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 Table of Contents 
CASE REPORT
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 552-553  

Primary inflammatory myofibroblastic tumor of stomach—report of a very rare case


Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India

Date of Submission08-Jun-2020
Date of Decision09-Sep-2020
Date of Acceptance01-Dec-2020
Date of Web Publication30-Jan-2021

Correspondence Address:
Dr. Ranendra Hajong
Department of General Surgery, NEIGRIHMS, Shillong - 793 018, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_1126_20

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  Abstract 


Primary inflammatory myofibroblastic tumor (IMT) is a very rare tumor arising from stomach and it closely mimics gastric GIST. It usually affects the lung and found in children and young patients. The diagnosis of gastric IMT is usually done post-operatively by immunohistochemistry examination where it is seen that IMT is positive to SMA and vimentin. Complete surgical excision is the treatment of choice and local recurrence is usually seen in incompletely resected cases.

Keywords: Gastric, myofibroblastic tumor, surgical resection


How to cite this article:
Hajong R, Newme K, Khongwar D. Primary inflammatory myofibroblastic tumor of stomach—report of a very rare case. J Family Med Prim Care 2021;10:552-3

How to cite this URL:
Hajong R, Newme K, Khongwar D. Primary inflammatory myofibroblastic tumor of stomach—report of a very rare case. J Family Med Prim Care [serial online] 2021 [cited 2021 Feb 24];10:552-3. Available from: https://www.jfmpc.com/text.asp?2021/10/1/552/307874




  Introduction Top


Primary inflammatory myofibroblastic tumor (IMT) is found commonly in lungs of young adults and children and is a very rare tumor of stomach in adults.[1],[2] It encompasses a spectrum of myofibroblastic proliferation along with varying amount of inflammatory infiltrate. A number of terms have been applied to the lesion, namely, inflammatory pseudotumor, fibrous xanthoma, plasma cell granuloma, pseudosarcoma, lymphoid hamartoma, myxoid hamartoma, inflammatory myofibrohistiocytic proliferation, benign myofibroblatoma, and most recently, inflammatory myofibroblastic tumor. The diverse nomenclature is mostly descriptive and reflects the uncertainty regarding true biologic nature of these lesions. Recently, the concept of this lesion being reactive has been challenged based on the clinical demonstration of recurrences and metastasis and cytogenetic evidence of acquired clonal chromosomal abnormalities. We hereby report a case of inflammatory pseudotumor and review its inflammatory versus neoplastic behavior.

It was previously known as, inflammatory pseudotumor, fibrous xanthoma, plasma cell granuloma, pseudosarcoma, lymphoid hamartoma, myxoid hamartoma, inflammatory myofibrohistiocytic proliferation, benign myofibroblatoma, and most recently, inflammatory myofibroblastic tumor.[3] IMT does not have any specific clinical manifestations or imaging characteristics. Its biological behavior range from benign to aggressive lesions and may be locally recurrent but it rarely metastasizes to distant organs.[4]


  Case Report Top


A 25-year-old lady presented with pain and swelling in upper abdomen of one-month duration. Pain was dull aching and burning in nature. The swelling was insidious in onset, approximately 10cms in diameter. Her appetite was normal. Upper GI Endoscopy showed external compression from anterior wall of the stomach. Ultrasonography and CECT of abdomen showed a large heterogeneously enhancing mass lesion arising from anterior wall of the body of stomach. Pre-operatively, a diagnosis of GIST (Gastrointestinal stromal tumour) was made. At operation, an exophytic growth emanating from the body and antrum of stomach was seen with no infiltration to adjacent organs was noted. Distal gastrectomy [Figure 1] with roux-en-Y gastrojejunostomy was done. Histopathological [Figure 2] and immuno-histochemical examinations confirmed the diagnosis of IMT. The tumour was weakly positive for SMA (Smooth muscle actin) and vimentin. CD117, CD34, and S100 were negative.
Figure 1: Showing resected IMT with part of stomach

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Figure 2: Showing histopathological findings of IMT

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Patient recovered well and was doing well till 6 months after surgery.


