignoli A, Elwood L, Vaughn DJ, Griffin CA, Epstein JI. Inflammatory myofibroblastic tumors of the urinary tract: a clinicopathologic study of 46 cases, including a malignant example inflammatory fibrosarcoma and a subset associated with high-grade urothelial carcinoma. Am J Surg Pathol 2007; 30:1502-12. [PMID: 17122505 DOI: 10.1097/01.pas.0000213280.35413.1b] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Inflammatory myofibroblastic tumor (IMT) of the urinary tract, also termed postoperative spindle cell nodule, inflammatory pseudotumor, and pseudosarcomatous fibromyxoid tumor, is rare and in the past was believed to reflect diverse entities. We reviewed a series of 46 IMTs arising in the ureter, bladder, and prostate, derived primarily from a large consultation practice. There were 30 male and 16 females aged 3 to 89 years (mean 53.6). Lesions were 1.2 to 12 cm (mean 4.2). There was a history of recent prior instrumentation in 8 cases. Morphology was similar to that previously described for IMT occurring in this region, with the exception of 1 case that focally appeared sarcomatous. Polypoid cystitis coexisted in 5 patients (11%). Mitoses were typically scant (0 to 20/10 hpf, mean 1). Necrosis was seen in 14 (30%) cases. Invasion of the muscularis propria was documented in 19 (41%). By immunohistochemistry (IHC), lesions at least focally expressed anaplastic lymphoma kinase (ALK) (20/35, 57%), AE1/3 (25/34, 73%), CAM5.2 (10/15, 67%), CK18 (6/6, 100%), actin (23/25, 92%), desmin (15/19, 79%), calponin (6/7, 86%), caldesmon (4/7, 57%, rare cells), p53 (10/13, 77%), and most lacked S100 (0/14), CD34 (0/13), CD117 (2/13, 15%), CD21 (0/5), and CD23 (0/3). ALK gene alterations were detected by fluorescence in situ hybridization (FISH) in 13/18 (72%) tested cases, including 2 with prior instrumentation; 13/18 (72%) showed agreement between FISH ALK results and ALK protein results by IHC. Most bladder IMTs were managed locally, but partial cystectomy was performed as the initial management in 7 cases and cystectomy in 1 (1 IMT was initially misinterpreted as carcinoma, 1 IMT was found incidentally as a separate lesion in a cystectomy specimen performed for urothelial carcinoma). Follow-up was available in 32 cases (range 3 to 120 mo; mean 33; median 24). There were 10 patients with recurrences (2 with 2 recurrences). Recurrences were unassociated with muscle invasion or with ALK alterations. In 2 cases, tumors of the urinary tract (TURs) showing IMT preceded (1 and 2 mo, respectively) TURs showing sarcomatoid carcinoma with high-grade invasive urothelial carcinoma accompanied with separate fragments of IMT. Even on re-review the IMT in these 2 cases were morphologically indistinguishable from other cases of IMT, with FISH demonstrating ALK alterations in the IMT areas in one of them. Both these patients died of their carcinomas. Lastly, there was 1 tumor with many morphological features of IMT and an ALK rearrangement, yet overtly sarcomatous. This case arose postirradiation for prostate cancer 4 years before the development of the lesion, with tumor recurrence at 4 months and death from intra-abdominal metastatic disease at 9 months. In summary, urinary tract IMTs are rare and share many features with counterparts in other sites, displaying similar morphology and immunogenotypic features whether de novo or postinstrumentation. Typical IMTs can be locally aggressive, sometimes requiring radical surgical resection, but none of our typical cases metastasized, although they can rarely arise contemporaneously with sarcomatoid urothelial carcinomas. For these reasons, close follow-up is warranted.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anaplastic Lymphoma Kinase
- Biomarkers, Tumor/metabolism
- Carcinoma, Transitional Cell/enzymology
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/pathology
- Child
- Child, Preschool
- Female
- Fibrosarcoma/enzymology
- Fibrosarcoma/genetics
- Fibrosarcoma/pathology
- Granuloma, Plasma Cell/enzymology
- Granuloma, Plasma Cell/genetics
- Granuloma, Plasma Cell/pathology
- Humans
- In Situ Hybridization, Fluorescence
- Inflammation/pathology
- Male
- Middle Aged
- Prostate/enzymology
- Prostate/pathology
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/metabolism
- Receptor Protein-Tyrosine Kinases
- Ureter/enzymology
- Ureter/pathology
- Urinary Bladder/enzymology
- Urinary Bladder/pathology
- Urologic Diseases/enzymology
- Urologic Diseases/genetics
- Urologic Diseases/pathology
- Urothelium/enzymology
- Urothelium/pathology
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