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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==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:
Line 46: Line 90:
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, abbreviated IMT, is an uncommon soft tissue lesion.

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

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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