1
|
Suezumi K, Uehara T, Taira A, Akamatsu N, Tanaka T, Hayashi Y, Komuta M, Shiomi T, Murai H. IgG4-related pachyleptomeningitis with inflammatory pseudotumor. eNeurologicalSci 2024; 34:100490. [PMID: 38229909 PMCID: PMC10789997 DOI: 10.1016/j.ensci.2023.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/23/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
•We report the first case of IgG4-related pachyleptomeningitis.•Our case showed also an inflammatory pseudotumor on the side ipsilateral to the pachyleptomeningitis.•The pachyleptomeningitis is probably due to inflammation from the dural pseudotumor spreading along the adjacent meninges.
Collapse
Affiliation(s)
- Koki Suezumi
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Taira Uehara
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Akihiko Taira
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Naoki Akamatsu
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Yuichiro Hayashi
- Department of Anatomic Pathology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Mina Komuta
- Department of Anatomic Pathology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Takayuki Shiomi
- Department of Anatomic Pathology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| |
Collapse
|
2
|
Abd-Elfattah AM, Gaafar A, Ebada HA, Seif-Elnasr M, Domain A, Habaza FR, Zalata K, Tawfik A. Tracheal resection anastomosis for rare tracheal inflammatory lesions mimicking malignancy: report of 2 cases. J Cardiothorac Surg 2024; 19:43. [PMID: 38310241 PMCID: PMC10837908 DOI: 10.1186/s13019-024-02532-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Tumor-like lesions of the trachea are rare and challenging in diagnosis and management. Inflammatory myofibroblastoma, also known as Inflammatory pseudo tumors (IPTs), as well as Rosai Dorfman Disease (RDD) are inflammatory lesions that may involve the central airways with variable non-specific clinical features mimicking tumors. CASE PRESENTATION In this study 2 cases with tumor-like lesions are presented. One case with an inflammatory pseudotumor and the other one with Rosai-Dorfman disease affecting the upper trachea. Both cases were successfully managed with tracheal resection anastomosis. CONCLUSION Tracheal Inflammatory myofibroblastoma, and Rosai-Dorfman diseases are rare tumor like lesions that present with upper airway obstruction. Despite being benign, these lesions may have features suggestive of malignancy, requiring prompt management. Complete surgical excision by segmental resection and primary anastomosis (if feasible) is the treatment of choice with an optimum outcome.
Collapse
Affiliation(s)
| | | | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
| | | | | | | | - Khaled Zalata
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Ali Tawfik
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| |
Collapse
|
3
|
Ouzzaouit H, Kaitouni BI, Zouaidia F, Hamza S, Hrora A, Raiss M. Pseudotumor inflammatory of the spleen: A rare entity with diagnostic and therapeutic challenges: A case report. Int J Surg Case Rep 2024; 115:109215. [PMID: 38280342 PMCID: PMC10839638 DOI: 10.1016/j.ijscr.2023.109215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Inflammatory pseudotumor (IPT) of the spleen is a rare entity that can be difficult distinguishing it from malignancies, both in clinical presentation and radiological imaging. CASE PRESENTATION We present the case of a 43-year-old female presented with 15-cm left hypochondrial mass, Initial imaging studies raised concerns of malignancy, leading to a splenectomy. However, the final pathological examination determined that the patient had IPT of the spleen with focal expression of Smooth Muscle Antibody (SMA). CLINICAL DISCUSSION This case highlights the importance of considering IPT as a potential diagnosis of splenic masses that was difficult to diagnose before surgery. CONCLUSION The uniqueness of the case under consideration lies in the rarity and the atypical localization of IPT of the spleen.
Collapse
Affiliation(s)
- Hamza Ouzzaouit
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.
| | - Boubker Idrissi Kaitouni
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Fouad Zouaidia
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco; Anatomopathology department, Ibn Sina University Hospital, Rabat, Morocco
| | - Sekkat Hamza
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| |
Collapse
|
4
|
Ito K, Ide T, Tanaka T, Nagayasu E, Hasegawa H, Noshiro H. A surgical case of inflammatory pseudotumor by hepatic anisakiasis. Clin J Gastroenterol 2024; 17:143-147. [PMID: 38085443 DOI: 10.1007/s12328-023-01891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/29/2023] [Indexed: 02/01/2024]
Abstract
Anisakiasis is a parasitic infection caused by the ingestion of raw or undercooked seafood infected with Anisakis larvae. It generally affects the gastrointestinal tract, particularly the stomach, but very rare cases have been reported in which infection of the liver leads to the formation of inflammatory pseudotumors. We herein report an extremely rare case of an inflammatory pseudotumor induced by hepatic anisakiasis that was laparoscopically resected for the purpose of both diagnosis and treatment. A 51-year-old woman underwent a routine medical checkup by ultrasound examination, which incidentally detected a 15-mm mass on the surface of S6 of the liver. Because a malignant tumor could not be ruled out on several preoperative imaging studies, laparoscopic partial resection of the liver was performed. Histopathological examination revealed Anisakis larva in the inflammatory pseudotumor, suggesting hepatic anisakiasis. This report describes an extremely rare case of an inflammatory pseudotumor induced by hepatic anisakiasis. Because the preoperative diagnosis could not be obtained by several imaging modalities, laparoscopic liver resection with a sufficient margin might be suitable for diagnosis and treatment of this disease.
Collapse
Affiliation(s)
- Kotaro Ito
- Faculty of Medicine, Department of Surgery, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Takao Ide
- Faculty of Medicine, Department of Surgery, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomokazu Tanaka
- Faculty of Medicine, Department of Surgery, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Eiji Nagayasu
- Faculty of Medicine, Division of Parasitology, Department of Infectious Diseases, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-City, Miyazaki, 889-1692, Japan
| | - Hideo Hasegawa
- Faculty of Medicine, Department of Biomedicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hirokazu Noshiro
- Faculty of Medicine, Department of Surgery, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| |
Collapse
|
5
|
Acharya S, Agrawal P, Dash RK, Dash S. Inflammatory Pseudotumor of Neck (anterior aspect) in a Child: A Rare Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:4170-4172. [PMID: 37974877 PMCID: PMC10645791 DOI: 10.1007/s12070-023-03921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 11/19/2023] Open
Abstract
Inflammatory pseudotumor mostly occurs in the lungs and orbit, with only 15% occurring in the nonorbital head and neck region. We hereby present a 2 year old child with a progressive swelling over the anterior aspect of neck since 7 months, that was insidious in onset and gradually progressive in nature. MRI of neck and FNAC were inconsistent with our diagnosis. Post op HPE confirmed it to be Inflammatory Pseudotumor. So inflammatory pseudotumor should be considered as differential diagnosis of neck swelling and treated accordingly.
Collapse
|
6
|
Patel A, Chen A, Lalos AT. Inflammatory pseudotumors in the liver associated with influenza: A case report. World J Hepatol 2023; 15:1164-1169. [PMID: 37970616 PMCID: PMC10642433 DOI: 10.4254/wjh.v15.i10.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) is a rare and benign lesion that mimics malignancy and can develop in any part of the body. The pathophysiology and etiology of these quasineoplastic lesions remain unclear. CASE SUMMARY We report a case of a 65-year-old male who presented with fevers, night sweats, and unintentional weight loss following an influenza infection and was found to have multiple hepatic IPT's following an extensive work up. CONCLUSION Our case highlights the importance of considering hepatic IPT's in the differential in a patient who presents with symptoms and imaging findings mimicking malignancy shortly following a viral infection.
Collapse
Affiliation(s)
- Ankoor Patel
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States.
| | - Alexander Chen
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Alexander T Lalos
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| |
Collapse
|
7
|
Pi J, Fan G, Huang Y, Wu Y. Inflammatory pseudotumor of the right lobe of liver: A case report. Asian J Surg 2023; 46:4072-4073. [PMID: 37147260 DOI: 10.1016/j.asjsur.2023.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Affiliation(s)
- Jiangyuan Pi
- Kunming Medical University, Kunming, Yunnan 650500, China
| | - Guangtao Fan
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Yilong Huang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China
| | - Ying Wu
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, China.
| |
Collapse
|
8
|
Argyris PP, Wakely PE. Mycobacterial Spindle Cell Pseudotumor of the Nasal Cavity. Head Neck Pathol 2023; 17:782-787. [PMID: 37027086 PMCID: PMC10513965 DOI: 10.1007/s12105-023-01550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Mycobacterial spindle cell pseudotumor (MSCP) represents an uncommon tumor-like proliferation associated with nontuberculous mycobacterial infection, i.e., M. avium intracellulare, affecting primarily the lymph nodes of immunocompromised men in their 5th decade. Involvement of the nasal cavity by MSCP is exceedingly rare with only 3 well-documented examples in the literature. METHODS A 74-year-old, HIV-negative, man presented with a 0.5-cm nodule of the left nasal cavity clinically presenting as a "nasal polyp." His medical history was significant for colonic adenocarcinoma, cutaneous basal cell carcinoma, and chronic lymphocytic leukemia (CLL) transforming to B-cell prolymphocytic leukemia, responsive to chemotherapy. The patient was diagnosed with prostatic adenocarcinoma treated with radiotherapy two months before the nasal lesion was detected. No lymph node enlargement, pulmonary involvement or hepatosplenomegaly were noticed. The nasal nodule was surgically excised and histopathologically examined to rule out metastatic disease or CLL relapse. RESULTS Microscopically, the lesion comprised a well-circumscribed, monotonous, spindle cell population in a vaguely storiform arrangement mixed with a heavy infiltrate of neutrophils and sparse lymphocytes. The spindle cells featured finely granular rich eosinophilic cytoplasm with rounded, oval to epithelioid, or elongated nuclei with vesicular chromatin and one or two distinct nucleoli. The lesional cells lacked overt cytologic atypia and showed occasional regular mitoses. The surface epithelium was intact or focally ulcerated. By immunohistochemistry, the spindle cell population stained strongly and diffusely for CD68 and was negative for AE1/AE3, SMA, CD34, and PSA. CD3 highlighted scattered lymphocytes. Ziehl-Neelsen stain disclosed numerous intracytoplasmic acid-fast bacilli. A diagnosis of MSCP was rendered. No recurrences were observed during a 24-month follow-up period. CONCLUSION Although exceptionally rare, MSCP should be considered in the differential diagnosis of nodular lesions of the nasal cavity that are characterized microscopically by marked spindle cell proliferation in a vague storiform pattern, admixed with a lymphocytic or mixed inflammatory infiltrate. A negative medical history for HIV infection and medication-induced immunosuppression should not preclude a diagnosis of MSCP, particularly in extranodal sites. Once the diagnosis is established, prognosis appears to be excellent for nasal MSCP following conservative surgical excision.
