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Retroperitoneal inflammatory myofibroblastic tumor
Suresh VS Attili, C Rama Chandra, Dadhich K Hemant, Poonamalle P Bapsy, Clementeena RamaRao, G Anupama
World Journal of Surgical Oncology , 2005, DOI: 10.1186/1477-7819-3-66
Abstract: The present case is of a 46 years old woman presented with a history of flank pain, abdominal mass and intermittent hematuria for last 6 months. The initial diagnosis was kept as renal cell carcinoma. Finally, it turned out to be a case of retroperitoneal IMT. The patient was managed by complete surgical resection of the tumor.IMT is a rare neoplasm of uncertain biological potential. Complete surgical resection remains the mainstay of the treatment.Inflammatory myofibroblastic tumor (IMT) is a relatively rare neoplasm. The outlook of this disease has changed with time from a benign reactive process to a malignant neoplasm, based on the multiple case reports demonstrating recurrent and constant clonal genetic alterations [1-5]. There are three main histological patterns: nodular fasciitis-like, fibrous histiocytoma-like, and desmoid or scar tissue-type. Though morphologically similar, they encompass a spectrum of entities with varied etiology, ranging from reactive/regenerative proliferations to low-grade neoplasms with a risk of local recurrence, and metastatic potential [3]. The commonest site of IMT is lung with a few case reports from extra pulmonary sites [6]. In the genitourinary tract, it most commonly occurs in the bladder. However it rarely originates in the kidney, renal pelvis, and ureter [4]. In the English literature only six cases of retroperitoneal IMT were reported [6-8]A 46-years-old woman presented with history of flank pain, abdominal lump and intermittent hematuria of 6 months duration. She was diagnosed as renal cell carcinoma (RCC) elsewhere and referred. The investigations at our hospital revealed normal hematological and biochemical parameters. The urine microscopy showed deformed RBC. The computerized tomography (CT) scan of the abdomen showed a large irregular well defined heterogeneous lesion occupying the left hypochondrium, lumbar and supra umbilical regions, measuring approximately 16 × 13.6 × 12.1 cm, and showed presence of predominant
Undescended testis in Spigelian hernia  [cached]
Ravi Kumar V,Singal Arbinder
Journal of Indian Association of Pediatric Surgeons , 2007,
Abstract: Spigelian hernias are uncommon in children. We report a 3-year-old boy with right spigelian hernia and right undescended testis. The hernial sac contained the testis, which is a rare presentation. The repair of the large defect with a prosthetic mesh and a concomitant orchidopexy were performed uneventfully.
EPIDEMIOLOGICAL STUDY ON UNDESCENDED TESTIS
RE Iacob,Z Moldovan,M Soiu,HI Osakwe
Jurnalul Pediatrului , 2009,
Abstract: Although half a century ago doctors believed undescended testis could descend in the scrotum anytime during the childhood up to the beginning of puberty, today it is accepted that both testes should be in the bursae at the time of birth (in 3 – 4% of cases this is not the situation). Otherwise, according to the most authors, one can wait at most one year (incidence drops to 1%), and then, during the second year of life, the testicular descent must be performed, as pathological changes in the undescended testis are visible as early as from the age of two thanks to the improvement of optical microscopy. However, an important number of cases are still diagnosed as late as around puberty, the purpose of this study being to evidence some of the possible causes that lead to this delayed diagnosis, which results in the modification of condition prognosis.
