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A large inflammatory myofibroblastic tumor involving both stomach and spleen: A case report and review of the literature.

Chen WC, Jiang ZY, Zhou F, Wu ZR, Jiang GX, Zhang BY, Cao LP - Oncol Lett (2014)

Bottom Line: IMT has been reported in a number of locations throughout the body; however, cases occurring in the gastrointestinal tract are rare and to date, no case involving both the stomach and spleen has been reported.As the tumor had invaded the stomach and spleen, it was completely excised and concomitantly, the entire stomach and spleen were removed.Histological examination of the biopsy revealed fascicles of spindle cells in a mixed inflammatory background, with inflammatory cells that were immunopositive for vimentin, smooth muscle actin, and negative for anaplastic lymphoma kinase and CD30, confirming the diagnosis of IMT.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.

ABSTRACT

Inflammatory myofibroblastic tumor (IMT) is a rare, benign neoplasm that most commonly occurs in pediatric patients; it has been described as a pseudosarcomatous proliferation of spindled myofibroblasts mixed with lymphoplasmacytic cells. IMT has been reported in a number of locations throughout the body; however, cases occurring in the gastrointestinal tract are rare and to date, no case involving both the stomach and spleen has been reported. The current study presents a case of an extremely large IMT invading both the stomach and spleen in a 50-year-old female, presenting with a three-month history of left-sided abdominal distension without abdominal pain, fever or vomiting. As the tumor had invaded the stomach and spleen, it was completely excised and concomitantly, the entire stomach and spleen were removed. Histological examination of the biopsy revealed fascicles of spindle cells in a mixed inflammatory background, with inflammatory cells that were immunopositive for vimentin, smooth muscle actin, and negative for anaplastic lymphoma kinase and CD30, confirming the diagnosis of IMT. Four months following local excision of the mass, accompanied by a total gastrectomy and splenectomy, no abdominal distension, abdominal pain, fever or vomiting were observed and no IMT recurrence was identified.

No MeSH data available.


Related in: MedlinePlus

Inflammatory myofibroblastic tumor. Spindle and plump cells in diffuse inflammatory background; hematoxylin and eosin staining for (A) magnification, 100× and (B) magnification, 400x). Immunostaining of (C) vimentin, (D) smooth muscle actin, (E) CD23, (F) CD21, (G) CD68 and (H) LCA. (I) In situ hybridization was positive for EBV.
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f3-ol-09-02-0811: Inflammatory myofibroblastic tumor. Spindle and plump cells in diffuse inflammatory background; hematoxylin and eosin staining for (A) magnification, 100× and (B) magnification, 400x). Immunostaining of (C) vimentin, (D) smooth muscle actin, (E) CD23, (F) CD21, (G) CD68 and (H) LCA. (I) In situ hybridization was positive for EBV.

Mentions: On macroscopic examination, an extremely large mass, measuring 22×13×8.5 cm, was tightly adhered to the stomach and spleen. In the stomach lesion, tumor tissue invaded the entire gastric wall and the overlying mucosa appeared ulcerated (7). Lymph nodes along the greater curvature were excised and underwent biopsy, the result of which was negative for tumor cells. On microscopic examination, a neoplasm composed of spindle cells in inflammatory background with mixed lymphocytes, plasma cells and eosinophils was observed (Fig. 3). Immunohistochemical staining was positive for vimentin, smooth muscle actin (SMA), and negative for CD30 and anaplastic lymphoma kinase (ALK). There were a number of cells expressing CD68, but negative for LCA, excluding the possibility that the tumor was derived from lymphatic and hematopoietic system. Furthermore, for markers of dendritic cell neoplasms, including CD21 and CD35, staining was negative. Additionally, in situ hybridization revealed positive results for EBV and EBVR. Based on these results, which were confirmed by the Department of Pathology at the University of California, Los Angeles (UCLA), a diagnosis of IMT was determined. The patient experienced right-sided lower limb venous thrombosis, however, four months following surgery, her recovery is favorable.