Collapse
Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, 2191 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA.
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| |
Collapse
|
9
|
Wang D, Misdraji J. Inflammatory Pseudotumor of the Liver. Surg Pathol Clin 2023; 16:565-580. [PMID: 37536889 DOI: 10.1016/j.path.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Hepatic inflammatory pseudotumor (IPT) describes a mass lesion composed of fibroblasts or myofibroblasts with a dense inflammatory infiltrate comprising lymphocyte, plasma cells, and histiocytes. These lesions are presumed to be an exuberant response to an infectious organism, although in most cases the causative agent is unknown. In specific circumstances, pathologists should consider ancillary techniques to exclude specific infections, such as mycobacteria, Candida, or syphilis. IgG4-related disease may cause a plasma-cell rich IPT. Finally, true neoplasms can mimic IPTs and must be excluded with appropriate ancillary studies, including inflammatory myofibroblastic tumor, follicular dendritic cell tumor, inflammatory angiomyolipoma, Hodgkin lymphoma, and inflammatory hepatocellular carcinoma.
Collapse
Affiliation(s)
- Donghai Wang
- Department of Pathology, New York University Grossman School of Medicine, NYU Langone Health, 560 First Avenue TH-483, New York, NY 10016, USA
| | - Joseph Misdraji
- Department of Pathology, Yale School of Medicine, Yale New Haven Hospital, 20 York Street EP2-611, New Haven, CT 06510, USA.
| |
Collapse
|
10
|
Higashihara M, Kawamura T, Miyazaki Y, Yokoo T, Joh K. Granulomatosis with polyangiitis presenting as a solitary renal mass: a case report. BMC Nephrol 2023; 24:223. [PMID: 37507681 PMCID: PMC10375652 DOI: 10.1186/s12882-023-03276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous vasculitis involving small-sized vessels in the upper airways, lower airways, and kidneys. Renal pathology is usually characterized by focal segmental necrotizing glomerulonephritis, which often leads to rapidly progressive renal failure. This type of renal involvement is usually unapparent on radiography. The presence of a renal mass in a patient with GPA, although extremely rare, is recognizable. Herein, we report a rare case of GPA presenting as a solitary renal mass and present a review of the literature. CASE PRESENTATION A 75-year-old woman presented with a solitary right kidney mass measuring 4 × 3.5 cm detected by enhanced computed tomography. There was no history of sinusitis, rhinitis, cough, or pneumonia suggestive of systemic GPA. Nephrectomy was performed based on the suspicion of renal cell carcinoma or malignant lymphoma. Three months later, she was admitted because her serum creatinine levels increased from 54.81 μmol/L to 405.76 μmol/L accompanied by a high C-reactive protein level of 159 mg/L. Anti-neutrophil cytoplasmic antibodies against myeloperoxidase and anti-proteinase 3 were negative. Histological examinations of the solitary renal mass revealed necrotizing granulomatous arteritis in the cortex and medullary vasa recta, surrounded by interstitial fibrosis, and focal segmental necrotizing glomerulonephritis in the localized lesion; however, signs of vasculitis were not observed in areas other than the solitary mass. Therefore, the patient was diagnosed with granulomatosis with polyangiitis (GPA). Despite treatment with prednisolone (30 mg/day), the patient developed oliguria with an elevation of her serum creatinine level to 583.44 μmol/L, which required hemodialysis within one month after the initiation of steroid therapy. The patient could successfully discontinue hemodialysis 21 months later, following a decrease in her serum creatinine level to 251.06 μmol/L. CONCLUSIONS GPA should be considered as one of the differential diagnoses of a solitary renal mass. Furthermore, patients with solitary renal masses associated with GPA may exhibit a favorable response to steroid or immunosuppressive treatment.
Collapse
Affiliation(s)
- Mai Higashihara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, Japan.
| | - Tetsuya Kawamura
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, Japan
| | - Yoichi Miyazaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, Japan
| | - Kensuke Joh
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Nguyen H, Pham DH, Luong TH. Successful surgical management of an aggressive IgG4-related sclerosing esophageal inflammatory pseudotumor: a case report and review of literature. J Cardiothorac Surg 2023; 18:215. [PMID: 37403075 DOI: 10.1186/s13019-023-02317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) of the esophagus is a very rare benign lesions which clinical presentation is not clear and difficult to make a definitive diagnosis preoperatively. CASE PRESENTATION In this report, we presented a case of a 24-year-old female with signs of severe malnutrition state due to dysphagia increasing gradually and losing 10 kg in weight for 2 months. Comprehensive preoperative radiologic investigations were proceeded with a circumferential severe stricture caused smooth submucosal swelling in the esophagus under 23 cm from the upper dental arch and two times of negative biopsy. Due to the aggressive clinical symptoms and gross lesion characteristics, the patient underwent laparoscopic-thoracoscopic esophagectomy and reconstruction with a gastric tube. Histopathological examination showed that the squamous epithelium of the esophagus had a small, benign nucleus, the submucosal layer and the smooth muscle layer increased fibrous, with infiltrating many lymphocytes, plasma cells, and macrophages. Immunohistochemical staining was negative for CD68, CD34, Desmin and ALK markers, and there was an increase in the number of IgG4-positive plasma cells. The final diagnosis was an aggressive IgG4-related sclerosing esophageal inflammatory pseudotumor. CONCLUSIONS Inflammatory pseudotumor of the esophagus is an extremely rare benign lesion but could led to aggressive clinical presentation. The gold standard of diagnosis is histopathological examination of surgically removed specimens. Radical resection is still the most efficient treatment method.
Collapse
Affiliation(s)
- Hoang Nguyen
- Department of Gastrointestinal and Hepatobiliary surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Ha Noi, Hanoi, 11521, Vietnam
| | - Duc Huan Pham
- Center for Gastroenterology - Hepatobiliary - Urology - Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Ha Noi, Hanoi, 11521, Vietnam.
- Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam.
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
13
|
Agaimy A, Förster S, Kalla J, Stacher-Priehse E, Titze U, Vieth M. Paravertebral fibrous pseudotumor: Four cases of a distinctive tumefactive lesion overlapping with eosinophilic angiocentric fibrosis and tumoral erythema elevatum diutinum. Ann Diagn Pathol 2023; 62:152073. [PMID: 36502765 DOI: 10.1016/j.anndiagpath.2022.152073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare tumefactive fibroinflammatory disease with predilection for the upper respiratory tract, characterized by concentric (onionskin) fibrosis around small arterioles with variable intervening storiform fibrosis admixed with chronic inflammatory infiltrates rich in eosinophils. Erythema elevatum diutinum (EED), another autoimmunological disorder that mainly affects acral sites and extensor surfaces, is characterized by neutrophilic leukocytoclastic vasculitis. Rarely, older EED lesions may present as tumefactive nodular (pseudotumoral) fibrous masses closely mimicking EAF. We herein describe four patients (all males) aged 66-70 years who presented with large (median, 7 cm) tumor-like fibrous lesions in the paravertebral region not associated with a known clinical autoimmune disease. All cases were resected surgically with the suspicion of a neoplasm. They displayed a strikingly similar histological appearance with combined features of EAF and nodular fibrous EED. None had evidence of obliterative phlebitis or increased IgG4: IgG ratio. The etiology of this distinctive lesion and its predilection for the paravertebral area of males remains obscure. A distinctive tumefactive localized reaction to trauma caused by degenerative disease of adjacent vertebrae might be a possible explanation.
