Clinical and pathological characteristics of patients with pulmonary inflammatory pseudotumors: An 18-year retrospective study of 31 cases

To investigate the clinical and pathological characteristics in patients with pulmonary inflammatory pseudotumors (PIP).This retrospective study included 31 patients with PIP from 2001 to 2019. Preoperative computed tomography scan was performed in all patients. Clinical and pathological characteristics were collected and analyzed.Thirty-one patients (16 female and 15 male) were recruited, with a median age of 57 years (range, 11-72 years). Eight (25.8%) patients were asymptomatic, and the others had symptoms characterized by cough with sputum, chest and back pain, dry cough, fever and blood in sputum, or hemoptysis. All cases were single lesions, including 23 cases in the right lung, and 8 cases in the left lung. Computed tomography scan demonstrated irregular lobulated nodules or masses in 14 patients, and regular round or oval nodules or masses in 11 cases. The blurred edge of tumors and spiculation was found in 12 cases. Microscopic results were characterized by the collection of inflammatory mesenchymal cells. Immunohistochemical examination showed vimentin, smooth muscle actin, and anaplastic lymphoma kinase positive. Complete tumor resection was obtained in all cases. No recurrence or metastasis was observed during the follow-up period.PIP has a variety of manifestations. Preoperative diagnosis is difficult to reach. The final diagnosis still depends on the pathological and immunohistochemical examination. Complete surgical resection is the main treatment at present, and the overall prognosis is good.

Hepatic Inflammatory Pseudotumor Protruding from the Liver Surface and Directly Penetrating the Colon

A 69-year-old man was diagnosed with a liver abscess and received antibiotics at a local hospital. He was referred to our hospital due to a persistent fever. He had hepatic masses protruding from the liver surface toward the transverse colon. We reached a diagnosis of inflammatory pseudotumor (IPT) by a percutaneous liver biopsy. Colonoscopy showed direct invasion of IPT to the colon. His condition improved by the intravenous administration of antibiotics. Hepatic IPT is often misdiagnosed as a malignant tumor. We should consider IPT when we encounter hepatic tumors, and a percutaneous liver biopsy is useful for avoiding unnecessary excessive treatments.

Unusual olecranon mass with ulnar nerve compressive neuropathy caused by a haemophilic pseudotumour

A 55-year-old man with a history of haemophilia A and bilateral haemophilic arthropathy of the elbows presented with an enlarging left elbow mass and worsening paresthesias in the ulnar distribution of the left hand. The mass, originally thought to be olecranon bursitis and treated as such, was found to be due to a haemophilic pseudotumour. The patient underwent successful excision of the haemophilic pseudotumour with concomitant ulnar nerve decompression and had sustained resolution of the pseudotumour and symptoms at 10 years of follow-up. This case demonstrates the need for consideration of haemophilic pseudotumour in the differential diagnosis for olecranon masses and cubital tunnel compressive neuropathy in patients with haemophilia, and highlights the viability of surgical excision as a therapeutic option for the treatment of haemophilic pseudotumours in the elbow.

Pseudotumours and IgG4-related disease: a case report

We report a case of a patient presenting with abdominal pain, weight loss and CT imaging showing mass lesions in the chest and abdomen associated with lymphadenopathy. He was diagnosed as having IgG4-related disease and responded well to steroid treatment.

[Inflammatory myofibroblastic tumor of the lung: problems in differential diagnosis]

Inflammatory myofibroblastic tumor is a neoplasm of intermediate biological potential, a marked inflammatory component, and characteristic genetic changes. Once it was identified as an independent nosological entity from a rather heterogeneous group of inflammatory pseudotumors. This paper describes a case of inflammatory myofibroblastic tumor of the chest in a child, by discussing the criteria for differential diagnosis in the use of up-to-date radiology techniques. When thoracic neoplasms are detected, it is necessary to determine their site and the most likely origin organ as exactly as possible and to assess the X-ray pattern of the pathological process. By applying the state-of-the-art radiodiagnostic techniques, the clarification of the pattern of the disease makes it possible to choose an optimal treatment policy and a surgical procedure and scope, to avoid anesthesia overload, and to decrease the probability of resurgery. Our observation is to demonstrate possible problems in the diagnosis of inflammatory myofibroblastic tumor of the lung in childhood and to recall again the algorithm of radiological approaches to detecting mediastinal and lung masses.

