Clinicopathological features of gastric inflammatory myofibroblastic tumor: Report of five cases

Therapeutic strategy and prognostic analysis of inflammatory myofibroblastic tumor in the head and neck: a retrospective study

Objective

This study aimed to investigate the clinical features, treatment methods, and prognosis of head and neck inflammatory myofibroblastic tumor (HNIMT).

Methods

A retrospective analysis was conducted using the clinical data of 12 HNIMT patients who were admitted to Shanxi Cancer Hospital between January 2016 and December 2023. This analysis focused on their clinical manifestations, pathological characteristics, treatment strategies, and prognosis.

Results

Among the 12 cases analyzed, four involved inflammatory myofibroblastic tumors (IMT) located in the nasal sinuses or nasopharynx, with symptoms including nasal congestion, rhinorrhea, and maxillofacial swelling. Two cases each in the salivary glands and oral cavity presented as localized, painless masses. One right cervical IMT case also presented as a painless lump. Two laryngeal IMT cases had hoarseness, and one subglottic endotracheal IMT case showed inspiratory dyspnea. All patients received surgery, with postoperative pathology confirming IMT. During follow-up, four cases recurred. Finally, nine patients were disease-free, two survived with disease, and one died.

Conclusions

HNIMT is a rare, low-grade malignant or borderline tumor that is generally associated with a favorable prognosis. Accurate diagnosis relies on pathological examination, and surgical resection remains the primary treatment for HNIMT. The need for adjuvant therapy following surgery should be determined by clinicians based on tumor location, surgical approach, and the presence of high-risk factors.

Clinical diagnosis and treatment of abdominal inflammatory myofibroblastic tumors

OBJECTIVE

This study aims to summarize the clinicopathological characteristics, treatment methods, and prognosis of these patients. The goal is to enhance our understanding of the disease and provide insights for the standardized diagnosis and treatment of abdominal inflammatory myofibroblastic tumors(IMT).

METHODS

This retrospective cohort study included clinical data of 26 patients with abdominal IMT admitted to the First Hospital of Jilin University between January 2015 and December 2023. The clinical manifestations, pathological features, treatment methods, and prognoses were analyzed.

RESULTS

Among 26 patients, 6 had hepatic IMT, 2 splenic IMT, and 1 abdominal wall IMT, all detected incidentally as painless masses during routine exams. Six patients with mesenteric IMT reported abdominal distension, pain, nausea, vomiting, and low-grade fever. Of five patients with gastric IMT, three had gastrointestinal bleeding, one had distension and fever, and one had dysphagia. Four small intestine cases included one asymptomatic and three with obstruction symptoms. The colon and rectal cases presented with intermittent hematochezia. Surgery was performed in 24 patients, and 2 with metastases received palliative therapy. During follow-up, five patients relapsed; three received palliative therapy, and two had surgery. At last follow-up, 20 patients were disease-free, 3 were living with tumors, and 3 had died.

CONCLUSIONS

Abdominal IMTs are rare, low-grade tumors with favorable prognoses. Pathological examination is essential for diagnosis, and surgery is the primary treatment. Adjuvant therapy depends on tumor location and risk factors. Close follow-up is necessary due to the potential for recurrence and metastasis.

Inflammatory myofibroblastic tumor of the lung: a comprehensive narrative review of clinical and therapeutic insights

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm classified by the World Health Organization as an intermediate malignancy with less than a 5% chance of metastasis. IMTs consist of myofibroblastic and spindle fibroblastic cells accompanied by inflammatory infiltration, primarily affecting patients under 16 years old, though they can also occur in adults. The etiology and pathogenesis of IMTs remain unclear, with possible contributing factors including inflammation, trauma, autoimmune diseases, prior surgery, viral infections, and uncontrolled myofibroblast proliferation. The primary treatment is complete surgical resection, which is associated with long-term survival and a significantly reduced recurrence rate of 2%, compared to 60% for incomplete resections. Chemotherapy is generally not recommended but may be necessary for unresectable tumors. Advances in histopathological diagnosis provide deeper insights into IMT biology, aiding in the selection of appropriate treatments. This paper presents a comprehensive review of the literature on this rare clinical entity.

A Diagnosis of Gastric Inflammatory Myofibroblast Tumor: A Challenge Like No Other!

Inflammatory myofibroblastic tumors (IMTs) are mesenchymal tumors of intermediate malignant potential. Gastric IMTs are rare and commonly affect young adults. They are typically confused with gastrointestinal stromal tumors, inflammatory fibroid polyps, and leiomyosarcomas. The etiology of IMTs remains unclear, but is theorized to be due to hyperinflammatory response to chronic infections. We present a middle-aged woman found to have a gastric mass positive for Helicobacter pylori, underwent multiple endoscopies with endoscopic ultrasound, and a definitive diagnosis of gastric IMT was only made after a partial gastrectomy with immunohistochemistry negative for CD-117, S-100, ALK-1, and positive for vimentin and SMA.