Collapse
Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Germany.
| | - Stefan Förster
- Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Jörg Kalla
- Institut für Pathologie, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | | | - Ulf Titze
- Institut für Pathologie des Klinikum Lippe, Detmold, Germany
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Germany; Institut für Pathologie, Klinikum Bayreuth GmbH, Bayreuth, Germany
| |
Collapse
|
14
|
Verboven G, Sluyts Y, De Mulder G, Stessels F, De Cauwer H. Intracranial rheumatoid nodules: a rare localization of rheumatoid arthritis. Acta Neurol Belg 2023; 123:753-755. [PMID: 36682007 DOI: 10.1007/s13760-023-02200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/18/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Griet Verboven
- Department of Neurology, Geel General Hospital. Ziekenhuis Netwerk Kempen, Ziekenhuis Geel, JB Stessenstraat 2, 2440, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Yasmine Sluyts
- Department of Neurology, Geel General Hospital. Ziekenhuis Netwerk Kempen, Ziekenhuis Geel, JB Stessenstraat 2, 2440, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Gert De Mulder
- Department of Neurosurgery, Geel General Hospital. Ziekenhuis Netwerk Kempen, Geel, Belgium
| | - Filip Stessels
- Department of Pathology, Geel General Hospital. Ziekenhuis Netwerk Kempen, Geel, Belgium
| | - Harald De Cauwer
- Department of Neurology, Geel General Hospital. Ziekenhuis Netwerk Kempen, Ziekenhuis Geel, JB Stessenstraat 2, 2440, Geel, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| |
Collapse
|
15
|
Oh JS, Kim HW, Park SB, Kang DH, Choi CW, Kim SJ, Nam HS, Ryu DG. A large and pedunculated inflammatory pseudotumor with pseudosarcomatous change of the cecum mimicking a malignant polyp: a case report and literature review. Clin Endosc 2023; 56:119-124. [PMID: 34275257 PMCID: PMC9902694 DOI: 10.5946/ce.2021.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown etiology that can occur in almost any organ system. It has neoplastic features such as local recurrence, invasive growth, and vascular invasion, leading to the possibility of malignant sarcomatous changes. The clinical presentations of colonic IPT may include abdominal pain, anemia, a palpable mass, and intestinal obstruction. A few cases of colonic IPT have been reported, but colonic IPT with pedunculated morphology is very rare. Furthermore, since it can mimic malignant polyps, understanding the endoscopic findings of colonic IPT is important for proper treatment. Herein, we present a case of colonic IPT with pseudosarcomatous changes, presenting as a large polyp, mimicking a malignant polyp in the cecum, along with a literature review.
Collapse
Affiliation(s)
- Jong Suk Oh
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea,Correspondence: Hyung Wook Kim Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea E-mail:
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
16
|
Chantada-de la Fuente D, San Miguel-Fraile MP, Serantes Combo A, Ortiz-Rey JA, Gándara-Cortés M, Fernández-Martín J. IgG4-related disease diagnosed in a paratesticular pseudotumor simulating malignancy, in a patient with retroperitoneal fibrosis. Rev Esp Patol 2022; 55 Suppl 1:S2-S6. [PMID: 36075657 DOI: 10.1016/j.patol.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 06/15/2023]
Abstract
IgG4 related disease is a term used to describe a fibroinflammatory condition characterized by storiform fibrosis, inflammation with a dense lymphoplasmocytic infiltrate rich in plasma cells expressing IgG4, and often, if not always, raised serum levels of IgG4. We report a case of a patient with a past history of retroperitoneal fibrosis presenting with a swollen left testicle, who underwent an orchidectomy due to suspicion of malignancy. The surgical specimen revealed a paratesticular pseudotumor with histopathological and immunohistochemical characteristics of IgG4 related disease. To the best of our knowledge, just nine such cases have previously been reported, of which only three were manifestations of systemic disease, as in the present case. Whilst it is important to recognize the clinical and radiological features of this entity, histopathology is often essential in order to confirm the diagnosis.
Collapse
|
17
|
Huang Y, Shu SN, Zhou H, Liu LL, Fang F. Infant biliary cirrhosis secondary to a biliary inflammatory myofibroblastic tumor: A case report and review of literature. World J Clin Cases 2022; 10:8375-8383. [PMID: 36159551 PMCID: PMC9403675 DOI: 10.12998/wjcc.v10.i23.8375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A biliary inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymoma that, although it has a broad age spectrum, usually occurs in adults. Diagnosis is difficult because biliary IMTs often exhibit nonspecific clinical symptoms and imaging features, resulting in delayed or inappropriate treatment. Although most IMTs are benign, some show malignant properties such as infiltration, recurrence, and metastasis.
CASE SUMMARY Here, we retrospectively describe a 10-month-old infant who was admitted to our hospital due to stubborn jaundice. The patient responded poorly to routine medical treatment and his clinical manifestations and laboratory tests lacked specificity, so we turned to repeated ultrasound scans and other imaging examinations. As both hepatosplenic ultrasonography and diffusion-weighted magnetic resonance imaging demonstrated a space-occupying lesion, an exploratory laparotomy was performed. The final diagnosis made over two mo after the disease onset was infant biliary cirrhosis caused by a biliary IMT, which partially infiltrated into the liver. This infant is the youngest case of biliary IMTs that has been reported till now. The patient underwent an incomplete resection of the mass and Kasai Portoenterostomy. However, because of cirrhosis, he also received a paternal liver transplant. Since some IMTs show malignant properties, we proceeded with a three-year of follow-up; however, no recurrence or metastasis has been noted.
CONCLUSION Neoplastic disease such as IMTs should be considered when routine medical treatment of obstructive jaundice is not successful. Observation of dynamic imaging changes is helpful for diagnosis. Periodic follow-up is necessary for IMTs.
Collapse
Affiliation(s)
- Yuan Huang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hua Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ling-Ling Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Feng Fang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| |
Collapse
|
18
|
Carrasco Rodríguez R, García Fontán EM, Blanco Ramos M, Magdalena Benavides LJ, Otero Lozano D, Moldes Rodriguez M, Cañizares Carretero MA. Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. Cir Esp 2022; 100:329-335. [PMID: 35577280 DOI: 10.1016/j.cireng.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Otero Lozano
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | | |
Collapse
|
19
|
Geiselmann MT, Acampa DJ, Melamed J, Arif F, Takabe K, Seitelman E, Datta R, Gunasekaran G, Takahashi H. Immunoglobulin G4-Negative Inflammatory Pseudotumors of the Pancreas. World J Oncol 2022; 12:240-245. [PMID: 35059084 PMCID: PMC8734500 DOI: 10.14740/wjon1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 11/11/2022] Open
Abstract
Inflammatory pseudotumor (IPT) can occur in any organ, but rarely shows pancreatic involvement. While surgical excision has been recommended as the primary treatment for IPT of the pancreas in the past, some authors suggest observation while medical management often results in regression. Corticosteroids, nonsteroidal anti-inflammatory drugs and immunosuppressive therapy have been used to treat IPTs. Spontaneous regression has also been reported in IPT managed without surgical intervention. A 62-year-old female was evaluated for worsening abdominal pain and a mass in the neck of the pancreas that was identified on ultrasound. Further imaging with magnetic resonance imaging revealed a pancreatic mass with dilated pancreatic duct and an atrophic parenchyma of the pancreatic neck. Her serum tumor markers were not elevated. As this lesion appeared to be resectable pancreatic cancer based on cross-sectional imaging, no biopsy was performed prior to surgical resection. Distal pancreatectomy and splenectomy was recommended and the patient desired to proceed. Her recovery was uneventful with no postoperative complications, including pancreatic fistula. Final pathology revealed a lesion consistent with the diagnosis of immunoglobulin G4 (IgG4)-negative IPT without neoplasm. IPT of the pancreas is a difficult entity to diagnose and treat due to clinical and imaging characteristics closely resembling pancreatic adenocarcinoma. Biopsy with immunohistochemical analysis can be useful in diagnosing IPT; however, symptomatic lesions and concerning findings on cross-sectional imaging may warrant more definitive surgical intervention.
Collapse
Affiliation(s)
- Matthew T Geiselmann
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Daniel J Acampa
- New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA.,Both authors contributed equally
| | - Joshua Melamed
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Farzana Arif
- Department of Pathology, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eric Seitelman
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Rajiv Datta
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| | - Ganesh Gunasekaran
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA.,Department of Surgery, Division of HPB Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Hideo Takahashi
- Department of Surgery, Mount Sinai South Nassau, Oceanside, NY, USA
| |
Collapse
|
20
|
Abstract
Inflammatory Myofibroblastic Tumors (IMTs) are rare fibroblastic/myofibroblastic neoplasms that affect predominately pediatric patients and young adults. Almost half of the patients with IMTs have a chromosomal abnormality in the Anaplastic Lymphoma Kinase 1 gene on chromosome 2p23. Although these tumors occur primarily in the lung, lesions have been reported in a variety of intra-abdominal organs like the liver, spleen, and mesentery. Small bowel IMTs are particularly rare. IMTs generally pursue a benign clinical course, however intra-abdominal and retroperitoneal tumors have typically shown higher local recurrence and even distant metastases. The most common presenting symptoms of an intra-abdominal IMT are abdominal pain and change in bowel habits. Laboratory results are nonspecific and can include anemia and minor elevation of inflammatory markers like C-reactive protein. We report an unusual case of IMT in the small bowel causing the obstruction.
