The CT and pathological features of intestinal inflammatory myofibroblastic tumor

Abstract

To explore computed tomography (CT) findings and pathological features of intestinal inflammatory myofibroblastic tumors (IMT). A retrospective review was conducted on the CT features of five patients with pathologically confirmed IMT, which were then compared with the corresponding pathological findings. The study included four female and one male patients. The tumors were located in the rectum (n = 1), small intestine (n = 2), or cecum (n = 2). One patient exhibited a cystic solid mass with exophytic growth and the solid components showed moderate enhancement. Additionally, flaky low-density, marginal line-like calcified shadows were observed around the lesions. Two cases presented as solid masses within the lumen of the intestinal tract, showing obvious non-uniform enhancement along with visible enhancement shadows of small blood vessels. One patient had a metastasis. In two other cases, solid masses grew outside the lumen of the intestinal tract, demonstrating progressive and delayed enhancement on enhanced scans, as well as local nodular enhancement and ring enhancement. These two cases also exhibited focal sarcomatoid lesions, along with their respective IMTs. Histologically, these tumors mainly consist of proliferating spindle myofibroblast cells accompanied by variable infiltration by interstitial inflammatory cells, such as fibroblasts. Immunohistochemical analysis revealed positive staining for smooth muscle actin (SMA) in ∼80% of the cells tested, while vimentin staining was positive in ∼60% of the cells. Intestinal IMT is an extremely rare tumor with imaging features that can reflect the underlying pathological characteristics to some extent, thus aiding diagnosis.

Keywords

CT / inflammatory myofibroblastic tumor / intestinal tumor

References

[1] Coffin CM, Watterson J, Priest JR, et al. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol. 1995; 19: 859-872.

[2] Tan H, Wang B, Xiao H, Lian Y, Gao J. Radiologic and clinicopathologic findings of inflammatory myofibroblastic tumor. J Comput Assist Tomogr. 2017; 41: 90-97.

[3] Venkataraman S, Semelka RC, Braga L, Danet IM, Woosley JT. Inflammatory myofibroblastic tumor of the hepatobiliary system: report of MR imaging appearance in four patients. Radiology. 2003; 227: 758-763.

[4] Liang WJ, Zhou XY, Xu SL, et al. CT manifestations of inflammatory myofibroblastic tumors (inflammatory pseudotumors) of the urinary system. AJR Am J Roentgenol. 2016; 206: 1149-1155.

[5] Coffin CM, HornickK JL, Fletcher CD. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases. Am J Surg Pathol. 2007; 31: 509-520.

[6] Surabhivr VR, Chua S, Patel RP, et al. Inflammatory myofibroblastic tumors: current update. Radiol Clin North Am. 2016; 54: 553-563.

[7] Zhang Y, Dong W, Li SX, Zhao JJ, du B. Clinical and molecular pathological features of uterine inflammatory myofibroblastic tumor. Zhonghua Bing Li Xue Za Zhi. 2021; 50: 1020-1023.

[8] Strianese D, Tranfa F, Finelli M, Iuliano A, Staibano S, Mariniello G. Inflammatory myofibroblastic tumor of the orbit: a clinico-pathological study of 25 cases. Saudi J Ophthalmol. 2018; 32: 33-39.

[9] Guan Y, Chen G, Zhang W, Chen H, He J. Computed tomography appearance of inflammatory myofibroblastic tumor in the mediastinum. J Comput Assist Tomogr. 2012; 36: 654-658.

[10] Kirchgesner T, Danse E, Sempoux C. Mesenteric inflammatory myofibroblastic tumor: MRI and CT imaging correlated to anatomical pathology. Journal of the Belgian Society of Radiology. 2014; 97: 301-302.

[11] Horger M, Pfannenberg C, Bitze M, et al. Synchronous gastrointestinal and musculoskeletal manifestations of different subtypes of inflammatory myofibroblastic tumor: CT, MRI and pathological features. Eur Radiol. 2005; 15: 1713-1716.

[12] Groenveld RL, Raber MH, Oosterhof-Berktas R. Eijken E, Klaase JM. CT findings of inflammatory myofibroblastic tumor of different pathological types. Abdominal inflammatory myofibroblastic tumor. Case Rep Gastroenterol. 2014; 8: 67-71.

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2024 The Author(s). Precision Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Nanjing Medical University Affiliated Cancer Hospital & Jiangsu Cancer Hospital.