Difference between revisions of "Inflammatory myofibroblastic tumour"

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Inflammatory myofibroblastic tumour (view source)

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#redirect [[Fibroblastic/myofibroblastic_tumours#Inflammatory_myofibroblastic_tumour]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Inflammatory_myofibroblastic_tumour_-_very_high_mag.jpg
| Width      =
| Caption    = Inflammatory myofibroblastic tumour. [[H&E stain]].
| Synonyms  =
| Micro      = inflammation ([[plasma cells]] - predominant, lymphocytes, eosinophils), [[spindle cells]] without atypia +/-fascicular architecture, +/-mitoses (none atypical), +/-[[necrosis]], +/-hemorrhage, +/-calcification
| Subtypes  =
| LMDDx      = [[calcifying fibrous pseudotumour]], [[inflammatory fibroid tumour]], [[nodular fasciitis]], [[gastrointestinal stromal tumour]], [[epithelioid inflammatory myofibroblastic sarcoma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[soft tissue lesions|soft tissue]] - see ''[[fibroblastic/myofibroblastic tumours]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other soft tissue lesions
| Tx        =
}}
'''Inflammatory myofibroblastic tumour''', abbreviated '''IMT''', is an uncommon [[soft tissue lesion]].
 
It is also known as '''inflammatory pseudotumour''', and '''inflammatory fibrosarcoma'''<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref> and '''plasma cell granuloma'''.<ref>URL: [http://www.uptodate.com/contents/inflammatory-myofibroblastic-tumor-plasma-cell-granuloma-of-the-lung http://www.uptodate.com/contents/inflammatory-myofibroblastic-tumor-plasma-cell-granuloma-of-the-lung]. Accessed on: 27 November 2011.</ref><ref name=pmid21772725>{{Cite journal  | last1 = Manohar | first1 = B. | last2 = Bhuvaneshwari | first2 = S. | title = Plasma cell granuloma of gingiva. | journal = J Indian Soc Periodontol | volume = 15 | issue = 1 | pages = 64-6 | month = Jan | year = 2011 | doi = 10.4103/0972-124X.82275 | PMID = 21772725 }}</ref>
 
==General==
*Mostly benign.
*Children & young adults.
 
May be treated with:
*[[ALK inhibitors]].<ref name=pmid30790150>{{Cite journal  | last1 = Honda | first1 = K. | last2 = Kadowaki | first2 = S. | last3 = Kato | first3 = K. | last4 = Hanai | first4 = N. | last5 = Hasegawa | first5 = Y. | last6 = Yatabe | first6 = Y. | last7 = Muro | first7 = K. | title = Durable response to the ALK inhibitor alectinib in inflammatory myofibroblastic tumor of the head and neck with a novel SQSTM1-ALK fusion: a case report. | journal = Invest New Drugs | volume =  | issue =  | pages =  | month = Feb | year = 2019 | doi = 10.1007/s10637-019-00742-2 | PMID = 30790150 }}</ref>
*Drugs that act on ROS1 rearrangements, e.g. [[crizotinib]].<ref name=pmid30642440>{{Cite journal  | last1 = Mai | first1 = S. | last2 = Xiong | first2 = G. | last3 = Diao | first3 = D. | last4 = Wang | first4 = W. | last5 = Zhou | first5 = Y. | last6 = Cai | first6 = R. | title = Case report: Crizotinib is effective in a patient with ROS1-rearranged pulmonary inflammatory myofibroblastic tumor. | journal = Lung Cancer | volume = 128 | issue =  | pages = 101-104 | month = Feb | year = 2019 | doi = 10.1016/j.lungcan.2018.12.016 | PMID = 30642440 }}</ref>
 
==Gross==
*Classically located in mesentery of ileocolic region or [[small bowel]].<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref>
*May be seen in the [[urinary bladder]].<ref name=pmid15577680/>
 
==Microscopic==
Features:<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref>
*Inflammation:
**[[Plasma cells]] - predominant - '''key feature'''.<ref name=pmid21297584>{{Cite journal  | last1 = Saab | first1 = ST. | last2 = Hornick | first2 = JL. | last3 = Fletcher | first3 = CD. | last4 = Olson | first4 = SJ. | last5 = Coffin | first5 = CM. | title = IgG4 plasma cells in inflammatory myofibroblastic tumor: inflammatory marker or pathogenic link? | journal = Mod Pathol | volume = 24 | issue = 4 | pages = 606-12 | month = Apr | year = 2011 | doi = 10.1038/modpathol.2010.226 | PMID = 21297584 }}</ref>
**Lymphocytes.
**[[Eosinophil]]s.
*Spindle cells without atypia.
*+/-Fascicular architecture.
*Mitoses -- though none atypical.
*+/-Necrosis.
*+/-Hemorrhage.
*Calcifications.
 