  Discussion Top


IMT may be pre-disposed by infections, autoimmune or neoplastic in origin.[5] It usually involves lung and affect children and young adults; however, IMT can affect any organ of the body and any age group of patients.[2] Primary IMT of stomach is an extremely rare entity and usually confused with GIST, unless correlated with immunohistochemistry study post-operatively.[6] IMT is usually positive for SMA (Smooth muscle actin) and vimentin[7] similar to the present case. Computed tomographic scan usually shows well-demarcated soft tissue masses with heterogeneous enhancement and areas of necrosis.[8] Complete surgical resection is usually the sufficient treatment with subsequent follow-up.[2] Gastric IMTs have relatively good prognosis, but recurrence rate of approximately 15% to 37% have been seen within a year after surgery.[1] Chemotherapy and radiotherapy are advocated for cases with recurrence or metastasis.[9] Cheng B et al.[10] also reported recently a similar case of primary gastric IMT involving the gastric antrum and managed successfully by laparoscopic distal gastrectomy.


  Conclusion Top


Primary gastric IMT is a very rare disease and very closely mimics gastric GIST. Only post-operative immunohistochemistry examination can differentiate IMT from GIST, which stains positively for SMA and vimentin. When resected completely, the prognosis is usually good. Hence, it is emphasized particularly for the benefit of the rural surgeons that gastric IMT should be one of the differential diagnosis in cases of exophytic growth arising from the stomach.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shi H, Wei L, Sun L, Guo A. Primary gastric inflammatory myofibroblastic tumor: A clinicopathologic and immunohistochemical study of 5 cases. Pathol Res Pract 2010;206:287-91.  Back to cited text no. 1
    
2.
Katakwar A, Gedam BS, Mukewar S, Agasti A. Primary gastric inflammatory myofibroblastic tumor in an adult-case report with brief review. Indian J Surg Oncol 2014;5:66-70.  Back to cited text no. 2
    
3.
Poh CF, Priddy RW, Dahlman DM. Intramandibular inflammatory myofibroblastic tumour: A true neoplasm or reactive lesion? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:460-6.  Back to cited text no. 3
    
4.
Coffin CM, Hornick 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;31:509-20.  Back to cited text no. 4
    
5.
Margaret S, Silloo BK, Gnepp DR. Nonsquamous pathology of the larynx, hypopharynx, and trachea. In: Gnepp DR, editor. Diagnostic Surgical Pathology of the Head and Neck. 4th ed. New York: W.B. Saunders Company; 2001. pp. 287-8.  Back to cited text no. 5
    
6.
Greenson JK. Gastrointestinal Stromal Tumors and Other Mesenchymal Lesions of the Gut,” Modern Pathology, vol. 16, no. 4, 2003. pp. 366-75.  Back to cited text no. 6
    
7.
Telugu RB, Prabhu AJ, Kalappurayil NB, Mathai J, Gnanamuthu BR, Manipadam MT. Clinicopathological study of 18 cases of inflammatory myofibroblastic tumors with reference to ALK-1 expression: 5-year experience in a tertiary care center. J Pathol Transl Med 2017;51:255-63.  Back to cited text no. 7
    
8.
Aptel S, Gervaise A, Fairise A, Henrot P, Leroux A, Guillemin F, et al. Abdominal inflammatory myofibroblastic tumour. Diagn Interv Imaging 2012;93:410-2.  Back to cited text no. 8
    
9.
Arpacı E, Yetisyigit T, Ulas A, Paksoy F, Kos F T, Tokluoglu S, et al. A case of intraabdominal myofibroblastic tumor with aggressive behavior. Turkish J Oncol 2010;25:28-32.  Back to cited text no. 9
    
10.
Cheng B, Yang C, Liu Z, Liu L, Zhou L. Primary gastric inflammatory myofibroblastic tumor: A case report. Medicine (Baltimore) 2018;97:e13423.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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