A large inflammatory myofibroblastic tumor involving both stomach and spleen: A case report and review of the literature.

Chen WC, Jiang ZY, Zhou F, Wu ZR, Jiang GX, Zhang BY, Cao LP - Oncol Lett (2014)

Inflammatory myofibroblastic tumor. Spindle and plump cells in diffuse inflammatory background; hematoxylin and eosin staining for (A) magnification, 100× and (B) magnification, 400x). Immunostaining of (C) vimentin, (D) smooth muscle actin, (E) CD23, (F) CD21, (G) CD68 and (H) LCA. (I) In situ hybridization was positive for EBV.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301536&req=5

f3-ol-09-02-0811: Inflammatory myofibroblastic tumor. Spindle and plump cells in diffuse inflammatory background; hematoxylin and eosin staining for (A) magnification, 100× and (B) magnification, 400x). Immunostaining of (C) vimentin, (D) smooth muscle actin, (E) CD23, (F) CD21, (G) CD68 and (H) LCA. (I) In situ hybridization was positive for EBV.
Mentions: On macroscopic examination, an extremely large mass, measuring 22×13×8.5 cm, was tightly adhered to the stomach and spleen. In the stomach lesion, tumor tissue invaded the entire gastric wall and the overlying mucosa appeared ulcerated (7). Lymph nodes along the greater curvature were excised and underwent biopsy, the result of which was negative for tumor cells. On microscopic examination, a neoplasm composed of spindle cells in inflammatory background with mixed lymphocytes, plasma cells and eosinophils was observed (Fig. 3). Immunohistochemical staining was positive for vimentin, smooth muscle actin (SMA), and negative for CD30 and anaplastic lymphoma kinase (ALK). There were a number of cells expressing CD68, but negative for LCA, excluding the possibility that the tumor was derived from lymphatic and hematopoietic system. Furthermore, for markers of dendritic cell neoplasms, including CD21 and CD35, staining was negative. Additionally, in situ hybridization revealed positive results for EBV and EBVR. Based on these results, which were confirmed by the Department of Pathology at the University of California, Los Angeles (UCLA), a diagnosis of IMT was determined. The patient experienced right-sided lower limb venous thrombosis, however, four months following surgery, her recovery is favorable.

Bottom Line: IMT has been reported in a number of locations throughout the body; however, cases occurring in the gastrointestinal tract are rare and to date, no case involving both the stomach and spleen has been reported.As the tumor had invaded the stomach and spleen, it was completely excised and concomitantly, the entire stomach and spleen were removed.Histological examination of the biopsy revealed fascicles of spindle cells in a mixed inflammatory background, with inflammatory cells that were immunopositive for vimentin, smooth muscle actin, and negative for anaplastic lymphoma kinase and CD30, confirming the diagnosis of IMT.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.

ABSTRACT

Inflammatory myofibroblastic tumor (IMT) is a rare, benign neoplasm that most commonly occurs in pediatric patients; it has been described as a pseudosarcomatous proliferation of spindled myofibroblasts mixed with lymphoplasmacytic cells. IMT has been reported in a number of locations throughout the body; however, cases occurring in the gastrointestinal tract are rare and to date, no case involving both the stomach and spleen has been reported. The current study presents a case of an extremely large IMT invading both the stomach and spleen in a 50-year-old female, presenting with a three-month history of left-sided abdominal distension without abdominal pain, fever or vomiting. As the tumor had invaded the stomach and spleen, it was completely excised and concomitantly, the entire stomach and spleen were removed. Histological examination of the biopsy revealed fascicles of spindle cells in a mixed inflammatory background, with inflammatory cells that were immunopositive for vimentin, smooth muscle actin, and negative for anaplastic lymphoma kinase and CD30, confirming the diagnosis of IMT. Four months following local excision of the mass, accompanied by a total gastrectomy and splenectomy, no abdominal distension, abdominal pain, fever or vomiting were observed and no IMT recurrence was identified.

No MeSH data available.


Related in: MedlinePlus