PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of gcrLink to Publisher's site
 
Gastrointest Cancer Res. 2009 Nov-Dec; 3(6): 254–255.
PMCID: PMC3000074

Inflammatory Myofibroblastic Tumor Mimics an Abdominal Neoplasm

Charudutt J. Sambhaji, MD, Associate Professor
Department of Radiodiagnosis
Aman Chauhan, MBBS
Medical Intern
Chandan Kakkar, MD, Senior Resident

Inflammatory myofibroblastic tumor, commonly known as inflammatory pseudotumor, is often said to be a quasineoplastic lesion. Inflammatory pseudotumor literally means an enlargement mimicking a tumor arising as a result of inflammatory accumulation of fibrous and granulation tissue as well as inflammatory cells.1,2 It is usually a benign disease that is often clinically and radiologically mistaken for a malignant condition. We present a case of inflammatory pseudotumor adherent to the cecum, which was thought to be neuroganglionoma radiologically but was found to be otherwise on histopathology.

CASE REPORT

A 17-year-old girl presented with body aches, fever, and generalized abdominal pain. She had a history of minimal weight loss and anorexia. No symptoms suggestive of infection were observed anywhere in the body. Her menstrual history was not significant, and she had no comorbidities or history of previous treatment or surgeries. Results of physical examination were normal except for pallor and lumbar kyphosis. An abdominal examination revealed a mass in the region of the right iliac fossa. The lower border of the mass was not palpable, and the mass was mildly tender and mobile. All laboratory parameters were within normal limits except for slightly reduced hemoglobin and mildly elevated alkaline phosphatase (234 U/L).

Contrast enhanced CT scan of the abdomen showed a well circumscribed, lobulated, moderate and heterogeneously enhancing mass lesion in the right hemipelvis (Figures 1 & 2). Perioperative findings revealed a hard, right iliac fossa and right hemipelvic mass with dilated veins over the surface and adhesions with the omentum. The mass was free from the iliac vessels, uterus, fallopian tube, and ovaries. It was adherent to the cecum. Histopathology revealed an inflammatory myofibroblastic tumor, commonly referred to as inflammatory pseudotumor.

Figure 1.
Nonenhanced computed tomography scan of the pelvis shows a mass lesion along the right iliac vessels that is isodense to the muscles, displacing the adjacent hollow viscera.
Figure 2.
Contrast enhanced computed tomography scan of the mass shows moderate and heterogenous enhancement. The iliac vessels show normal contrast opacification.

DISCUSSION

The lung and orbit are the most common sites affected by inflammatory myofibroblastic tumors. We offer this report to our colleagues in gastrointestinal oncology because this relatively rare entity can easily be mistaken for a neoplasm on imaging virtually anywhere in the body, presenting as an abdominal neoplasm in this case. The incidence of inflammatory pseudotumor is higher in younger patients, with both male and females being equally affected.3 Pathology of this disease is still unclear but most believe it to be of reactive origin.4,5 Some studies suggest a relation to infection.6 Other data suggest a potential for low-grade neoplasia. 7 This notion is fueled by occasional local aggressiveness and the multifocal nature of pseudotumor.8,9

Clinical features are usually determined by site and size of the lesion. Laboratory investigations are often inconclusive. Computed tomography is one of the most commonly employed diagnostic modalities, and the impression it gives is often suggestive of a tumor. This is partly due to inconsistent radiologic appearance of these lesions, which can present with varying degrees of enhancements, peripheral enhancement, and varying patterns of calcification.3 Inflammatory pseudotumor has been mistaken for intra-abdominal gastrointestinal malignancy on numerous occasions. For example, approximately 25 cases of inflammatory pseudotumor mimicking malignancy in the pancreas have been reported. 1013 Depending on the location of the pseudotumor within the abdominal cavity, wrong diagnoses from cholangiocarcinoma to Burkitt’s lymphoma have been made. 14,15

It is our intent to reaffirm that this entity, though rare, should always be considered as a differential diagnosis, where a well circumscribed solid lesion is seen on sectional imaging and when laboratory analyses, as well as clinical details, are inconclusive. The importance of this case lies in that is illustrative of a benign disease that is often misdiagnosed and frequently mismanaged. If inflammatory pseudotumor is diagnosed correctly, a conservative approach toward management can spare unnecessary risk to the patient and reduce treatment-associated morbidity and mortality.

