Difference between revisions of "Inflammatory myofibroblastic tumour"

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'''Inflammatory myofibroblastic tumour''' is an uncommon [[soft tissue lesion]].
{{ 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>
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>
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*Mostly benign.
*Mostly benign.
*Children & young adults.
*Children & young adults.
*Classically located in mesentery of ileocolic region or small bowel.<ref name=Ref_WMSP610>{{Ref WMSP|610}}</ref>
 
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==
==Microscopic==
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**[[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>
**[[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.
**Lymphocytes.
**Eosinophils.
**[[Eosinophil]]s.
*Spindle cells without atypia.
*Spindle cells without atypia.
*+/-Fasciular architecture.
*+/-Fascicular architecture.
*Mitoses -- though none atypical.
*Mitoses -- though none atypical.
*+/-Necrosis.
*+/-Necrosis.
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*[[Inflammatory fibroid tumour]].
*[[Inflammatory fibroid tumour]].
*[[Nodular fasciitis]].
*[[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:
Notes:
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===Images===
===Images===
*[http://commons.wikimedia.org/wiki/File:Inflammatory_myofibroblastic_tumour_-_high_mag.jpg IMT - high mag. (WC)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Inflammatory_myofibroblastic_tumour_-_very_high_mag.jpg IMT - very high mag. (WC)].
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==
==IHC==
Features - dependent on site:
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 }}
*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>
</ref>
*Vimentin +ve.
*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:
Variable staining with:
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Negative:<ref name=pmid20350216/>
Negative:<ref name=pmid20350216/>
*S100, CD117, CD68.
*S100, CD117, CD68.
Others:
*ALK-1 +ve. ???


==Molecular==
==Molecular==
*ALK rearrangements.<ref name=pmid21297584/>
*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==
==See also==

Latest revision as of 00:28, 26 March 2024

Inflammatory myofibroblastic tumour
Diagnosis in short

Inflammatory myofibroblastic tumour. H&E stain.
LM inflammation (plasma cells - predominant, lymphocytes, eosinophils), spindle cells without atypia +/-fascicular architecture, +/-mitoses (none atypical), +/-necrosis, +/-hemorrhage, +/-calcification
LM DDx calcifying fibrous pseudotumour, inflammatory fibroid tumour, nodular fasciitis, gastrointestinal stromal tumour, epithelioid inflammatory myofibroblastic sarcoma
Site soft tissue - see fibroblastic/myofibroblastic tumours
Prevalence uncommon
Prognosis benign
Clin. DDx other soft tissue lesions

Inflammatory myofibroblastic tumour, abbreviated IMT, is an uncommon soft tissue lesion.

It is also known as inflammatory pseudotumour, and inflammatory fibrosarcoma[1] and plasma cell granuloma.[2][3]

General

  • Mostly benign.
  • Children & young adults.

May be treated with:

Gross

Microscopic

Features:[1]

  • Inflammation:
  • Spindle cells without atypia.
  • +/-Fascicular architecture.
  • Mitoses -- though none atypical.
  • +/-Necrosis.
  • +/-Hemorrhage.
  • Calcifications.

DDx:

Notes:

  • Some consider this a wastebasket diagnosis... for benign appearing spindle cell lesions.[9]

Images

  • IMT - high mag. (WC)

  • IMT - very high mag. (WC)

IHC

Features - dependent on site:

  • SMA +ve.[10]
  • Vimentin +ve.
  • ALK-1 +ve.[6]
  • CD117 -ve.
    • Case report of CD117 +ve.[8]
  • CD30 -ve.

Variable staining with:

Negative:[10]

  • S100, CD117, CD68.

Molecular

  • ALK rearrangements.[7]
  • ROS1 rearrangements.[5]

See also

References

  1. ↑ 1.0 1.1 1.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 610. ISBN 978-0781765275.
  2. ↑ URL: http://www.uptodate.com/contents/inflammatory-myofibroblastic-tumor-plasma-cell-granuloma-of-the-lung. Accessed on: 27 November 2011.
  3. ↑ Manohar, B.; Bhuvaneshwari, S. (Jan 2011). "Plasma cell granuloma of gingiva.". J Indian Soc Periodontol 15 (1): 64-6. doi:10.4103/0972-124X.82275. PMID 21772725.
  4. ↑ Honda, K.; Kadowaki, S.; Kato, K.; Hanai, N.; Hasegawa, Y.; Yatabe, Y.; Muro, K. (Feb 2019). "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.". Invest New Drugs. doi:10.1007/s10637-019-00742-2. PMID 30790150.
  5. ↑ 5.0 5.1 Mai, S.; Xiong, G.; Diao, D.; Wang, W.; Zhou, Y.; Cai, R. (Feb 2019). "Case report: Crizotinib is effective in a patient with ROS1-rearranged pulmonary inflammatory myofibroblastic tumor.". Lung Cancer 128: 101-104. doi:10.1016/j.lungcan.2018.12.016. PMID 30642440.
  6. ↑ 6.0 6.1 Tsuzuki, T.; Magi-Galluzzi, C.; Epstein, JI. (Dec 2004). "ALK-1 expression in inflammatory myofibroblastic tumor of the urinary bladder.". Am J Surg Pathol 28 (12): 1609-14. PMID 15577680.
  7. ↑ 7.0 7.1 7.2 Saab, ST.; Hornick, JL.; Fletcher, CD.; Olson, SJ.; Coffin, CM. (Apr 2011). "IgG4 plasma cells in inflammatory myofibroblastic tumor: inflammatory marker or pathogenic link?". Mod Pathol 24 (4): 606-12. doi:10.1038/modpathol.2010.226. PMID 21297584.
  8. ↑ 8.0 8.1 Kataoka, TR.; Yamashita, N.; Furuhata, A.; Hirata, M.; Ishida, T.; Nakamura, I.; Hirota, S.; Haga, H. et al. (2014). "An inflammatory myofibroblastic tumor exhibiting immunoreactivity to KIT: a case report focusing on a diagnostic pitfall.". World J Surg Oncol 12: 186. doi:10.1186/1477-7819-12-186. PMID 24938355.
  9. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970283-2. Accessed on: 10 May 2011.
  10. ↑ 10.0 10.1 10.2 Shi, H.; Li, Y.; Wei, L.; Sun, L. (Apr 2010). "Primary colorectal inflammatory myofibroblastic tumour: a clinicopathological and immunohistochemical study of seven cases.". Pathology 42 (3): 235-41. doi:10.3109/00313021003631312. PMID 20350216.
  11. ↑ Miyamoto, H.; Montgomery, EA.; Epstein, JI. (Apr 2010). "Paratesticular fibrous pseudotumor: a morphologic and immunohistochemical study of 13 cases.". Am J Surg Pathol 34 (4): 569-74. doi:10.1097/PAS.0b013e3181d438cb. PMID 20216379.
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