DDx:
*[[Calcifying fibrous pseudotumour]] (has [[psammoma body|psammomatous calcifications]]).
*[[Inflammatory fibroid tumour]].
*[[Nodular fasciitis]].
*[[Gastrointestinal stromal tumour]].<ref name=pmid24938355>{{Cite journal  | last1 = Kataoka | first1 = TR. | last2 = Yamashita | first2 = N. | last3 = Furuhata | first3 = A. | last4 = Hirata | first4 = M. | last5 = Ishida | first5 = T. | last6 = Nakamura | first6 = I. | last7 = Hirota | first7 = S. | last8 = Haga | first8 = H. | last9 = Katsuyama | first9 = E. | title = An inflammatory myofibroblastic tumor exhibiting immunoreactivity to KIT: a case report focusing on a diagnostic pitfall. | journal = World J Surg Oncol | volume = 12 | issue =  | pages = 186 | month =  | year = 2014 | doi = 10.1186/1477-7819-12-186 | PMID = 24938355 }}</ref>
*[[IgG4-related systemic disease]].<ref name=pmid21297584/>
*[[Epithelioid inflammatory myofibroblastic sarcoma]].
 
Notes:
*Some consider this a wastebasket diagnosis... for benign appearing spindle cell lesions.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970283-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970283-2]. Accessed on: 10 May 2011.</ref>
 
===Images===
<gallery>
Image:Inflammatory_myofibroblastic_tumour_-_high_mag.jpg | IMT - high mag. (WC)
Image:Inflammatory_myofibroblastic_tumour_-_very_high_mag.jpg | IMT - very high mag. (WC)
</gallery>
 
==IHC==
Features - dependent on site:
*SMA +ve.<ref name=pmid20350216>{{Cite journal  | last1 = Shi | first1 = H. | last2 = Li | first2 = Y. | last3 = Wei | first3 = L. | last4 = Sun | first4 = L. | title = Primary colorectal inflammatory myofibroblastic tumour: a clinicopathological and immunohistochemical study of seven cases. | journal = Pathology | volume = 42 | issue = 3 | pages = 235-41 | month = Apr | year = 2010 | doi = 10.3109/00313021003631312 | PMID = 20350216 }}</ref>
*Vimentin +ve.
*ALK-1 +ve.<ref name=pmid15577680>{{Cite journal  | last1 = Tsuzuki | first1 = T. | last2 = Magi-Galluzzi | first2 = C. | last3 = Epstein | first3 = JI. | title = ALK-1 expression in inflammatory myofibroblastic tumor of the urinary bladder. | journal = Am J Surg Pathol | volume = 28 | issue = 12 | pages = 1609-14 | month = Dec | year = 2004 | doi =  | PMID = 15577680 }}</ref>
*CD117 -ve.
**Case report of CD117 +ve.<ref name=pmid24938355/>
*CD30 -ve.
 
Variable staining with:
*CD34, AE1/AE3, calretinin.<ref name=pmid20216379>{{Cite journal  | last1 = Miyamoto | first1 = H. | last2 = Montgomery | first2 = EA. | last3 = Epstein | first3 = JI. | title = Paratesticular fibrous pseudotumor: a morphologic and immunohistochemical study of 13 cases. | journal = Am J Surg Pathol | volume = 34 | issue = 4 | pages = 569-74 | month = Apr | year = 2010 | doi = 10.1097/PAS.0b013e3181d438cb | PMID = 20216379 }}</ref><ref name=pmid20350216>{{Cite journal  | last1 = Shi | first1 = H. | last2 = Li | first2 = Y. | last3 = Wei | first3 = L. | last4 = Sun | first4 = L. | title = Primary colorectal inflammatory myofibroblastic tumour: a clinicopathological and immunohistochemical study of seven cases. | journal = Pathology | volume = 42 | issue = 3 | pages = 235-41 | month = Apr | year = 2010 | doi = 10.3109/00313021003631312 | PMID = 20350216 }}</ref>
 
Negative:<ref name=pmid20350216/>
*S100, CD117, CD68.
 
==Molecular==
*ALK rearrangements.<ref name=pmid21297584/>
*ROS1 rearrangements.<ref name=pmid30642440>{{Cite journal  | last1 = Mai | first1 = S. | last2 = Xiong | first2 = G. | last3 = Diao | first3 = D. | last4 = Wang | first4 = W. | last5 = Zhou | first5 = Y. | last6 = Cai | first6 = R. | title = Case report: Crizotinib is effective in a patient with ROS1-rearranged pulmonary inflammatory myofibroblastic tumor. | journal = Lung Cancer | volume = 128 | issue =  | pages = 101-104 | month = Feb | year = 2019 | doi = 10.1016/j.lungcan.2018.12.016 | PMID = 30642440 }}</ref>
 
==See also==
*[[Soft tissue lesions]].
*[[Fibroblastic/myofibroblastic tumours]].
 
==References==
{{Reflist|2}}
 
[[Category:Soft tissue lesions]]
[[Category:Fibroblastic/myofibroblastic tumours]]
[[Category:Diagnosis]]
Michael
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