A Rare Inflammatory Myofibroblastic Tumor of the Spleen: A Case Report

BACKGROUND/AIM

Inflammatory myofibroblastic tumors (IMTs) are rare, solid, potentially malignant lesions of uncertain etiology. Histologically, IMTs exhibit a combination of lymphocytes and inflammatory cells within a fibroblastic myxoid layer. The diagnosis of IMTs poses a challenge for various medical specialties, including surgeons, pathologists, and oncologists, due to their non-specific clinical presentation. Furthermore, radiologists face difficulties in interpreting computed tomography (CT) or magnetic resonance imaging (MRI) results, which often yield polymorphic and inconclusive findings. Ultimately, histopathologists play a crucial role in reaching a definitive diagnosis based on the tumor's histological characteristics. They are detected in every system of the human body, most commonly in the lungs. Here, we report an uncommon occurrence of IMT in the spleen of a patient with nonspecific abdominal pain.

CASE REPORT

A 56-year-old Caucasian female presented to Konstantopouleio General Hospital of Nea Ionia, Athens, Greece, with abdominal pain and discomfort. The patient had no significant medical history and normal laboratory tests. An abdominal CT revealed a large mass in the spleen. A splenectomy was performed. Histopathological analysis of the tumor revealed IMTS.

CONCLUSION

Splenic IMT is a rare benign tumor with moderate malignant potential. It lacks a distinct clinical presentation and is typically identified either incidentally or during the examination of abdominal pain.

Gastric and cardiac inflammatory myofibroblastic tumor: an extremely rare case

BACKGROUND

Inflammatory myofibroblastic tumor (IMT) is a unique, rarely metastatic tumor composed of myofibroblasts and fibrous spindle cells with inflammatory cell infiltration that can affect any organ in the human body. By reviewing the relevant literature on PubMed, we found that this is the first case report of IMT with both gastric and cardiac involvement.

CASE PRESENTATION

A 57-year-old male patient was admitted to the hospital with complaints of malaise, poor appetite, and epigastric pain with black stools. We found a mass in the patient's stomach and left atrium by contrast-enhanced computed tomography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and other tests. The patient underwent laparoscopic Billroth II subtotal gastrectomy and Braun's gastrointestinal reconstruction under general anesthesia. On the 46th day following stomach surgery, the cardiac tumor was removed under general anesthesia. The patient has treated with doxorubicin 70 mg of D1 chemotherapy two months after cardiac surgery. Postoperative pathological immunohistochemistry of the mass confirmed the diagnosis of an IMT. His review three months after the cardiac surgery suggested the progression of the left atrial mass, but he declined further treatment and finally died one month after the review.

CONCLUSIONS

As a unique class of tumors that rarely metastasize, IMTs have an unknown etiology and pathogenesis, and distant metastasis is primarily observed in patients with negative activin receptor-like kinase (ALK) expression. The preferred treatment for IMT is complete surgical resection, and the effectiveness of adjuvant therapy for patients with distant metastases is still being determined. The clinical presentation of IMT lacks specificity and is often related to the location of tumor growth, which poses a diagnostic challenge. Pathological immunohistochemistry is the only way to confirm the diagnosis at present. Our case report reminds clinicians that a category of ALK-negative IMT with a tendency toward distant metastasis should not be ignored.

Diagnosis of inflammatory myofibroblastic tumor in a pediatric patient initially suspected of tuberculosis

BACKGROUND

Symptoms of inflammatory myofibroblastic tumor (IMT) are atypical, and histopathological misdiagnosis of IMT is still inevitable. Here we present a pediatric case that an eight-year-old boy with recurrent fever for fifteen months, received anti-tuberculosis therapy for five months and was ultimately confirmed to be IMT.

CASE PRESENTATION

An eight-year-old boy experienced a recurrent fever for fifteen months, accompanied by cough, vomiting, meteorism, night sweating, and emaciation. Thoracoabdominal computer tomography revealed multiple enlarged lymph nodes in the thorax, abdomen, and axilla, as well as minimal bilateral pleural effusion. Histopathological examinations of the intestines and greater omentum implied fibrous tissue hyperplasia along with eosinophil and lymphocyte infiltration. The patient was initially misdiagnosed with tuberculosis, and symptoms were relieved partially following anti-tuberculosis treatment. However, after four months, the symptoms aggravated again and a subsequent histopathological analysis of a second sample from the greater omentum revealed the presence of IMT. Eventually, after surgical resection of the lesions and chemotherapy, the clinical symptoms in the child gradually alleviated.