REFERENCES

1. Scott L, Blair G, Taylor G, et al. Inflammatory pseudotumors in children. J Pediatr Surg. 1988;23:755–758. [PubMed]
2. Hedlund GL, Navoy JF, Galliani CA, et al. Aggressive manifestations of inflammatory pulmonary pseudotumor in children. Pediatr Radiol. 1999;29:112–116. [PubMed]
3. Agrons GA, Rosado-de-christenson ML, Kirejczy KWM, et al. Pulmonary inflammatory pseudotumor: radiologic features. Radiology. 1998;206:511–518. [PubMed]
4. Young RH. Pseudoneoplastic lesions of the urinary bladder and urethra: a selective review with emphasis on recent information. Semin Diagn Pathol. 1997;14:133–146. [PubMed]
5. Young RH, Scully RE. Pseudosarcomatous lesions of the urinary bladder, prostate gland, and urethra. A report of three cases and review of the literature. Arch Pathol Lab Med. 1987;111:354–358. [PubMed]
6. Dehner LP. The enigmatic inflammatory pseudotumors: the current state of our understanding, or misunderstanding (editorial) J Pathol. 2000;192:277–279. [PubMed]
7. Albores-Saavedra J, Manivel JC, Essenfeld H, et al. Pseudosarcomatous myofibroblastic proliferations in the urinary bladder of children. Cancer. 1990;66:1234–1241. [PubMed]
8. Maier HC, Sommers SC. Recurrent and metastatic pulmonary fibrous histiocytoma/plasma cell granuloma in a child. Cancer. 1987;60:1073–1076. [PubMed]
9. Griffin CA, Haukins AL, Dvorack C, et al. Recurrent involvement of 2p23 in inflammatory myofibroblastic tumors. Cancer Res. 1999;59:2776–2780. [PubMed]
10. Pungpapong Surakit, Geiger Xochi J, Raimondo Massimo. Inflammatory Myofibroblastic Tumor Presenting as a Pancreatic Mass: A Case Report and Review of the Literature. JOP. J Pancreas (Online) 2004;5:360–367. [PubMed]
11. Yamamoto H, Watanabe K, Nagata M, et al. Inflammatory myofibroblastic tumor (IMT) of the pancreas. J Hepatobiliary Pancreat Surg. 2002;9:116–119. [PubMed]
12. Walsh SV, Evangelista F, Khettry U. Inflammatory myofibroblastic tumor of the pancreaticobiliary region: morphologic and immunocytochemical study of three cases. Am J Surg Pathol. 1998;22:412–418. [PubMed]
13. Wreesmann V, van Eijck CH, Naus DC, et al. Inflammatory pseudotumour (inflammatory myofibroblastic tumour) of the pancreas: a report of six cases associated with obliterative phlebitis. Histopathology. 2001;38:105–110. [PubMed]
14. Kai Ke, Matsuyama S, Ohtsuka T, et al. multiple inflammatory pseudotumor of the liver, mimicking cholangiocarcinoma with tumor embolus in the hepatic vein: report of a case. Surgery Today. 2007;37:6. [PubMed]
15. Çorapçioğlu F, Kargi A, Olgun N, et al. Inflammatory myofibroblastic tumor of the ileocecal mesentery mimicking abdominal lymphoma in childhood: report of two cases. Surgery Today. 2005;35:8. [PubMed]

Articles from Gastrointestinal Cancer Research : GCR are provided here courtesy of International Society of Gastrointestinal Oncology