Coffin C M, Dehner L P, Meis-Kindblom J M
Department of Pathology, University of Utah School of Medicine, Salt Lake City, USA.
Semin Diagn Pathol. 1998 May;15(2):102-10.
The concept of the inflammatory myofibroblastic tumor (IMT) has evolved from an already perplexing pathological process, the inflammatory pseudotumor, which was initially recognized in the lung and regarded as a pseudoneoplasm, although its histological features resembled a spindle cell sarcoma. Despite the pathological findings and their apparent prognostic implications, most affected individuals regardless of the primary site have had favorable clinical outcomes. The designation of inflammatory pseudotumor came to be widely accepted, although these lesions were clearly tumors or masses that may or may not have been pseudoneoplasms. An aberrant or exaggerated response to tissue injury without an established cause has generally been favored as the pathogenesis of the inflammatory pseudotumor or IMT. Once the myofibroblast was identified and its function in tissue repair was established, this cell type was found in a variety of soft tissue lesions from nodular fasciitis to malignant fibrous histiocytoma. The myofibroblast was eventually recognized as the principal cell type in the inflammatory pseudotumor, which provided the opportunity to redesignate this tumor as IMT. Some of the clinical and pathological aspects of the IMT began to suggest the possibility that these lesions are more similar to neoplasms than a postinflammatory process. Another step in the evolution of the inflammatory pseudotumor and IMT occurred with the report of a mesenteric or retroperitoneal tumor with similar pathological features to the latter tumors but with more aggressive behavior to warrant an interpretation of malignancy as an inflammatory fibrosarcoma. The IMT and inflammatory fibrosarcoma appear to have many overlapping clinical and pathological features. These tumors are histogenetically related, and if they are separate entities, they are differentiated more by degrees than absolutes. The therapeutic approach to these tumors should relay primarily on surgical resection. Studies in the future may possibly resolve the question whether the IMT and inflammatory fibrosarcoma are synonomous or closely related entities.
炎性肌纤维母细胞瘤（IMT）的概念源自一个本就令人困惑的病理过程，即炎性假瘤。炎性假瘤最初在肺部被发现，尽管其组织学特征类似梭形细胞肉瘤，但起初被视为假肿瘤。尽管有病理发现及其明显的预后意义，但大多数受累个体，无论原发部位如何，临床结局都较好。炎性假瘤这一命名被广泛接受，尽管这些病变显然是肿瘤或肿块，可能是也可能不是假肿瘤。对无明确病因的组织损伤的异常或过度反应通常被认为是炎性假瘤或IMT的发病机制。一旦肌成纤维细胞被识别且其在组织修复中的功能得以确立，这种细胞类型便在从结节性筋膜炎到恶性纤维组织细胞瘤等多种软组织病变中被发现。肌成纤维细胞最终被确认为炎性假瘤中的主要细胞类型，这为将该肿瘤重新命名为IMT提供了契机。IMT的一些临床和病理特征开始提示，这些病变与肿瘤的相似性可能超过炎症后过程。炎性假瘤和IMT演变过程中的又一步是，有报道称一种肠系膜或腹膜后肿瘤，其病理特征与后者相似，但行为更具侵袭性，因此被解释为恶性的炎性纤维肉瘤。IMT和炎性纤维肉瘤似乎有许多重叠的临床和病理特征。这些肿瘤在组织发生学上相关，如果它们是不同的实体，那么它们更多是程度上的差异而非绝对的区分。对这些肿瘤的治疗方法应主要依靠手术切除。未来的研究可能会解决IMT和炎性纤维肉瘤是同义词还是密切相关实体的问题。