Extramedullary hematopoiesis: a rare occurrence in the sinonasal tract

Extramedullary hematopoiesis (EMH) is a systemic reaction to inadequate hematopoiesis. We report two exceedingly rare cases of EMH involving the paranasal sinuses. The first patient, a 30-year-old man, presented with a maxillary sinus mass. The lesion was excised by endoscopic surgery: definitive histology identified foci of EMH within an inflammatory fibromyxoid pseudotumor. The second case occurred in a 29-year-old man affected by intermediate beta-thalassemia. He was hospitalized with a diagnosis of sphenoid sinus mucocele secondary to an ethmoid lesion. The patient underwent endoscopic excision of the mass and drainage of the sphenoid mucocele. At definitive histology, a diagnosis of EMH was established. Herein, the presenting modalities, imaging profile, and treatment options of this rare EMH localization are reviewed.

Inflammatory myofibroblastic tumor ofabdomen: computerized tomographic (CT) and pathological findings

Inflammatory Myofibroblastic Tumor (IMT) is the recent name of Inflammatory pseudotumor which was in intermediate group of fibrous-origin tumor. The authors retrospectively reviewed such cases in Ramathibodi Hospital from January 2001 to December 2005. There were 115 cases of fibrous-origin tumor which was IMT in 17 cases. Nine cases occurred in the abdomen and only 3 of these had complete computerized tomographic (CT) imaging. One was hypodense liver mass with thick rim enhancement. Another one in the liver presented as a liver abscess which appeared as multiloculated hypodense mass with enhanced septum. The third case was a large malignant-looking retroperitoneal mass and having a small accompanying hepatic lesion which rapidly grew in the follow up study at nine months. IMT in the abdomen was scanty. The diagnosis was done with difficulty because of different signs and symptoms such as fever and palpable abdominal mass. The laboratory findings were nonspecific or within normal limits. Tissue biopsy was the way of definite diagnosis. We reported 3 cases of abdominal IMT with variable imaging findings that may lead to inappropriate treatment. Recognization of such findings will help achieve correct diagnosis.

Immune reconstitution inflammatory syndrome presenting as sinusitis with inflammatory pseudotumor in an HIV-infected patient: a case report and review of the literature

Immune reconstitution inflammatory syndrome (IRIS) encompasses a variety of conditions that occur among HIV-infected patients in a temporal relationship with increases in CD4 cell count as a result of highly active antiretroviral therapy (HAART). Most conditions associated with IRIS are infectious. Malignancies, such as Kaposi's sarcoma, have also been reported. We report a case of sinusitis with presumptive inflammatory pseudotumor as a manifestation of IRIS that occurred 20 weeks after the initiation of HAART.

Inflammatory myofibroblastic tumor of the central nervous system: clinicopathologic analysis of 10 cases