Inflammatory Myofibroblastic Tumor of the Nasal Septum  [PDF]
Yuri Okumura,Kazuhiro Nomura,Takeshi Oshima,Atsuko Kasajima,Takahiro Suzuki,Eichi Ishida,Toshimitsu Kobayashi
Case Reports in Otolaryngology , 2013, DOI: 10.1155/2013/670105
Abstract: 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 [1], 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
Inflammatory myofibroblastic tumor successfully treated with chemotherapy and nonsteroidals: A case report
Yun-Lu Tao,Zhen-Jun Wang,Jia-Gang Han,Ping Wei
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i47.7100
Abstract: Inflammatory myofibroblastic tumor (IMT) occurring at retroperitoneal sites has rarely been reported. We report the case of a previously well 14-year-old girl with no history of abdominal disease whose past medical history and family tumor history were unremarkable. She complained of intermittent abdominal pain for one month. An abdominal mass was found on physical examination and abdominal contrast-enhanced computed tomography (CT) showed a hypodense soft mass, the size and location of which suggested a well delineated retroperitoneal tumor surrounding the superior mesenteric vessels measuring 3.3 cm × 4.5 cm × 4.5 cm with enlarged lymph nodes. The patient underwent an exploratory laparotomy followed by biopsy and was subsequently diagnosed with retroperitoneal IMT. She was successfully treated with postoperative chemotherapy and oral diclofenac sodium. Following completion of therapy the mass was no longer palpable and no longer visible on CT scanning. The use of methotrexate and cisplatin for aggressive myofibroblastic tumors is also reviewed.
Inflammatory myofibroblastic tumor of the larynx  [PDF]
Mijovi? ?aklina,Mihailovi? Dragan,Kostov Milo?
Vojnosanitetski Pregled , 2008, DOI: 10.2298/vsp0810779m
Abstract: Background/Aim. Inflammatory myofibroblastic tumor (IMT) of the larynx is a rare borderline lesion composed of myofibroblastic and inflammatory cells. Case report. We presented a case of 77-year-old male with hoarseness for about three months. Laryngoscopy showed a polypoid tumor originated from the anterior commissure with glottic projection. Grossly, the tumor was 22 × 15 mm, whitish, oval nodus with firm consistency. Histologically, the lesion was composed of spindled to stellate cells arranged in a fascicular to storiform pattern and inflammatory cells: lymphocytes, histiocytes, plasma cells and neutrophils. The stroma was fibromyxoid and collagenous. Immunohistochemically, tumor cells showed strong positivity for actin and vimentin and negativity for cytokeratin, CD34, S100 and desmin. The proliferation (Ki67) was less than 10%. Conclusion. Inflammatory myofibroblastic tumor may be mistaken as a malignancy and the differential diagnosis can be difficult without immunohistochemistry. It is critical to recognize this uncommon entity to avoid unnecessary aggressive treatment.
Laparoscopic orchidectomy for undescended testis in adults.  [cached]
Desai C,Prabhu R,Supe A
Journal of Postgraduate Medicine , 2002,
Abstract: BACKGROUND: Impalpable testis is a significant diagnostic and therapeutic challenge in adults, for both radiologist and surgeons, with few reports in literature addressing this problem in adults. Laparoscopy is a reliable and definitive procedure obviating the necessity of advance investigation and subsequent inguinal exploration in adults. AIMS: To study the utility of laparoscopy as combined diagnostic and therapeutic modality for undescended testis in adults. SETTINGS AND DESIGN: Prospective study from a single surgical unit of a large tertiary referral centre during August 2000 to January 2002. METHODS AND MATERIAL: Nine patients of unilateral undescended testis with average age 22.7 years (range 13-31 years) underwent diagnostic laparoscopy and orchidectomy subsequent to detailed clinical, ultrasound and examination under anaesthesia (EUA) procedure. All patients were operated with one 10 mm umbilical camera port, one suprapubic port and 1 lateral port. RESULTS: None of the patients had palpable testis or an inguinal cough impulse on clinical examination and during EUA. In only 3(33.3%) patients, the ultrasound could locate the testis situated at the deep ring. On laparoscopy all testes were identified, 4 were present at the deep ring, 3 were intra-abdominal and 2 had blind ending vas entering the deep ring. Mesh plug was inserted in the internal ring in these 2 patients, after dissecting the peritoneum. None of the patients had intra or post-operative complications and all were discharged on the next day. CONCLUSION: Laparoscopy is one of the most satisfactory methods for the diagnosis and management of non-palpable testis in adult cryptorchid patients.