Collapse
Affiliation(s)
- Anatoly Budylev
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irit Solar
- The Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rivka Kessner
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Aizic
- The Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
21
|
Li J, Hu L, Wang Q, Sun XB, Yang M. [A case of immunoglobulin G4-related sclerosing cholangitis combined with inflammatory pseudotumor of the liver]. Zhonghua Gan Zang Bing Za Zhi 2021; 29:1118-1120. [PMID: 34933435 DOI: 10.3760/cma.j.cn501113-20201119-00622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- J Li
- Department of Gastroenterology, the Third People's Hospital of Chengdu, Chengdu 610031, China
| | - L Hu
- Department of Gastroenterology, the Third People's Hospital of Chengdu, Chengdu 610031, China
| | - Q Wang
- Department of Gastroenterology, the Third People's Hospital of Chengdu, Chengdu 610031, China
| | - X B Sun
- Department of Gastroenterology, the Third People's Hospital of Chengdu, Chengdu 610031, China
| | - M Yang
- Department of Gastroenterology, the Third People's Hospital of Chengdu, Chengdu 610031, China
| |
Collapse
|
22
|
Nilles C, Poillon G, Deschamps L, Daval M, Diallo IM, Deschamps R, Boudot de la Motte M. IgG4-related pachymeningitis and mastoiditis, associated with cerebral venous thrombosis: A case report. J Neuroimmunol 2021; 360:577717. [PMID: 34517153 DOI: 10.1016/j.jneuroim.2021.577717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 11/17/2022]
Abstract
IgG4-related disease (IgG4-RD) is a multisystem fibroinflammatory condition; this can be a challenging diagnosis that requires clinico-pathologic correlation. We report a young woman, presenting with cranial nerve palsy. The work-up revealed pachymeningitis, cerebral venous thrombosis (CVT), and a destructive lesion in the mastoid. We diagnosed IgG4-RD through mastoidectomy. Thus, a biopsy of asymptomatic, infrequently affected organs, like the mastoid, can meet all histopathological criteria. In neuro-meningeal presentations, CVT may be secondary to the local inflammatory environment of pachymeningitis. Since our patient had a deep vein thrombosis one year prior, we discuss a possible higher risk of thrombosis in IgG4-RD patients.
Collapse
Affiliation(s)
- Christelle Nilles
- Service de Neurologie, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Guillaume Poillon
- Service de Radiologie, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Lydia Deschamps
- Service d'Anatomopathologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Mary Daval
- Service d'ORL, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Romain Deschamps
- Service de Neurologie, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | |
Collapse
|
23
|
Koiwai A, Hirota M, Satoh M, Takasu A, Meguro T, Endo K, Kogure T, Murakami K, Murakami K, Satoh K. Immunoglobulin G4-Related Hepatic Inflammatory Pseudotumor Diagnosed with Endoscopic Ultrasound-Guided Fine-Needle Biopsy. Case Rep Gastroenterol 2021; 15:488-494. [PMID: 34616245 PMCID: PMC8454245 DOI: 10.1159/000516687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
A 71-year-old man with obstructive jaundice was referred to our department. He underwent cholangiojejunostomy 15 years ago for palliative drainage. At that time, he had obstructive jaundice caused by an unresectable pancreatic head tumor. Contrast-enhanced computed tomography (CE-CT) now revealed a mass with low enhancement in the hepatic hilum that occluded the hilar bile duct and infiltrated extensively along the portal vein and hepatic artery. CE-CT also showed marked atrophy of the left hepatic lobe. No swelling or tumors were observed in the pancreas. Serum immunoglobulin G4 (IgG4) levels were as high as 465 mg/dL. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed targeting the hepatic hilar lesion. Immunohistological results of the biopsy specimens suggested that the lesion was an IgG4-related hepatic inflammatory pseudotumor (IPT) with no atypical cells. Steroid treatment resulted in rapid clinical improvement. This case suggested the usefulness of EUS-FNB for diagnosing IgG4-related hepatic hilar IPT.
Collapse
Affiliation(s)
- Akinobu Koiwai
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mari Satoh
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuko Takasu
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayoshi Meguro
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Katsuya Endo
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayuki Kogure
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Keigo Murakami
- Division of Pathology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuhiro Murakami
- Division of Pathology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kennichi Satoh
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| |
Collapse
|
24
|
Liu B, Huang Y, Tang L, Guan J, Zhou X, Zhan H. Inflammatory pseudotumor of Castleman disease and IgG4-related disease masquerading as kidney malignancy. Diagn Pathol 2021; 16:74. [PMID: 34376196 PMCID: PMC8353839 DOI: 10.1186/s13000-021-01134-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background With widespread clinical application of imaging techniques, renal space-occupying lesions have been identified at an increasing frequency. Here, we report two rare cases, Castleman disease (CD) and IgG4-related disease (IgG4-RD), presenting primarily with the symptoms and imaging findings of kidney malignancy. Case presentation In case 1, an occupying lesion located in the right renal pelvis was detected using magnetic resonance imaging in a 32-year-old female who presented with hematuria and lumbago. First misdiagnosed as carcinoma of the renal pelvis, the patient underwent right radical nephroureterectomy. However, postoperative pathological and immunohistochemistry studies finally confirmed the diagnosis of CD. In case 2, a 45-year-old male presented with the chief complaint of anuria. Nephrostomy and renal biopsy indicated lymphoma, following which, antegrade urography and computed tomography urography were performed, which revealed bilateral hydronephrosis and mass lesions around the renal pelvis. Partial resection of the masses and frozen section examination indicated the diagnosis of CD. However, the results of postoperative histopathology and immunohistochemistry combined with serum IgG4 were consistent with IgG4-RD. Both the patients recovered well after drug treatment without recurrence of the diseases. Conclusions Inflammatory pseudotumor of CD and IgG4-RD with kidney involvement are primarily diagnosed by postoperative histopathology and can pose a preoperative diagnostic challenge because these lesions can masquerade as kidney malignancy. Therefore, we recommend core biopsy as a nonnegligible procedure to evaluate renal masses and potentially prevent unnecessary surgical treatment.
Collapse
Affiliation(s)
- Bolong Liu
- Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yong Huang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Luying Tang
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiexia Guan
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangfu Zhou
- Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Hailun Zhan
- Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
25
|
Pascariu AD, Neagu AI, Neagu AV, Băjenaru A, Bețianu CI. Hepatic inflammatory pseudotumor-like follicular dendritic cell tumor: a case report. J Med Case Rep 2021; 15:410. [PMID: 34321082 PMCID: PMC8320187 DOI: 10.1186/s13256-021-02957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Inflammatory pseudotumor-like follicular dendritic cell sarcoma is a rare histological variant of follicular dendritic cell sarcoma involving typically the spleen and the liver, often linked to the presence of Epstein–Barr virus infection. Definite diagnosis of this type of sarcoma is difficult to make owing to nonspecific clinical and imaging findings and is based on histopathological features. Inflammatory pseudotumor-like follicular dendritic cell sarcoma is described as a low-aggressivity tumor with a favorable prognosis. Case presentation We report the case of a 34-year-old Caucasian woman, Epstein–Barr virus positive, diagnosed with hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma and surgically treated in November 2014, who developed 6 years later a recurrence for which she underwent once again surgical treatment. As far as we know, fewer than 30 reports of inflammatory pseudotumor-like follicular dendritic cell liver tumors have been reported in the English literature. Conclusions Although it is an uncommon tumor, inflammatory pseudotumor-like sarcoma is a diagnostic worth being taken in consideration, and surveillance is recommended owing to the possibility of recurrence.
Collapse
Affiliation(s)
- Ana Daniela Pascariu
- Department of Radiology, "Carol Davila" Central Military Emergency University Hospital, Mircea Vulcanescu Street, no. 88, 010825, Bucharest, Romania
| | - Andreea Ioana Neagu
- Department of Radiology, "Carol Davila" Central Military Emergency University Hospital, Mircea Vulcanescu Street, no. 88, 010825, Bucharest, Romania
| | - Andrei Valentin Neagu
- Department of Radiology, "Carol Davila" Central Military Emergency University Hospital, Mircea Vulcanescu Street, no. 88, 010825, Bucharest, Romania
| | - Alexandru Băjenaru
- Department of Radiology, "Carol Davila" Central Military Emergency University Hospital, Mircea Vulcanescu Street, no. 88, 010825, Bucharest, Romania
| | - Cezar Iulian Bețianu
- Department of Interventional Radiology, "Carol Davila" Central Military Emergency University Hospital, Mircea Vulcanescu Street, no.88, 010825, Bucharest, Romania.
| |
Collapse
|
26
|
El-Diasty MT, Wazzan MA, Abduljabbar AH. Inflammatory Myofibroblastic Tumor of the Porta Hepatis: A Case Report. J Clin Imaging Sci 2021; 11:28. [PMID: 34221637 PMCID: PMC8247711 DOI: 10.25259/jcis_91_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old man presented with painless jaundice. Imaging revealed a porta hepatis mass compressing the common bile duct. Endoscopic biopsy was negative for malignancy. Complete surgical resection was performed. Pathological assessment showed IGg4 negative inflammatory myofibroblastic tumor.
Collapse
|
27
|
Mainolfi CG, D'Antonio A, Mango G, De Lucia D, Buffardi S, Marra N, Errico ME, Cuocolo A. Ileal inflammatory pseudotumor in adolescent male patient with prior Burkitt lymphoma: A challenging diagnosis. Radiol Case Rep 2021; 16:2047-2052. [PMID: 34158889 PMCID: PMC8203584 DOI: 10.1016/j.radcr.2021.04.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Inflammatory pseudotumor is a rare benign mesenchymal pediatric neoplasm, that can mimic tumoral residue or relapse at metabolic imaging with nonspecific clinical presentation and difficult diagnosis. We present the case of a 14year old male patient with fever of unknown origin and large ileal mass, diagnosed with and treated for Burkitt lymphoma, who performed several 18-fluoro-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) scans, during and after first line chemotherapy, showing persistent and focal uptake, while ileal mass volume decreased dramatically and the patient was clinically asymptomatic. Histopathological analysis of residual ileal mass was suggestive for xanthomatous pseudotumor, a type of inflammatory pseudotumor. No more treatment was performed and a short-term follow up with 18F-FDG PET/CT showed tracer uptake intensity decreasing progressively over the next few months. This case reports an uncommon presentation of a rare disease, inflammatory pseudotumor of the small bowel developed at the site of treated Burkitt lymphoma, underscoring the potential role of 18F-FDG PET/CT imaging in the diagnosis and management of these rare neoplasms, particularly in asymptomatic patients.