To verify the pathologic features, anaplastic lymphoma kinase (ALK) expression and biologic behavior of inflammatory myofibroblastic tumors (IMTs) of the central nervous system (CNS), we analyzed 10 cases of IMTs-CNS (8 cranial, 1 spinal, and 1 orbital). Our series of IMTs of the CNS showed a male predominance (male:female = 6:4) and a wide age range (10-60 years; mean age, 46.7 years). Lesion location also varied, but they were basically dura-based. Radiologically, they showed two patterns: isolated mass forming (n = 6) and an en plaque-like pattern (n = 4). Histopathologically, plasma cell granuloma (PCG)-like (n = 5) or fibrohistiocytic (FHC) variant (n = 5) was present. No correlation was found between the radiologic and histopathologic patterns. Spindle-shaped mesenchymal cells of IMTs expressed smooth muscle actin (SMA) in all cases. ALK expression was not found in our IMTs of the CNS. Late recurrence was found in 2 cases in different sites (20%). Pathologically, IMT-CNS could be subclassified into PCG-like and FHC. Immunostaining for SMA was found to helpfully discriminate myofibroblastic cells and to make a differential diagnosis. Although our cases did not show ALK immunoreactivity, some IMTs-CNS can recur, which suggests the neoplastic potential of these tumors. The rearrangement of the ALK gene in IMTs-CNS should be verified by an examination of more cases.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the breast

Inflammatory myofibroblastic tumor of the lung has often been reported but extrapulmonary cases are rare. Here we describe a case of inflammatory myofibroblastic tumor of the breast in a 60-year-old woman. This is only the eleventh case reported in the English language literature. The patient was free of disease 85 months after surgery.

Extrapulmonary inflammatory myofibroblastic tumor: a clinical and pathological survey

Inflammatory myofibroblastic tumor (IMT) or inflammatory pseudotumor was initially recognized in the lung, and somewhat later, a similar-appearing pathological process was reported in the liver. Presently, this tumor has been described in virtually all major organs and extrapulmonary sites with a few exceptions. It was thought initially that the IMT was nonneoplastic and represented an aberrant inflammatory response despite its gross and microscopic features of a spindle cell neoplasm. The inflammatory hypothesis about the pathogenesis has been more readily accommodated in the lung than in the extrapulmonary sites of involvement. Some cases, however, were accompanied by the constitutional symptoms and signs of an inflammatory process, which resolved in most cases after surgical resection. There were some pathological aspects of the IMT that seemingly contradicted its purely inflammatory nature, including its potential for local recurrence; development of multifocal, noncontiguous tumors; infiltrative local growth; vascular invasion; and malignant transformation. These pathological features seemed to support the hypothesis that the IMT is a neoplastic process, which has been augmented by reports that these tumors have clonal characteristics. Other studies have suggested that IMTs of the liver and spleen are associated with the Epstein-Barr virus. From the diagnostic perspective, there are several potential difficulties that the pathologist may encounter in the examination of one of these tumors. Just as it was true 60 years ago, the potential for a pathological diagnosis of one or another type of spindle cell sarcoma has not diminished with time. Because these tumors have a predilection for children, embryonal rhabdomyosarcoma is another diagnostic temptation when an IMT presents in the bladder or other hollow viscus. The IMT should probably be regarded as a soft tissue-mesenchymal tumor with an indeterminant or low malignant potential, which is a somewhat indefinite but realistic prognostic category.

Inflammatory myxohyaline tumor of distal extremities with virocyte or Reed-Sternberg-like cells: a distinctive lesion with features simulating inflammatory conditions, Hodgkin's disease, and various sarcomas