Inflammatory myofibroblastic tumor of the urinary bladder
Yagnik Vipul,Chadha Amit,Chaudhari Sanjay,Patel Keyuri
Urology Annals , 2010,
Abstract: Inflammatory myofibroblastic tumor (IMT) of bladder is an uncommon benign tumor of bladder, which is of unknown neoplastic potential, characterized by spindle cell proliferation with characteristic fibroinflammatory and pseudosarcomatous appearance. Essential criteria for the diagnosis of IMT are: spindle myoepithelial cell proliferation and lymphocytic infiltrate. Complete surgical resection is the treatment of choice.
Cancer Risk in Mothers of Men Operated for Undescended Testis  [PDF]
Hadriano M. Lacerda,Lorenzo Richiardi,Andreas Pettersson,Marine Corbin,Franco Merletti,Olof Akre
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014285
Abstract: Undescended testis, or cryptorchidism, occurs in 2–5% of boys born at term, and by 12 months of age about 1% of all boys have manifest cryptorchidism. Several hormonal substances control this process and disruption of the foetal sex-hormones balance is a potential cause of undescended testis, however, to a great extent the aetiology of cryptorchidism is unclear.
Inflammatory Myofibroblastic Tumor: A Rare Tumor in the Tongue  [PDF]
Nur Yucel Ekici,Tuba Bayindir,Ahmet Kizilay,Nasuhi Engin Aydin
Case Reports in Otolaryngology , 2013, DOI: 10.1155/2013/787824
Abstract: Inflammatory myofibroblastic tumor is composed of myofibroblast and inflammatory cell infiltration of the tissue. Malign transformation and recurrence rate of this tumor is rare and accepted as benign fibroinflammatory disease. The main etiology is unclear, but infection, trauma, and immunologic event are accused. In this study, we presented a 75-year-old man with a mass on his tongue, which was diagnosed as “inflammatory myofibroblastic tumor.” This type of tumor is rarely seen in the tongue and might be difficult to diagnose. Complete mass excision was provided for an adaquete treatment. 1. Introduction Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor [1]. The etiology of IMT is contentious, also the nature of this tumor type (benign or malign) is still controversial [1–3]. But, because of its rarity, the current conception is altered from a benign reactive process to an intermediate neoplasm [4]. Different terms such as; inflammatory pseudotumor, histiocytoma, plasma cell histiocytoma complex, plasma cell granuloma, fibrohistiocytoma, xanthomatous granuloma, myxoid hamartoma, xanthomatous pseudotumor, spindle cell pseudotumor, inflammatory fibrosarcoma, benign myofibroblastoma, and inflammatory myofibroblastic proliferation were used for defining this tumor. World Health Organization (WHO) had consolidated this term as IMT in 1994 and declared it as a diagnostic classification for intermediate soft-tissue myofibroblastic neoplasm according to its well reproducible histological morphology [4, 5]. The tumor reported in the lung originally, but extra-pulmonary form, has been described in different organs and anatomic sites [6, 7]. Regardless of the site of origin, it is a circumscribed mass-forming process, composed of myofibroblasts, fibroblasts, histiocytes, and plasma cells. Although stromal fibrosis is a finding that is usually seen, tumor tends to be limited in the focal area [6, 8]. IMT is preferentially occurring in children and young adults [6]. In this report, we presented a 75-year-old male patient with inflammatory myofibroblastic tumor of the tongue presenting with pediculated large mass. 2. ??Case Report A 75-year-old man was referred to our clinic with a painless, pediculated large mass on the left side of the tongue. The lesion grew rapidly within four months. Oral examination revealed an approximately 4 centimeter (cm) in diameter, hard, partially ulcerated, and pediculated large mass on the left side of the tongue (Figure 1). There was no regional lymphadenopathy, and the remainder of physical examination was
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