Collapse
Affiliation(s)
- Ciro Gabriele Mainolfi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Gaia Mango
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Dalila De Lucia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Salvatore Buffardi
- Pediatric Haemato-Oncology Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Nicoletta Marra
- Pediatric Haemato-Oncology Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Elena Errico
- Pathological Anatomy Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| |
Collapse
|
28
|
Carrasco Rodríguez R, García Fontán EM, Blanco Ramos M, Juaneda Magdalena Benavides L, Otero Lozano D, Moldes Rodriguez M, Cañizares Carretero MA. Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. Cir Esp 2021; 100:S0009-739X(21)00112-3. [PMID: 33896608 DOI: 10.1016/j.ciresp.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didńt find any loco-regional or distant recurrence in the patients studied. CONCLUSION IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Otero Lozano
- Servicio de Cirugía Torácica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | | | | |
Collapse
|
29
|
Kaplan J, Mangum C, Shoukry M, Gabriel E. Inflammatory Pseudotumor Resembling a Malignant Pancreatic Disease Process. Anticancer Res 2021; 41:2079-2082. [PMID: 33813417 DOI: 10.21873/anticanres.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Inflammatory pseudotumors are complex entities given that they carry varying characteristics with a multitude of behaviors that can resemble a malignancy clinically, radiographically, and histologically. PATIENTS AND METHODS Our case report presents a 65-year-old-female with a history of fever, abdominal pain, and anemia with imaging suggestive of a malignant disease process involving an ill-defined soft tissue mass between the left adrenal gland and pancreatic tail. RESULTS Following diagnostic laparoscopy with abdominal washings and subsequent open resection of the mass, final pathology revealed multiple specimens demonstrating dense fibrosis with admixed spindled cells and inflammatory cells, an overarching morphology, and an immunohistochemical staining profile consistent with pancreatic inflammatory pseudotumor. CONCLUSION Inflammatory pseudotumor is a challenging diagnosis and should be included in the differential diagnosis for a patient who presents with nonspecific symptoms and an ill-defined mass on imaging.
Collapse
Affiliation(s)
- Jamie Kaplan
- Department of General Surgery, Mayo Clinic, Jacksonville, FL, U.S.A.
| | - Catherine Mangum
- Department of General Surgery, Mayo Clinic, Jacksonville, FL, U.S.A
| | - Mira Shoukry
- Department of General Surgery, Mayo Clinic, Jacksonville, FL, U.S.A
| | - Emmanuel Gabriel
- Department of General Surgery, Mayo Clinic, Jacksonville, FL, U.S.A
| |
Collapse
|
30
|
Wang X, Li Y, Wang S, Wang S, Sun S. A rare case of inflammatory pseudotumor located in the ventral of medullocervical junction. A case report and review of literature. Br J Neurosurg 2021; 37:1-3. [PMID: 33688755 DOI: 10.1080/02688697.2021.1895970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
Inflammatory pseudotumor is a benign lesion of unknown etiology, which mimics neoplasms clinically and radiographically. It most commonly involves the lungs and orbits and is rarely reported in the central nervous system. We report a rare case of inflammatory pseudotumor located in the ventral junction of the medulla oblangta and cervical cistern, which has not been reported before as far as we know. A 61-year-old male presented with right arm weakness. MRI showed a mass located in the ventral junction of the medulla oblongata and cervical cisten. The patient was diagnosed as inflammatory pseudotumor(IPT) after surgical excision and histopathology. This tumor-like lesion was surrounding the bilateral intracranial segment of the vertebral arteries. No evidence of vascular invasion was observed. Complete surgical resection was achieved.
Collapse
Affiliation(s)
- Xiaochen Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingying Li
- Department of Radiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sihui Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Affiliated Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
31
|
Higashizono K, Sato S, Nagai E, Taki Y, Nishida M, Watanabe M, Arai K, Takagi A, Oba N. Esophageal inflammatory pseudotumor with low-dose corticosteroid therapy after surgery. Clin J Gastroenterol 2021; 14:427-33. [PMID: 33677801 DOI: 10.1007/s12328-021-01377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Inflammatory pseudotumors of the esophagus are extremely rare, and the treatment has been controversial. Herein, we report a case of esophageal inflammatory pseudotumor with low-dose corticosteroid treatment following surgery. A 50-year-old woman with a 3-month history of progressive dysphagia and weight loss, was admitted to our hospital for examination and treatment. Esophagography and endoscopic examination revealed a mass present from the cervical esophagus to the upper thoracic esophagus with severe esophageal stricture. Ultrasound-guided fine needle aspiration cytology, boring biopsy, and mucosal incision-assisted biopsy reveal chronic inflammation, but histological diagnosis was not proven. Surgery was performed to confirm diagnosis and to relieve esophageal stricture. However, because of dense adhesions around the tumor, complete tumor resection was not achieved. Histopathological examination showed an inflammatory infiltrate with plasma cells, eosinophils, neutrophils, and lymphocytes, suggesting an inflammatory pseudotumor. After surgical resection, the esophageal stricture remained, possibly due to the residual tumor. We used a postoperative low-dose steroid treatment that resulted in complete resolution. There has not been any evident sign of recurrence for more than 2 years.
Collapse
|
32
|
Schmitz-Dräger BJ, Skutetzki A, Rieker RJ, Schwab SA, Stöhr R, Bismarck E, Savov O, Ebert T, Benderska-Söder N, Hartmann A. Eosinophilic cystitis mimicking bladder cancer-considerations on the management based upon a case report and a review of the literature. Virchows Arch 2021; 479:523-527. [PMID: 33576854 DOI: 10.1007/s00428-021-03049-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
The hypereosinophilic syndrome (HES) is a rare disorder characterized by hypereosinophilia and infiltration of various organs with eosinophils. Eosinophilic cystitis (EC), mimicking bladder cancer clinically but also in ultrasound and in radiographic imaging, is one potential manifestation of the HES occurring in adults as well as in children. This case report describes the course of disease in a 57-year-old male presenting with severe gait disorders and symptoms of a low compliance bladder caused by a large retropubic tumor. After extensive urine and serologic examination and histologic confirmation of EC the patient was subjected to medical treatment with cetirizine and prednisolone for 5 weeks. While gait disorders rapidly resolved, micturition normalized only 10 months after initiation of therapy. Based upon this course the authors recommend patience and reluctance concerning radical surgical intervention in EC. Key Points • Eosinophilic cystitis is a rare condition with app. 200 cases reported, so far. • Etiology of eosinophilic cystitis is obscure, but allergies and parasitic infections may trigger the disease. • Genetic alterations (e.g., BRAF mutations) may predispose for the disease • Corticosteroids and antihistamines are the backbone of therapy and may be complemented by antibiotics and non-steroidal anti-inflammatory drugs in case of concomitant (underlying) infections. • As recovery can occur even after a long time, radical surgery should be restricted to highly selected cases.
Collapse
Affiliation(s)
- Bernd J Schmitz-Dräger
- St. Theresienkrankenhaus, Nürnberg, Urologie 24, Nuremberg, Germany. .,Department of Urology and Pediatric Urology, Friedrich-Alexander University, Erlangen, Germany.
| | - Andreas Skutetzki
- Department of Trauma Surgery and Orthopedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Ralf J Rieker
- Department of Pathology, St. Theresienkrankenhaus, Nuremberg, Germany.,Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Siegfried A Schwab
- Radiologis, Dr. Meer und Kollegen, Oberasbach-Nuremberg, Zirndorf, Germany
| | - Robert Stöhr
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | | | - Orlin Savov
- St. Theresienkrankenhaus, Nürnberg, Urologie 24, Nuremberg, Germany
| | - Thomas Ebert
- St. Theresienkrankenhaus, Nürnberg, Urologie 24, Nuremberg, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
33
|
Garber ME, Wu A, Millet JD. IgG4-related disease presenting as a solitary paratesticular fibrous pseudotumor. Urol Case Rep 2021; 36:101584. [PMID: 33552918 PMCID: PMC7856315 DOI: 10.1016/j.eucr.2021.101584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/13/2023] Open
Abstract
Paratesticular fibrous pseudotumors (PFP) have long been described in the literature. Since the recognition of IgG4-related disease (IgG4-RD) as a distinct clinical entity, cases of PFP with similar pathological characteristics have been described. A case of IgG4-RD presenting as an isolated PFP is presented.
