We report an extremely rare case of inflammatory myofibroblastic tumor of the posterior edge of the nasal septum. An 11-year-old boy presented with frequent epistaxis and nasal obstruction persisting for one year. Based on the clinical presentation and imaging studies, juvenile angiofibroma was suspected, but angiography suggested the possibility of another type of tumor. Transnasal endoscopic surgery found that the tumor protruded into the nasopharynx from the posterior end of the nasal septum. Histological examination identified spindle cells with immunoreaction for vimentin, smooth muscle actin, and anaplastic lymphoma kinase (ALK), but not for desmin and cytokeratin. This is a report of inflammatory myofibroblastic tumor mimicking juvenile angiofibroma. This case suggests that angiography is helpful in the differential diagnosis of epipharyngeal tumor in adolescence. 1. Introduction Inflammatory myofibroblastic tumor (IMT) was first observed in the lung in 1990 , but extrapulmonary IMTs have also since been reported. IMT is classified as myofibroblastic neoplasm with intermediate grade, which rarely metastasizes. The clinical presentation is a neoplastic process with recurrence and metastasis in some cases [2, 3]. IMT may occur throughout the body and is most commonly found in the lung, abdominal cavity, retroperitoneum, and extremities but is uncommon in the head and neck region [1, 4]. We present a case of IMT located in the nasopharynx, which mimicked juvenile angiofibroma. 2. Case Presentation An 11-year-old boy had visited a provincial hospital because of frequent epistaxis and nasal obstruction persisting for one year. A tumorous mass was found in the nasopharynx, so computed tomography (CT) and magnetic resonance (MR) imaging studies were performed. Juvenile angiofibroma was suspected, so he was referred to our hospital for further examination and treatment. Physical examination found a smooth reddish mass in the nasopharynx. The imaging studies performed at the previous hospital were reexamined. CT scans showed a homogeneously enhanced soft tissue mass in the nasopharynx without bone destruction (Figure 1). The T1-weighted MR image with contrast medium demonstrated an isointense mass with homogeneous enhancement (Figure 2). These findings elucidated the diagnostic impression of juvenile angiofibroma, as suggested by the previous physicians. Angiography detected faint tumor staining, but no obvious feeding artery (Figure 3). This result suggested the possibility of tumors other than juvenile angiofibroma because of the unexpectedly poor
G. Pettinato, J. C. Manivel, N. De Rosa, and L. P. Dehner, “Inflammatory myofibroblastic tumor (plasma cell granuloma). Clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations,” American Journal of Clinical Pathology, vol. 94, no. 5, pp. 538–546, 1990.
C. M. Coffin, J. Watterson, J. R. Priest, and L. P. Dehner, “Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases,” American Journal of Surgical Pathology, vol. 19, no. 8, pp. 859–872, 1995.
V. Soysal, O. G. Yigitbasi, O. Kontas, et al., “Inflammatory myofibroblastic tumor of the nasal cavity: a case report and review of the literature,” International Journal of Pediatric Otorhinolaryngology, vol. 61, no. 2, pp. 161–165, 2001.
N. Gale, N. Zidar, J. Podboj, M. Volav？ek, and B. Luzar, “Inflammatory myofibroblastic tumour of paranasal sinuses with fatal outcome: reactive lesion or tumour?” Journal of Clinical Pathology, vol. 56, no. 9, pp. 715–717, 2003.
Z. J. Lu, S. H. Zhou, S. X. Yan, and H. T. Yao, “Anaplastic lymphoma kinase expression and prognosis in inflammatory myofibroblastic tumours of the maxillary sinus,” Journal of International Medical Research, vol. 37, no. 6, pp. 2000–2008, 2009.
C. M. Coffin, J. L. Hornick, and C. D. M. Fletcher, “Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases,” American Journal of Surgical Pathology, vol. 31, no. 4, pp. 509–520, 2007.
M. Karak？k, E. ？zer, I. Sar et al., “Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the maxillary sinus mimicking malignancy: a case report of an unusual location (is that a true neoplasm?),” Auris Nasus Larynx, vol. 29, no. 4, pp. 383–386, 2002.