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Year : 2004  |  Volume : 14  |  Issue : 1  |  Page : 103-104
Inflammatory myofibroblastic tumor of sigmoid mesocolon


Dept. of Radiology & Imaging University College of Medical Sciences, E-3. GTB Hospital Campus, Dilshad Garden, Delhi-110095, India

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How to cite this article:
Jain S, Bhargava S K, Upreti L, Mohta A. Inflammatory myofibroblastic tumor of sigmoid mesocolon. Indian J Radiol Imaging 2004;14:103-4

How to cite this URL:
Jain S, Bhargava S K, Upreti L, Mohta A. Inflammatory myofibroblastic tumor of sigmoid mesocolon. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Oct 20];14:103-4. Available from: http://www.ijri.org/text.asp?2004/14/1/103/28563
Sir,

Inflammatory myofibroblastic tumors (IMT) comprise a rare group of lesions characterized histologically by acute and chronic inflammatory cells with a variable degree of fibrous stroma. [1]. Inflammatory myofibroblastic tumors are most often seen in the lung of young adults, but there have been reports of these tumors occurring in children, in various sites [2]. The number of childhood cases in the current literature is limited [3]. Common sites of presentation include lung, mesentery, liver and spleen; intestinal presentations are rare and the etiology remains obscure [4].

The presenting symptoms are nonspecific and depend on location. As a result, differentiation from a neoplasm cannot be based on clinical findings alone [1]. We present an unusual case of an Inflammatory myofibroblastic tumor arising in the mesentery of sigmoid colon in a 4-year-old child.

A 4-year-old child presented with an abdominal lump and pain for 4 months. There was no history of fever. On examination, a hard lump was palpable in right hypochondrium extending till the umbilical region. The lump moved slightly with respiration. No other significant clinical finding was noted. The laboratory investigations were not contributory.

On ultrasonography, a sharply defined anechoic mass with lobular outline was seen in umbilical region [Figure - 1]. A provisional diagnosis of mesenteric cyst was given on the basis of ultrasonographic findings.

CT examination of the child was done on Somatom Plus 4 Volume Zoom Multislice CT scanner (M/s Siemens) installed at our institution. CT revealed a mass lesion with soft tissue attenuation. Strong, inhomogeneous enhancement was seen on post-contrast study [Figure - 2]. The mass appeared to be intra-peritoneal. There was no evidence of any communication with bowel. However, an interesting additional finding was found i.e. sigmoid colon was seen to course superiorly and to the right, instead of its normal course towards left [Figure - 3]. This finding was confirmed on subsequent barium study. Small extrinsic mass effect on the sigmoid colon was also seen. Thus, diagnosis of a benign soft tissue mass in relation to the sigmoid mesocolon was made.

The patient underwent laparotomy. On surgery, an 8x8cm mass was seen along the mesentery of sigmoid colon having adhesions with the overlying bowel. Mass was adherent to small bowel mesentery as well but could be separated from it with ease. The lesion was resected and sent for histo-pathological examination. Post-operative course was uneventful and patient was discharged on 10th post-operative day.

Histo-pathological examination revealed presence of spindle cells, myofibroblasts, plasma cells and histiocytes in the surgical specimen. Thus, a histopathological diagnosis of inflammatory myofibroblastic tumor in sigmoid mesocolon was suggested.

Initially described in 1937, inflammatory pseudotumor (IPT), inflammatory myofibroblastic tumor (IMT) or plasma cell granulomas are synonymous for inflammatory solid tumors that contain spindle cells, myofibroblasts, plasma cells and histiocytes [4]. It was thought initially that the inflammatory myofibroblastic tumor was non-neoplastic and represented an aberrant inflammatory response despite its gross and microscopic features of a spindle cell neoplasm. However, there were some pathological aspects of the IMT that seemingly contradicted its purely inflammatory nature, including its potential for local recurrence; development of multifocal, noncontiguous tumors; infiltrative local growth; vascular invasion; and malignant transformation [5]. In addition, these tumors have clonal characteristics. Therefore, inflammatory myofibroblastic tumor should probably be regarded as a soft tissue-mesenchymal tumor with an indeterminant or low malignant potential, which is a somewhat indefinite but realistic prognostic category [5].

Inflammatory myofibroblastic tumor can be suspected preoperatively through some hematologic abnormalities and radiologic findings [3]. Hematologic abnormalities that are associated with IMT include microcytic hypochromic anemia, hypergammaglobulinemia and a high erythrocyte sedimentation rate [5]. However, precise diagnosis is made on the basis of histologic findings only [3].

This tumor mimics, clinically and radiologically, malignant tumors-especially sarcoma [2]. However, this tumor tends to be localized in majority of cases [1]. On CT scan this lesion appears as mass of soft tissue attenuation without any internal calcification. Mild enhancement is seen on post-contrast study. There is usually no evidence of central necrosis. The reticulation of the adjacent fat is an important finding and may suggest an inflammatory origin of the mass [1].

Pathological differentiation of these lesions from malignancy is important for early total excision whenever possible. Long-term follow-up is necessary to detect local recurrence, which may develop many years later and to confirm the benign nature of these tumors [3].

 
   References Top

1.Oliveira Ribeiro AC, Joshi VM, Funkhouser WK and Mukherji SK: Inflammatory Myofibroblastic Tumor Involving the Pterygopalatine Fossa. American Journal of Neuroradiology 2001; 22: 518-520.  Back to cited text no. 1    
2.Bonnet JP, Basset T, Dijoux D: Abdominal inflammatory myofibroblastic tumors in children: report of an appendiceal case and review of the literature. J Pediatr Surg 1996 Sep; 31(9): 1311-4.  Back to cited text no. 2    
3.Karnak I, Senocak ME, Ciftci AO, Caglar M, Bingol-Kologlu M, Tanyel FC, Buyukpamukcu N: Inflammatory myofibroblastic tumor in children: diagnosis and treatment. J Pediatr Surg 2001 Jun; 36(6):908-12.  Back to cited text no. 3    
4.Sanders BM, West KW, Gingalewski C, Engum S, Davis M, Grosfeld JL: Inflammatory pseudotumor of the alimentary tract: clinical and surgical experience. J Pediatr Surg 2001 Jan; 36(1):169-73.  Back to cited text no. 4    
5.Coffin CM, Humphrey PA, Dehner LP: Extrapulmonary inflammatory myofibroblastic tumor: a clinical and pathological survey. Semin Diagn Pathol 1998 May; 15(2):85-101.  Back to cited text no. 5    

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Correspondence Address:
S Jain
Dept. of Radiology & Imaging University College of Medical Sciences, E-3. GTB Hospital Campus, Dilshad Garden, Delhi-110095
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2], [Figure - 3]

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