Collapse
Affiliation(s)
- Martin E Garber
- Department of Internal Medicine, Division of Rheumatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Angela Wu
- Genitourinary Pathology, Department of Pathology, Michigan Medicine, University of Michigan, Faculty Suite Rm. 36-1221-41, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109 - 2800, USA
| | - John D Millet
- Department of Radiology, Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr., B1D520D, Ann Arbor, MI, 48109-5030, USA
| |
Collapse
|
34
|
Liu X, Cao L, Chin W, Yu J, Liu Y, Zheng S. Epstein-Barr virus-negative inflammatory pseudotumor-like variant of follicular dendritic cell sarcoma of the liver: A case report and literature review. Clin Res Hepatol Gastroenterol 2021; 45:101457. [PMID: 32540141 DOI: 10.1016/j.clinre.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Follicular dendritic cell sarcoma (FDCS) can be divided into the conventional type, and the inflammatory pseudotumor (IPT)-like variant type. Epstein-Barr virus (EBV) infection is considered to be closely associated with the pathogenesis of IPT-like variant of FDCS. Hepatic FDCS has an exceedingly low incidence of only 29 cases reported, with most of these tumors being classified as the IPT-like type. We report a case of an IPT-like variant of FDCS of the liver in a 61-year old man who presented with no marked symptoms. The patient underwent laparoscopic surgery for the mass and was well during a 13-month follow-up periods. The postoperative pathological examination found a proliferation of spindle cells and a diffuse infiltration of inflammatory cells within the tumor. Immunohistochemistry revealed that neoplastic cells were positive for CD23, clusterin, fascin, and PD-L1, and weakly positive for CD35, SMA, and D2-40. The infiltrating lymphocytes were strongly positive for PD1, and IgG4-positive plasma cells were less than 10 cells/high-power field. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) was negative. To our knowledge, the present case is the second case of hepatic IPT-like variant of FDCS without EBV involvement, indicating that EBV infection is not an absolute prerequisite for a diagnosis of the IPT-like variant of FDCS.
Collapse
Affiliation(s)
- Xi Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Linping Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Wenjie Chin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Jun Yu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Yuanxing Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China.
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310003 Hangzhou, China; Key Laboratory of Combined Multi-organ Transplantation, 310003 Hangzhou, China.
| |
Collapse
|
35
|
Jandee S, Boonsri P. Atypical Manifestations of IgG4-Related Disease as Multiple Liver Abscesses with Subcapsular Tracts and Migratory Pulmonary Nodules Mimicking Parasitic Infection. Case Rep Gastroenterol 2020; 14:458-466. [PMID: 33173461 PMCID: PMC7588676 DOI: 10.1159/000509501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/16/2020] [Indexed: 12/24/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that becomes more recognized as multi-systemic disorders, characterized by three histological hallmarks of IgG4-positive lymphoplasmacytic tissue infiltrate, storiform fibrosis, and obliterative phlebitis. This disease has been reported in virtually every organ system, but the hepatic manifestations remain poorly defined. Moreover, IgG4-RD can mimic many malignancies, inflammatory disorders and infectious diseases. This report revealed IgG4-related liver disease with atypical presentation presenting with multiple liver abscesses and linear tracts mimicking parasitic infection.
Collapse
Affiliation(s)
- Sawangpong Jandee
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pattira Boonsri
- Diagnostic Radiology Unit, Division of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
36
|
Braham Y, Migaou A, Njima M, Achour A, Ben Saad A, Cheikh Mhamed S, Fahem N, Rouatbi N, Joobeur S. Inflammatory myofibroblastic tumor of the lung: A rare entity. Respir Med Case Rep 2020; 31:101287. [PMID: 33251105 PMCID: PMC7683262 DOI: 10.1016/j.rmcr.2020.101287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor usually seen within the first and second decade. They are extremely rare in adults, constituting less than 1% of adult lung tumors. It's usually benign, but it had a tendency for local recurrence. We report a case of asymptomatic inflammatory myofibroblastic tumor of lung in a 46-year-old non-smoker woman.
Collapse
Affiliation(s)
- Yosra Braham
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Asma Migaou
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Manel Njima
- Pathology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Asma Achour
- Radiology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ahmed Ben Saad
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Nesrine Fahem
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Naceur Rouatbi
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Samah Joobeur
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| |
Collapse
|
37
|
Ichikawa S, Motosugi U, Suzuki T, Shimizu T, Onishi H. Imaging features of hepatic inflammatory pseudotumor: distinction from colorectal liver metastasis using gadoxetate disodium-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2020; 45:2400-2408. [PMID: 32468212 DOI: 10.1007/s00261-020-02575-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To identify gadoxetate disodium-enhanced MRI features distinguishing hepatic IPT from CLM. METHODS From February 2008 to December 2019, 162 lesions (IPT, n = 31 and CLM, n = 131) from 94 patients (mean age 65.1 ± 12.2 years; 65 men and 29 women) were retrospectively assessed for the presence or absence of obscure boundary, rim enhancement on arterial phase (AP), persistent rim enhancement during AP to transitional phase (TP), blood vessel penetration, peritumoral parenchymal enhancement on AP, peritumoral parenchymal hypointensity on hepatobiliary phase (HBP), peritumoral parenchymal hyperintensity on T2-weighted imaging (T2WI), biliary dilatation, central hypointensity with a relatively hyperintense periphery on HBP, peripheral hyperintensity on diffusion-weighted imaging (DWI) and T2WI, and lesion to liver signal intensity ratio (SIRlesion/liver) on HBP and DWI. Relevant features for differentiating between ITP and CLM were identified by univariate and multivariate analyses. RESULTS Univariate analysis revealed significantly higher frequencies of the following features in IPT than CLM: younger age, obscure boundary, blood vessel penetration, central hypointensity with a relatively hyperintense periphery on HBP, higher SIRlesion/liver on HBP, and lower SIRlesion/liver on DWI (P < 0.001‒0.035). Rim enhancement on AP and persistent rim enhancement during AP to TP were significantly more common in CLM than in IPT (P ≤ 0.001). Multivariate analysis revealed that a central hypointensity with a relatively peripheral hyperintensity on HBP, higher SIRlesion/liver on HBP, and lower SIRlesion/liver on DWI were predictive of IPT (P = 0.003‒0.039). CONCLUSION Central hypointensity with a relatively peripheral hyperintensity on HBP and SIRlesion/liver on HBP and DWI may be reliable gadoxetate disodium-enhanced MRI features for distinguishing IPT from CLM.
Collapse
Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
- Department of Diagnostic Radiology, Kofu Kyoritsu Hospital, Kofu, Japan.
| | - Tatsuya Suzuki
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Tatsuya Shimizu
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| |
Collapse
|
38
|
Meng S, Liu G, Wang S, Yang F. Case report: inflammatory pseudotumor in the lung parenchyma caused by a medical suture originating from a cardiac surgery 35 years ago. J Cardiothorac Surg 2020; 15:151. [PMID: 32576201 PMCID: PMC7313219 DOI: 10.1186/s13019-020-01194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of the iatrogenic foreign body retained after surgery is extremely low. Iatrogenic foreign body retained is surrounded by normal tissue, which responds to foreign matter to form inflammatory pseudotumors. Surgical sponge or swap is the most common type of foreign body. There were no reports of medical sutures remaining as foreign bodies in the lung parenchyma to form inflammatory pseudotumors. CASE PRESENTATION A CT scan of a 50-year-old female showed an irregular soft tissue mass in the left upper lobe with rough edge and spiculation. After 20 months, the size increased from 2.8 × 1.9 cm to 3.2 × 2.2 cm. The patient underwent a ventricular septal repair surgery for congenital Fallot tetralogy 35 years ago and a left breast surgery for breast cancer. She had a family history of lung cancer. Evaluation of this mass highly suggested a lung malignant lesion. The patient underwent video-assisted thoracoscopic surgery (VATS) lobectomy and her pathology revealed an intrapulmonary inflammatory pseudotumor caused by a medical prolene suture. Based on her medical history and other reports of iatrogenic foreign bodies, we believe that this suture retained from the heart surgery 35 years ago entered the pulmonary artery, moved to the distal branch, and eventually formed an inflammatory pseudotumor in the lung parenchyma. Here we reported and analyze this rare case. CONCLUSION We reported a rare case of inflammatory pseudotumor in the lung parenchyma caused by a medical suture, and determined it was a prolene suture retained in the body during a cardiac surgery 35 years ago. Diagnosis of this rare disease required sufficient imaging experience. Besides, appropriate surgical exploration can help with the diagnosis and treatment.
Collapse
Affiliation(s)
- Shushi Meng
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Ganwei Liu
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| |
Collapse
|
39
|
Tanaka T, Ueda T, Yokoyama T, Harada S, Hatakeyama K, Yoshimura A. Pseudosarcomatous myofibroblastic proliferation of the appendix with an abdominal abscess due to diverticulum perforation: a case report. Surg Case Rep 2020; 6:144. [PMID: 32572649 PMCID: PMC7310037 DOI: 10.1186/s40792-020-00901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022] Open
Abstract
Background Pseudosarcomatous myofibroblastic proliferation is a rare proliferative lesion of the submucosal stroma characterized by myofibroblast proliferation and inflammatory cell infiltration, and is mainly reported in the urinary system. Case presentation We report a 65-year-old male who was referred to our emergency room with right-side iliac fossa pain. The pain gradually worsened for approximately 2 months, and rebound tenderness was positive. Blood examination showed severe inflammatory findings, and enhanced computed tomography revealed a heterogeneous contrast-enhancing mass lesion measured to be 55 × 50 mm in size at the lower right abdomen. Based on these results, the patient was diagnosed with appendicitis with an abdominal abscess. As the inflammation was severe, we drained the abscess before performing surgery. Approximately 1 month after the abscess diminished, interval appendectomy was performed. Macroscopic findings of the resected specimen showed a perforated diverticulum of the appendix and a small adjacent nodule measured to be 14 mm in size. Histopathological examination with hematoxylin and eosin staining revealed that the nodule consisted of fibroblast proliferation and inflammatory cell infiltration. Furthermore, immunohistochemical examination showed positive for smooth muscle actin and desmin and negative for S-100, c-kit, and anaplastic lymphoma kinase. Based on these histopathological results, we diagnosed the nodule as an unusual case of a pseudosarcomatous myofibroblastic proliferation associated with perforation of the diverticulum of the appendix. Conclusion Herein, we report a rare case of a pseudosarcomatous myofibroblastic proliferation that occurred in the appendix with diverticulitis.
