Segawa Yuichi, Yasumatsu Ryuji, Shiratsuchi Hideki, Tamae Akihiro, Noda Teppei, Yamamoto Hidetaka, Komune Shizuo
Department of Otorhinolaryngology, Hamanomachi Hospital, Nagahama 3-3-1, Chuou-ku, Fukuoka, Japan.
Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, Japan.
Auris Nasus Larynx. 2014 Jun;41(3):321-4. doi: 10.1016/j.anl.2013.11.002. Epub 2013 Dec 17.
Inflammatory pseudotumor (IPT) is a tumefactive lesion characterized by fibroblastic proliferations and a prominent inflammatory component. It behaves as a locally benign or aggressive lesion, clinically and radiologically mimicking a neoplastic process. Numerous entities can be diagnosed as IPT, from reactive lesions to true neoplasms. The diagnosis of IPT requires further elaboration, and IPT should be distinguished from other similar entities such as inflammatory myofibroblastic tumor and IgG4-related sclerosing disease.
We report two cases of IPT arising from the head and neck region. One occurred at the orbit and the other at the parapharyngeal space. Histologically, they showed aggregates of myofibroblasts and inflammatory cells. Immunohistochemically, the number of IgG4-positive cells was less than 40% of the number of IgG positive cells, and the myofibroblastic cells were negative for anaplastic lymphoma kinase. The diagnosis was IPT/not otherwise specified. One patient was treated by systemic administration of corticosteroid and had good response. The other, who was treated by local administration of corticosteroid, partially responded and is currently stable with limited disease.
IPT has been reported to occur in various anatomical sites, most commonly in the lungs. The incidence in the head and neck area is extremely rare. Treatment of IPT is controversial and may involve corticosteroids or surgical resection, or both. Other chemotherapeutic agents and radiotherapy may be considered in steroid-resistant patients. The pathological subtype, safety of resection, and safety of corticosteroid use must be included in the decision-making process for treatment.
炎性假瘤（IPT）是一种以成纤维细胞增殖和显著炎症成分为特征的肿块性病变。它表现为局部良性或侵袭性病变，在临床和放射学上可模拟肿瘤性过程。从反应性病变到真正的肿瘤，许多实体都可被诊断为IPT。IPT的诊断需要进一步细化，且应与其他类似实体如炎性肌纤维母细胞瘤和IgG4相关硬化性疾病相鉴别。
我们报告两例起源于头颈部区域的IPT。一例发生于眼眶，另一例发生于咽旁间隙。组织学上，它们显示肌成纤维细胞和炎性细胞聚集。免疫组化显示，IgG4阳性细胞数量少于IgG阳性细胞数量的40%，且肌成纤维细胞间变性淋巴瘤激酶染色阴性。诊断为IPT/未另作特殊说明。一名患者接受全身糖皮质激素治疗，反应良好。另一名患者接受局部糖皮质激素治疗，部分缓解，目前病情稳定但病变局限。
据报道，IPT可发生于各种解剖部位，最常见于肺部。头颈部区域的发病率极低。IPT的治疗存在争议，可能包括糖皮质激素治疗或手术切除，或两者兼用。对于激素抵抗的患者，可考虑使用其他化疗药物和放疗。治疗决策过程中必须考虑病理亚型、切除的安全性以及糖皮质激素使用的安全性。
