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Follow-Up Imaging of Inflammatory Myofibroblastic Tumor of the Uterus and Its Spontaneous Regression.

Markovic Vasiljkovic B, Plesinac Karapandzic V, Pejcic T, Djuric Stefanovic A, Milosevic Z, Plesinac S - Iran J Radiol (2016)

Bottom Line: Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery.The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen.At that time, the organ of origin was not specified.

View Article: PubMed Central - PubMed

Affiliation: Center for Radiology and MRI, Clinical Center of Serbia, Medical Faculty, Belgrade University, Belgrade, Serbia.

ABSTRACT
Inflammatory myofibroblastic tumor (IMT) is an aggressive benign mass that may arise from various tissues and organs with a great variability of histological and clinical appearances. Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery. The aim of this paper is to present CT and MRI findings during four-year follow-up of complete, spontaneous regression of IMT of the uterus. The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen. At that time, the organ of origin was not specified. After analysis of the follow-up imaging findings and the mode of tumor regression, the uterus was proclaimed as the probable site of origin. IMT of the uterus is extremely rare and has been reported in ten cases up to now. The gradual, complete regression of uterine IMT documented by CT and MRI may contribute to understanding of its nature.

No MeSH data available.


Related in: MedlinePlus

Diffusion weighted images of the pelvis on the 5-year follow-up MRI. There is no evidence of qualitative changes of water diffusion in the region of interest.
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fig26176: Diffusion weighted images of the pelvis on the 5-year follow-up MRI. There is no evidence of qualitative changes of water diffusion in the region of interest.

Mentions: A middle-aged female patient was admitted to the hospital with a 5-month history of febrile condition, weight loss, left lumbar pain, and edema of the left leg. Spontaneous expulsion of the intrauterine device occurred 2 months before the onset of symptoms. Laboratory findings revealed an accelerated sedimentation rate, hypochromic anemia, leukocytosis, and a mild rise in serum creatinine level. Abdominal ultrasound and intravenous urography depicted bilateral hydronephrosis and a large, soft tissue mass occupying the pelvis. Bimanual vaginal and rectal examination confirmed pelvic mass involving the uterus, parametria, and mostly the left adnexa. Cystoscopy with biopsy did not show any abnormality and rectosigmoidoscopy showed extrinsic lumen narrowing with negative biopsy findings. A detailed clinical evaluation of this patient has been presented in the previous report (10). The first CT revealed an enlarged uterus with homogeneous wall thickening and indistinct outer and inner margins. The uterus was embedded within the tumor mass that extended toward the pelvic walls. After an intravenous contrast administration, the mass density raised heterogeneously (10 to 20 HU) without evidence of necrosis or calcification. Soft tissue planes between the uterus and bowels, ureters and both ovaries were erased (Figure 1). Explorative laparotomy was done. The tumor was of rubbery consistence tightly adherent to pelvic organs and the sacrum. Because a complete tumor excision was technically impossible, bowel liberation and excisional biopsy were performed. Routine hematoxylin-eosin (HE) stain showed hyalinized stroma with myofibroblasts and numerous inflammatory cell infiltrates (Figure 2). Immunohistochemical analysis verified spindle cell positivity for actin and vimentin, inflammatory cell positivity for LCA and CD68, and vascular vessel wall positivity for anti-CD34 antibody. Immunohistochemical findings were negative for desmin, S-100, cytokeratin HMV, and focally positive for cytokeratin MNF116. The pathological diagnosis was inflammatory myofibroblastic tumor of unknown origin. Meanwhile, the patient underwent unilateral (right) percutaneous nephrostomy (PCN) catheter insertion. Broad-spectrum antibiotics were administered during a one-month period. Inflammatory symptoms and laboratory findings returned to normal within three months when PCN was extracted. Then, 4 months after surgery, the second CT depicted reduction of the tumor volume while its densities on both unenhanced and enhanced scans remained identical with the first CT. Eight months after the initial work-up, further tumor regression was noted with iso- and hypodense strands of tumor tissue arranged in the radial fashion connecting uterus and pelvic walls (Figure 3). Further on, ultrasound checkups were done periodically every 6 months, in which uterus wall thickening and its indistinct outer border were present. Two years after the initial diagnosis, follow-up CT depicted complete tumor regression with restoration of pelvic organ morphology and involution of the uterus to dimensions appropriate to the patient’s age. The only apparent abnormality was an invisible fat tissue plane between the uterus and the adjacent bowel loops, thus suggesting adhesions (Figure 4). MRI exams were done during the third, fourth and fifth year of follow-up. In T1 weighted fat suppression sequence, T2 weighted fat suppression sequence, fast spin echo sequence, pelvic organs with normal topography and morphology without residual periuterine fibrosis were depicted. The uterus corpus, cervix zone anatomy, and the width of the endometrium were within normal limits (Figure 5). Diffusion weighted images were obtained during these MRI exams and no apparent changes were observed (Figure 6).