Collapse
Affiliation(s)
- Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan.
| | - Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan
| | - Takashi Yokoyama
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan
| | - Suzuka Harada
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan
| |
Collapse
|
40
|
Zhou X, Mou Y, Zheng J, Liu Q. Hepatic inflammatory pseudotumor secondary to a foreign body at right lobe of liver. Asian J Surg 2020; 43:866-867. [PMID: 32461014 DOI: 10.1016/j.asjsur.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Xiaolin Zhou
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, PR China
| | - Yixuan Mou
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, PR China
| | - Jun Zheng
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, PR China
| | - Qiang Liu
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, PR China.
| |
Collapse
|
41
|
Du Y, Jiang Z. Pituitary inflammatory pseudotumor with amenorrhea, polyuria, and impaired vision: case report and review of the literature. Int J Clin Exp Pathol 2020; 13:778-784. [PMID: 32355527 PMCID: PMC7191143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) is a soft tissue lesion of unknown etiology. In 2002 the WHO classified it as a soft tissue tumor, and renamed it inflammatory myofibroblastic tumor. Inflammatory pseudotumor may involve various organs and tissues of the body, mainly the lungs and eyes. Primary intracerebral inflammatory pseudotumor is rare. If the differential diagnosis of IPT is made, surgical treatment can be avoided and the patient's trauma and risk can be reduced. CASE SUMMARY We present a case of a 25-year-old female who presented with amenorrhea, galactorrhea, polydipsia, and polyuria. Magnetic resonance image (MRI) demonstrated a tumor (15 mm in diameter) with suprasellar extension, optic nerve compression, and pituitary stalk involvement. Preoperative examination showed a large increase in prolactin and laboratory data showed elevation of the erythrocyte sedimentation rate, but other data were within normal ranges. We applied a lateral transfrontal approach by microscopic resection of the endplate saddle area, because it was large. Postoperative pathology confirmed IPT. Small doses of hormone and thyroxine were given after surgery, and most of the tumor was resected after re-examination. Two years after the operation, no recurrence or other abnormalities were found. CONCLUSION Attention should be paid to the differential diagnosis of inflammatory pseudotumor of pituitary. Steroid hormone therapy can be used first to observe its effect. It can reduce the harm caused by invasive operation.
Collapse
Affiliation(s)
- Yinglei Du
- Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College Bengbu, Anhui, China
| | - Zhiquan Jiang
- Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College Bengbu, Anhui, China
| |
Collapse
|
42
|
Bai S, Maykel JA, Yang MX. Inflammatory pseudotumor associated with HSV infection of rectal vascular endothelium in a patient with HIV: a case report and literature review. BMC Infect Dis 2020; 20:234. [PMID: 32192456 DOI: 10.1186/s12879-020-04960-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus (HSV) typically infects oral or anogenital squamous epithelium and causes blisters and ulcerations. Here we reported an unusual case of HSV induced exuberant rectal inflammatory pseudotumor with vascular endothelial involvement. CASE PRESENTATIONS A 52-year old man with HIV presented with abdominal pain, rectal drainage and constipation. Proctoscopy and CT scans revealed an 8 × 5 × 4 cm circumferential, mid-lower rectal mass that was concerning for malignancy. PET-CT showed mild to moderate FDG uptake of the rectal mass. Repeated biopsies showed exuberant lymphoplasmacytic inflammation with rich eosinophils and necrosis in the submucosa and scattered single or multi-nucleated viral inclusions in vascular endothelial cells that were positive for HSV by immunostains. There was no evidence of malignancy on histology or by immunostains. The patient started valacyclovir for three weeks and symptoms resolved after the antiviral therapy. Follow-up CT and sigmoidoscopy with biopsy revealed no rectal mass or drainable collection. CONCLUSIONS HSV may present as proctitis with exuberant inflammatory response and mass-like lesion, and damages vascular endothelial cells in patients with HIV. The HSV-associated mass-like lesion can be effectively treated by 3-week valacyclovir.
Collapse
|
43
|
Thanage R, Jain S, Sonthalia N, Udgirkar S, Chandnani S, Contractor Q, Rathi P. An Enigmatic Liver Mass in a Child. Euroasian J Hepatogastroenterol 2020; 9:104-107. [PMID: 32117700 PMCID: PMC7047306 DOI: 10.5005/jp-journals-10018-1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hepatic space occupying lesions in childhood are a diagnostic challenge, as they are caused by a variety of malignant and nonmalignant disorders with a different prognosis and, of course, treatment. They are often misdiagnosed or diagnosed only after surgical resection. A 14-year-old boy presented with abdominal pain, evening-rise fever with loss of appetite and weight. The patient also developed jaundice after 2 months of above symptoms. Ultrasound of the abdomen showed an irregular infiltrative mass in segment IV of the liver. Gadobenate disodium magnetic resonance imaging done showed T1 hypointense and T2 hyperintense lesions in segment VIII of the liver with extension into porta with delayed enhancement suggestive of fibrous tumor. Liver biopsy showed extensive liver parenchymal fibrosis with a mixed inflammatory infiltrate with eosinophils. Bacterial, tubercular, and fungal culture of liver biopsy were negative. Although serum IgG4 levels were 7.88 g/L (N =1.9 g/L), IgG4 staining of liver biopsy was negative. The patient was started on prednisolone 1 mg/kg considering the diagnosis of inflammatory pseudotumor (IPT). Twenty days after starting the steroid, mass lesions were converted into multicystic abscess requiring antibiotics and pigtail drainage. On follow-up, patient had improved symptoms with mass lesions turned into small-sized abscess cavity. Hepatic IPTs are difficult to differentiate from malignant tumors, as they are rare and can have variable imaging findings. To avoid inadvertent surgery, histological confirmation of the hepatic mass is essential. Steroids should be used with caution with close follow-up to prevent iatrogenic complications, such as a chronic liver abscess.
Collapse
Affiliation(s)
- Ravi Thanage
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Nikhil Sonthalia
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
44
|
Deng S, Gao J. Inflammatory pseudotumor-like follicular dendritic cell sarcoma: a rare presentation of a hepatic mass. Int J Clin Exp Pathol 2019; 12:3149-3155. [PMID: 31934158 PMCID: PMC6949706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
Follicular dendritic cell (FDC) sarcoma is a rare, low-grade malignant tumor originating from follicular dendritic cells in germinal centers that accounts for 0.4% of all soft tissue sarcomas. FDC sarcoma is classified into two types, the classic FDC sarcoma and inflammatory pseudotumor (IPT)-like follicular dendritic cell (FDC) sarcoma, the latter of which is rarer. IPT-like FDC sarcoma mainly involves the spleen and liver with non-specific clinical and imaging manifestations. It is often misdiagnosed as an inflammatory disease such as a liver abscess or a malignant tumor such as hepatocellular carcinoma, with a pathological morphology similar to inflammatory pseudotumors. IPT-like FDC sarcoma mainly consists of a large number of inflammatory and round, oval and spindle cells with less pleomorphism. These tumor cells are arranged in a whorled, storiform, or sheet pattern. The immunophenotype of IPT-like FDC sarcoma is the same as that of FDC sarcoma and is positive for CD21, CD23, and CD35, and positive for EBER in situ hybridization (ISH). This disease is easily misdiagnosed because it is so rare that clinicians and pathologists may not consider it in diagnosis. Here, a case of IPT-like FDC sarcoma in the liver was reported, and the related literature was reviewed to summarize the clinicopathological features, treatment, and prognosis of this rare new type of FDC sarcoma, providing new knowledge of this rare neoplasm.
Collapse
Affiliation(s)
- Shuangshuang Deng
- Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China
| | - Jinli Gao
- Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China
| |
Collapse
|
45
|
Surintrspanont J, Sanpawat A, Sasiwimonphan K, Sitthideatphaiboon P. IgG4-related pseudo-tumor of the kidney and multiple organ involvement mimicked malignancy. Urol Case Rep 2019; 26:100953. [PMID: 31309039 DOI: 10.1016/j.eucr.2019.100953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized systemic condition characterized by particular clinical, serologic, and pathologic features that are consistent across a wide range of organ systems. Herein, we present a rare case of IgG4-RD presenting as multiple inflammatory pseudotumors involving the kidney and other organs involvement mimicking urothelial cell carcinoma with liver, lymph node and lung metastasis. The final diagnosis was made based on characteristic histopathological finding and analysis of IgG4 immunostaining that can distinguish from other conditions. Greater awareness of this disease is needed to ensure diagnoses, which can prevent unnecessary surgical intervention.