CONCLUSIONS

The clinical course of IMT is variable, and pediatricians should pay attention to differentiating IMT from tuberculosis.

A rare case of inflammatory myofibroblast tumor of the stomach successfully treated by inverted laparoscopic and endoscopic cooperative surgery

BACKGROUND

An Inflammatory myofibroblastic tumor (IMT) is a rare intermediate malignancy characterized by myofibroblast proliferation and inflammatory cell infiltration. Various organs are the primary sites of origin. However, primary tumors originating in the stomach tend to be extremely rare, making the diagnosis difficult. Herein, we present a case of IMT originating in the stomach that was effectively managed using inverted laparoscopic endoscopic cooperative surgery (LECS).

CASE PRESENTATION

A 47-year-old male who was admitted to the hospital because of a submucosal tumor that was discovered during upper gastrointestinal endoscopy. The diameter of the tumor was approximately 20 mm. A KIT-negative gastrointestinal stromal tumor was suspected based on the biopsy findings. Therefore, partial resection of the stomach was performed using inverted laparoscopic and endoscopic cooperative surgery. Histopathological examination revealed collagen fiber proliferation from the submucosal layer to the muscular layer, accompanied by infiltration of spindle-shaped cells, lymphocytes, and numerous inflammatory cells. Immunohistochemistry results were positive for SMA and negative for CD34, desmin, and c-kit. IgG4-positive cells were observed with an IgG4/IgG ratio > 50%, and specific nuclei were positive for ALK. Therefore, IMT was diagnosed. This condition may be difficult to diagnose both before and after surgery because of its rarity and submucosal tumor-like morphology.

CONCLUSION

When a submucosal tumor originating in the stomach is observed, IMT should be considered. Partial resection of the stomach with LECS and immunohistochemical diagnosis may be useful.

The significance of the microlymphangiogenesis, microangiogenesis, and combined detection of programmed cell death-1 protein (PD-1)/ki67 in gastric cancer tissues

PURPOSE

To investigate the relationship between the microlymphangiogenesis, microangiogenesis, and combined detection of the programmed cell death-1 protein (PD-1)/ki67 in patients with gastric cancer as well as the disease prognosis.

METHODS

Immunohistochemistry was used to detect the microlymphatic density (MLD) and microvessel density (MVD) in the central and peripheral zones in 92 cases of gastric cancer, along with the number of PD-1- and ki67-positive tumor cells.

RESULTS

The central zone of the gastric cancer tissue contained fewer atretic cord-like lymphatic vessels than the peripheral zone, while the peripheral zone contained an increased number of lymphatic vessels compared with the central zone. In most cases, the lumen was also dilated. Compared with the MLD in the peripheral zone, the MLD in central zone was significantly decreased. Compared with the number of PD-1-positive cells in the peripheral zone, the number of PD-1-positive cells in the central zone was significantly decreased, and compared with the number of ki67-positive cells in the peripheral zone. The differences in the microlymphangiogenesis, microangiogenesis, and the number of PD-1- and ki67-positive cells among the different histological types were not statistically significant. The microlymphangiogenesis, microangiogenesis, and PD-1- and ki67-positive cells were significantly decreased in the gastric cancer tissues from the patients in stages T1 and T2 compared with the gastric cancer tissues from the patients in stages T3 and T4.

CONCLUSIONS

The detection of the MLD and MVD as well as the positive expression of PD-1 and ki67 in gastric cancer tissue are important reference indicators for judging the prognosis of gastric cancer.

Mesenchymal tumors of the stomach: radiologic and pathologic correlation

Mesenchymal tumors of the stomach are uncommon, with gastrointestinal stromal tumor (GIST) being the most common among them. Majority of the tumors may arise from cells of Cajal, smooth muscle cells, neural cells, totipotent stem cells, adipocytes or fibroblasts. Imaging plays an important role not only in staging but also in characterizing these tumors. Many of these tumors have characteristic imaging features. GISTs usually present as large cavitating and necrotic tumors with exophytic component. Presence of fat tissue within the tumor suggests a lipoma or a teratoma, early phase hyperenhancement indicates glomus tumor and hemangioma, and delayed contrast enhancement is seen in schwannoma. Their differentiation from epithelial tumors like carcinoma and neuroendocrine tumors is often possible based on the location (mesenchymal tumors are intramural), spread, morphological appearance and enhancement patterns. However, overlapping features exist between these tumors with imaging often being only suggestive. A biopsy is necessary for a definitive diagnosis in many cases.