Follow-Up Imaging of Inflammatory Myofibroblastic Tumor of the Uterus and Its Spontaneous Regression.

Markovic Vasiljkovic B, Plesinac Karapandzic V, Pejcic T, Djuric Stefanovic A, Milosevic Z, Plesinac S - Iran J Radiol (2016)

Diffusion weighted images of the pelvis on the 5-year follow-up MRI. There is no evidence of qualitative changes of water diffusion in the region of interest.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835684&req=5

fig26176: Diffusion weighted images of the pelvis on the 5-year follow-up MRI. There is no evidence of qualitative changes of water diffusion in the region of interest.
Mentions: A middle-aged female patient was admitted to the hospital with a 5-month history of febrile condition, weight loss, left lumbar pain, and edema of the left leg. Spontaneous expulsion of the intrauterine device occurred 2 months before the onset of symptoms. Laboratory findings revealed an accelerated sedimentation rate, hypochromic anemia, leukocytosis, and a mild rise in serum creatinine level. Abdominal ultrasound and intravenous urography depicted bilateral hydronephrosis and a large, soft tissue mass occupying the pelvis. Bimanual vaginal and rectal examination confirmed pelvic mass involving the uterus, parametria, and mostly the left adnexa. Cystoscopy with biopsy did not show any abnormality and rectosigmoidoscopy showed extrinsic lumen narrowing with negative biopsy findings. A detailed clinical evaluation of this patient has been presented in the previous report (10). The first CT revealed an enlarged uterus with homogeneous wall thickening and indistinct outer and inner margins. The uterus was embedded within the tumor mass that extended toward the pelvic walls. After an intravenous contrast administration, the mass density raised heterogeneously (10 to 20 HU) without evidence of necrosis or calcification. Soft tissue planes between the uterus and bowels, ureters and both ovaries were erased (Figure 1). Explorative laparotomy was done. The tumor was of rubbery consistence tightly adherent to pelvic organs and the sacrum. Because a complete tumor excision was technically impossible, bowel liberation and excisional biopsy were performed. Routine hematoxylin-eosin (HE) stain showed hyalinized stroma with myofibroblasts and numerous inflammatory cell infiltrates (Figure 2). Immunohistochemical analysis verified spindle cell positivity for actin and vimentin, inflammatory cell positivity for LCA and CD68, and vascular vessel wall positivity for anti-CD34 antibody. Immunohistochemical findings were negative for desmin, S-100, cytokeratin HMV, and focally positive for cytokeratin MNF116. The pathological diagnosis was inflammatory myofibroblastic tumor of unknown origin. Meanwhile, the patient underwent unilateral (right) percutaneous nephrostomy (PCN) catheter insertion. Broad-spectrum antibiotics were administered during a one-month period. Inflammatory symptoms and laboratory findings returned to normal within three months when PCN was extracted. Then, 4 months after surgery, the second CT depicted reduction of the tumor volume while its densities on both unenhanced and enhanced scans remained identical with the first CT. Eight months after the initial work-up, further tumor regression was noted with iso- and hypodense strands of tumor tissue arranged in the radial fashion connecting uterus and pelvic walls (Figure 3). Further on, ultrasound checkups were done periodically every 6 months, in which uterus wall thickening and its indistinct outer border were present. Two years after the initial diagnosis, follow-up CT depicted complete tumor regression with restoration of pelvic organ morphology and involution of the uterus to dimensions appropriate to the patient’s age. The only apparent abnormality was an invisible fat tissue plane between the uterus and the adjacent bowel loops, thus suggesting adhesions (Figure 4). MRI exams were done during the third, fourth and fifth year of follow-up. In T1 weighted fat suppression sequence, T2 weighted fat suppression sequence, fast spin echo sequence, pelvic organs with normal topography and morphology without residual periuterine fibrosis were depicted. The uterus corpus, cervix zone anatomy, and the width of the endometrium were within normal limits (Figure 5). Diffusion weighted images were obtained during these MRI exams and no apparent changes were observed (Figure 6).

Bottom Line: Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery.The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen.At that time, the organ of origin was not specified.

View Article: PubMed Central - PubMed

Affiliation: Center for Radiology and MRI, Clinical Center of Serbia, Medical Faculty, Belgrade University, Belgrade, Serbia.

ABSTRACT
Inflammatory myofibroblastic tumor (IMT) is an aggressive benign mass that may arise from various tissues and organs with a great variability of histological and clinical appearances. Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery. The aim of this paper is to present CT and MRI findings during four-year follow-up of complete, spontaneous regression of IMT of the uterus. The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen. At that time, the organ of origin was not specified. After analysis of the follow-up imaging findings and the mode of tumor regression, the uterus was proclaimed as the probable site of origin. IMT of the uterus is extremely rare and has been reported in ten cases up to now. The gradual, complete regression of uterine IMT documented by CT and MRI may contribute to understanding of its nature.

No MeSH data available.


Related in: MedlinePlus