Collapse
|
46
|
Ryu G, Cho HJ, Lee KE, Lee JJ, Hong SD, Kim HY, Chung SK, Dhong HJ. Clinical significance of IgG4 in sinonasal and skull base inflammatory pseudotumor. Eur Arch Otorhinolaryngol 2019; 276:2465-73. [PMID: 31203383 DOI: 10.1007/s00405-019-05505-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Inflammatory pseudotumor (IPT) in the sinonasal cavity and skull base region is benign non-neoplastic inflammatory process. However, IPT can mimic malignant tumor or infectious disease and there are difficulties in confirmation of diagnosis. The aim of study is to evaluate the clinical significance of immunoglobulin G4 (IgG4) in IPT in terms of steroid response and differential diagnosis with other skull base infiltrative lesions. METHODS Medical records were reviewed retrospectively from 1998 to 2016. Subjects diagnosed with IPT by surgical biopsy were enrolled. IgG4 positivity was defined as IgG4/IgG ratio > 0.4. Additionally, IgG4/IgG ratio was calculated in eight skull base osteomyelitis (SBO) patients. RESULTS Twenty-six IPT patients were included and the average age was 52.3 years, and 57.7% were male and 42.3% were female. Most lesions were involved in the sinuses (88.5%) and the incidence of extension beyond the sinuses itself was as follows: the cheek/hard palate/parapharynx (15.4%), orbit (61.5%), skull base (57.7%), and dura or brain (23.1%). All IPT cases revealed IgG4 + plasma cells and IgG4/IgG ratio over 0.4 was detected in 42.3% (11/26) of cases. In case of SBO, no patients had IgG4/IgG ratio exceed 0.4. Main treatment modality was systemic steroids (61.5%) and other modalities were used: surgery (3.8%), immunosuppressant (7.7%), radiotherapy (30.8%), or a combination of these modalities (15.4%). Steroid responses were not significantly different, but IgG4-positive group tended to have better response to steroid therapy. CONCLUSIONS IgG4-positive and IgG4-negative IPT patients revealed no differences in involvement sites, clinical course, and steroid responses. However, IgG4/IgG ratio and IgG4 + plasma cell count can provide a diagnostic clue for infiltrative skull base lesions such as IPT and a differential diagnosis of SBO.
Collapse
|
47
|
Baião JM, Martins RM, Correia JG, Jordão D, Vieira Caroço T, Caetano Oliveira R, Agostinho PG, Ferrão H. Inflammatory Pseudotumor of the Pancreas Mimicking a Pancreatic Neoplasm. Case Rep Gastroenterol 2019; 13:245-252. [PMID: 31275087 PMCID: PMC6600032 DOI: 10.1159/000501064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/18/2019] [Indexed: 12/24/2022] Open
Abstract
A 78-year-old woman was admitted to our hospital with a pancreatic tumor, incidentally discovered in an abdominal ultrasound exam. She was asymptomatic and without any previous personal pathological condition. The computed tomography (CT) and the magnetic resonance imaging (MRI) scan showed a mass lesion of 4 cm in diameter, located in the pancreatic body, conditioning the invasion of the splenic vein. The patient was admitted to surgery. During the laparotomy, we found a tumoral lesion highly suspicious of pancreatic neoplasia located in the transition of the head/body of the pancreas, with an invasion of the portal vein and several peri-regional lymph nodes. We performed biopsies of the pancreatic mass and lymphadenectomy of the peri-regional pancreatic lymph nodes. Histological analysis found an inflammatory pseudotumor of the head/body of the pancreas, without signals of malign epithelial neoplasm and also without criteria for immunoglobulin G4-related disease. During the follow-up, a PET/CT and MRI confirmed that the pancreatic lesion had disappeared without any treatment. Inflammatory pseudotumor of the pancreas is a rare entity not fully understood. Despite this, the administration of corticosteroids and immunosuppressive therapy could be taken into consideration as the disease carries a risk.
Collapse
Affiliation(s)
- José Miguel Baião
- Surgical Department, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| | - Rui Miguel Martins
- Surgical Department, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| | | | - Daniel Jordão
- Surgical Department, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| | - Teresa Vieira Caroço
- Surgical Department, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| | - Rui Caetano Oliveira
- Pathology Department, Centro de Diagnóstico Anatomo-Patológico (CEDAP), Coimbra, Portugal
| | - Paulo Gil Agostinho
- Radiology Department, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| | - Henrique Ferrão
- Surgical Department, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal
| |
Collapse
|
48
|
Raffaeli E, Cardinali L, Fianchini M, Brancorsini D, Mosca P, Marmorale C. Inflammatory myofibroblastic tumor of the transverse colon with synchronous gastrointestinal stromal tumor in a patient with ulcerative colitis: a case report. Int J Surg Case Rep 2019; 60:141-144. [PMID: 31220684 PMCID: PMC6584907 DOI: 10.1016/j.ijscr.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) is a rare proliferative disease of uncertain etiology, characterized by the proliferation of fusate or epithelioid myofibroblasts admixed with predominantly mononuclear inflammatory cells. IMT is generally considered a benign lesion, although in some cases this neoplasm has shown an aggressive behavior in terms of local recurrence and metastasis. We report the case of a patient with a ten-year history of ulcerative colitis affected by IMT of the transverse colon and by synchronous gastrointestinal stromal tumor (GIST) of stomach. PRESENTATION OF CASE A 59-year-old woman with a ten-year history of ulcerative colitis has been admitted to our hospital with signs and symptoms of acute recurrence of ulcerative colitis: abdominal pain, diarrhea, hematochezia and rectal tenesmus. Colonoscopy showed a left colon with diffuse hyperemia, mucosal erosions and a 2-cm, irregularly shaped, polypoid lesion at the level of the transverse colon. Histopathological examination of the specimen obtained via biopsy of the polypoid lesion has revealed a mesenchymal neoplasm with uncertain characters of malignancy. Due to the severity of the inflammatory bowel disease resistant to immunosuppressive and steroid drug treatment, surgical indication was given. DISCUSSION Although the relationship between IMT and Crohn's disease has been widely reported in literature, the relationship between IMT and ulcerative colitis has never been previously described. CONCLUSION To the best of our knowledge, this is the first case of IMT associated with ulcerative colitis reported in literature and the synchronous association with a gastric GIST represents another primacy.
Collapse
Affiliation(s)
- Eugenia Raffaeli
- Department of General Surgery, Polytechnic University of Marche - Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Ancona, Italy
| | - Luca Cardinali
- Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy.
| | - Maurizio Fianchini
- Department of General Surgery, Polytechnic University of Marche - Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Ancona, Italy
| | - Donatella Brancorsini
- Section of Pathological Anatomy and Histopathology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-G.M. Lancisi-G. Salesi", Ancona, Italy
| | - Piergiorgio Mosca
- Digestive System Diseases, Endoscopy and Inflammatory Bowel Diseases Unit, Ospedali Riuniti, Ancona, Italy
| | - Cristina Marmorale
- Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
49
|
Di Giovanni B, Newmarch W, Weiler M, Casserly B, Scanlon T. A Curious Case of Cough in a Young Woman. Ir Med J 2019; 112:920. [PMID: 31190516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm derived from tissue of mesenchymal origin. This tumour occurs predominantly in the lung, though extrapulmonary sites have been documented throughout the body.1 Presentation can be variable depending on location of the tumour and can include constitutional symptoms (fever, weight loss), thrombocytosis, hypergammaglobulinemia, anemia, and mass effect on local structures.2 Majority of patients with intrapulmonary IMT remain asymptomatic but can have symptoms including chest pain, dyspnoea, cough or haemoptysis.3 Most cases of IMT present in younger individuals (under age 40).4 Although the aetiology of IMT is unclear, current hypotheses suggest an inflammatory response to infection or an underlying malignancy could promote such cellular changes. Alternatively, the inflammatory component itself may be a consequence of the development of these mesenchymal tumours.
Collapse
Affiliation(s)
- B Di Giovanni
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - W Newmarch
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M Weiler
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - B Casserly
- Department of Respiratory Medicine, University Hospital Limerick, Limerick, Ireland
| | - T Scanlon
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
50
|
Chang AI, Kim YK, Min JH, Lee J, Kim H, Lee SJ. Differentiation between inflammatory myofibroblastic tumor and cholangiocarcinoma manifesting as target appearance on gadoxetic acid-enhanced MRI. Abdom Radiol (NY) 2019; 44:1395-1406. [PMID: 30515535 DOI: 10.1007/s00261-018-1847-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the differential features of inflammatory myofibroblastic tumor (IMT) and intrahepatic cholangiocarcinoma (ICC) manifesting as target appearance on gadoxetic acid-enhanced MRI. METHODS Twenty-seven patients with 36 IMTs (1.2-6.0 cm) and 34 patients with 34 ICCs (1.5-6.0 cm) who underwent gadoxetic acid-enhanced MRI were enrolled in this study. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and gadoxetic acid-enhanced imaging. RESULTS As for 32 IMTs with target appearance, IMTs most commonly demonstrated early target appearance characterized by a peripheral hypointense rim on unenhanced T1WI (n = 27, 84.4%), central enhanced area with a hypointense rim on arterial phase (AP) and portal venous phase (PVP) (n = 29, 90.6%), and transitional phase (TP) (n = 28, 87.5%). Meanwhile, most of the ICCs showed homogeneous hypointensity on T1WI (100%), a hyperenhancing rim on AP, late target appearance on TP (n = 32, 94.1%) and HBP (n = 32, 94.1%). Target appearance on DWI appearing as hyperintensity with central hypointense area was seen in 2 IMTs and 32 ICCs. On T2WI, 24 IMTs (n = 24, 75.0%) displayed central iso- and peripheral hyperintensity and 27 ICCs (84.4%) showed layered hyperintensity with either brighter or darker area in center. The remaining six IMTs with no target were observed as cystic appearing nodules (n = 3) or ill-defined hypovascular nodules (n = 2) and fibrotic mass (n = 1). CONCLUSION IMTs often show early target appearance on unenhanced T1WI, and early dynamic phases of gadoxetic acid-enhanced MRI. Target appearance on later phases, such as TP and HBP, and DWI target appearance were commonly in ICCs, but rare in IMTs.
Collapse
|