We report 51 cases of a previously undescribed tumor of the distal extremities that is often mistaken for an inflammatory or infectious process, Hodgkin's disease, or various sarcomas. These lesions developed in patients of all ages (range, 4-81 yr; median, 40 yr) and affected the sexes nearly equally (27 men, 24 women). They presented as a painless mass of the fingers (14 cases), hand (11 cases), wrist or arm (10 cases), toe or foot (8 cases), or lower leg (5 cases), usually within the subcutaneous tissues. Grossly, they were infiltrative, multinodular masses characterized by a dense chronic inflammatory infiltrate that merged with a stroma, which varied from densely hyaline to focally myxoid and contained sheets of short spindled to rounded epithelioid cells. Focally, the epithelioid cells were extremely large with bizarre, vesicular nuclei and macronucleoli resembling Reed-Sternberg cells or virocytes. Despite the level of atypia, mitotic activity was low. The tumor cells consistently expressed vimentin but lacked a variety of other mesenchymal, epithelial markers, e.g., S100 protein, desmin, actin, neuron-specific endolase, epithelial membrane antigen, HMB-45, CD34) and leukocyte markers (CD15, CD30, CD45). Keratin was noted focally and weakly in four cases and CD68 focally in six cases, the latter suggesting that the cells had acquired phagocytic properties. Immunostains for cytomegalovirus were negative. Polymerase chain reaction for Epstein-Barr virus showed amplification levels consistent with latent infection in 4 of 10 cases, but no cases showed levels consistent with active infection. All of the bacterial and viral cultures were negative. Follow-up information was available in 27 cases. Recurrences developed in six patients (interval, 15 mo-10 yr), but there were no metastases or tumor-related deaths. In one patient, progressive proximal extension up the arm was noted. Although the most common submitting diagnosis was that of an inflammatory or infectious process, the negative studies for infectious agents, clinical behavior with local recurrences, immunophenotypic profile, and cytologic atypia support the idea that these are unusual mesenchymal neoplasms with at least the potential for local recurrence. It remains to be investigated whether with time these lesions will prove to have metastatic potential.

Inflammatory pseudotumor presenting as fever of unknown origin

Inflammatory pseudotumor (IPT) is an uncommon benign neoplasm of uncertain etiology that classically has been associated with the lung, where it is generally asymptomatic. In recent years, IPT has been increasingly recognized in other sites. Hepatic, abdominal, and pelvic IPTs produce a spectrum of nonspecific symptoms including fever, malaise, anemia, and weight loss. Because prolonged fever is a prominent feature of extrapulmonary IPT, patients with this condition may first come to the attention of specialists in infectious diseases. We describe an illustrative case of pelvic IPT and discuss its presentation, diagnosis, and treatment; we also suggest that infectious disease specialists should be familiar with this entity as a possible diagnosis for patients with fever of unknown origin.

Vascular invasion by hepatic inflammatory pseudotumor. A clinicopathologic study

BACKGROUND

Unusual lesions composed of fibrous tissue, lymphocytes, histiocytes, and plasma cells, called inflammatory pseudotumors (IPT), are being increasingly recognized in many organs and tissues. A hepatic IPT extending into the inferior vena cava has never been reported before to the authors' knowledge. The patient in this study underwent liver resection with cardiopulmonary bypass and circulatory arrest to excise the IPT.

METHODS

The tissue was studied extensively using histologic, immunohistologic, flow cytometric, and gene rearrangement analysis and electron microscopic methods.

RESULTS

On gross examination, the large hepatic tumor resembled a malignancy invading the vena cava. Microscopically, a mixture of T-lymphocytes, B-lymphocytes, and plasma cells were scattered throughout the tumor. DNA flow cytometry did not reveal aneuploidy suggestive of neoplasia. Genetic analysis of the immunoglobulin and T-cell receptor genes did not detect evidence of clonal expansion of B-cells or T-lymphocytes.

CONCLUSIONS

This experience with the vascular invasive and biliary obstructive nature of IPT and the difficulty in diagnosing it before or during surgery underscores the potentially adverse impact of this lesion on patients. The authors believe that an aggressive approach should be taken when evaluating and treating hepatic masses, even though they may later be confirmed as being IPT.

Spontaneous regression of hepatic pseudotumor

Inflammatory pseudotumor of the liver is a rare benign lesion that usually has been discovered at laparotomy and treated by hepatic resection. We report a case of hepatic pseudotumor that was treated without surgery and that subsequently spontaneously resolved. Hepatic pseudotumor occur in all age groups, but most commonly in middle-aged adults, with a 3.5:1 male predominance. Presenting symptoms are 1 or 2 months of fever (66%), abdominal pain (51%), and weight loss (21%). Most often, the lesions are solitary encapsulated tumors composed of whorled laminated fibrous stroma and chronic inflammatory infiltrate. Our report provides documentation of spontaneous resolution of a hepatic pseudotumor.