Unver Nurcan, Coban Ganime, Onaran Oyku Izel, Kunduz Enver, Arslan Adnan, Malya Fatma Umit, Hasbahceci Mustafa
Bezmialem Vakif University, Faculty of Medicine, Dept of Pathology, Turkey.
Bezmialem Vakif University, Faculty of Medicine, Turkey.
Ann Med Surg (Lond). 2015 Jul 9;4(3):217-20. doi: 10.1016/j.amsu.2015.07.001. eCollection 2015 Sep.
Inflammatory myofibroblastic tumor as a rare neoplastic lesion is seen most commonly in the pulmonary system. Beside the presence of limited number of inflammatory myofibroblastic tumors of the gastrointestinal tract in the literature, co-existence with acute appendicitis has not been reported before.
A 27-year-old woman admitted to emergency department with acute abdominal pain at the right lower quadrant. The initial diagnosis was as acute appendicitis. Intraoperatively, a mass with a diameter of almost 5 cm originated from the distal ileal segments neighboring the appendix was seen. The patient was managed by segmental resection of the small intestine including the mass with appendectomy. Histologically, there were bundles of spindle cells accompanied by lymphoplasmocytic infiltration. The immunohistochemical studies showed that tumor cells were positive for smooth muscle actin, vimentin, perinuclear activity for anaplastic lymphoma kinase and CD 68. The final pathologic diagnosis was inflammatory myofibroblastic tumor.
Concomitant resection of tumoral lesions detected in the neighbor intestinal segments during appendectomy should be considered to diagnose and treat. For the diagnosis of inflammatory myofibroblastic tumor, immunohistochemistry pattern including positivity for actin, vimentin, CD 68 and anaplastic lymphoma kinase plays a crucial role. Therefore, detailed immunohistochemistry analysis should be performed in suspicious cases.
Coexistence of inflammatory myofibroblastic tumor located in the gastrointestinal system with acute appendicitis is a rare event. Complete surgical excision should be regarded as the mainstay of the treatment. Long-term follow up with serial imaging techniques is recommended.
炎性肌纤维母细胞瘤作为一种罕见的肿瘤性病变,最常见于肺部系统。除了文献中报道的胃肠道炎性肌纤维母细胞瘤数量有限外,此前尚未有与急性阑尾炎并存的报道。
一名27岁女性因右下腹急性腹痛入住急诊科。初步诊断为急性阑尾炎。术中发现一个直径近5厘米的肿块,起源于邻近阑尾的回肠远端节段。患者接受了包括肿块和阑尾切除术在内的小肠节段性切除。组织学检查显示有梭形细胞束伴有淋巴细胞和浆细胞浸润。免疫组织化学研究表明,肿瘤细胞平滑肌肌动蛋白、波形蛋白、间变性淋巴瘤激酶核周活性及CD68均呈阳性。最终病理诊断为炎性肌纤维母细胞瘤。
在阑尾切除术中,应考虑同时切除在相邻肠段发现的肿瘤性病变以进行诊断和治疗。对于炎性肌纤维母细胞瘤的诊断,包括肌动蛋白、波形蛋白、CD68和间变性淋巴瘤激酶阳性的免疫组织化学模式起着关键作用。因此,对可疑病例应进行详细的免疫组织化学分析。
胃肠道系统的炎性肌纤维母细胞瘤与急性阑尾炎并存是一种罕见情况。完整的手术切除应被视为主要治疗方法。建议采用系列成像技术进行长期随访。