Agressive inflammatory myofibroblastic tumor of the liver with underlying schistosomiasis: A case report

Abstract

Inflammatory myofibroblastic tumor (IMT) occurs infrequently in the liver. It is controversial whether it represents a low grade mesenchymal neoplasm or a reactive inflammatory lesion. Local recurrence and metastasis are rare and some tumors are associated with infectious agents. We report on a case of a large and partially resected IMT with local recurrence and diaphragm and kidney infiltration detected on routine surveillance two years later. Histologically, the tumor showed spindle cells without atypia, mitosis or necrotic areas in a myxoid and collagenized background with inflammatory cells. In the liver portal tracts, granulomatous lesions with viable eggs of Schistosoma mansoni were identified. Immunohistochemistry demonstrated spindle cells which were smooth-muscle actin and vimentin positive. In conclusion, this case points out that these histological patterns do not predict the aggressive biological behavior of the lesion. A reason for the recurrence and the infiltration may be incomplete tumor resection. Further investigation is necessary in order to better clarify an infectious cause in some IMTs.

Inflammatory Pseudotumor of the Liver in Patient with Type 2 Diabetes

“…Moreover a fusion of ALK gene with a partner genes such as TPM3 and TPM4 has been demonstrated [33]. Although ALK-positive and ALK-negative tumors are histologically identical, variable immunophenotype support the heterogeneity of IPTs and may indicate a different pathogenetic processes in hepatic IPT [18,[31][32][33]. In presented case immunohistochemical reaction with ALK1 was negative.…”

“…They may sporadically recur usually as a consequence of incomplete resection [14,18]. Both, clinical and histopathological features of IPT did not predict the aggressive behavior [18].…”

“…Some microorganisms that access the portal vein including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Gram-positive cocci and Actinomyces were regarded as causative agents. Viral infections (Epstein-Barr virus [20], hepatitis B and C virus) [10,27] and parasitic infestations (Schistosoma mansoni) may play role in the pathogenesis [18]. Some authors suggested that disturbance of biliary drainage, e.g., due to biliary stones [1,7], recurrent pyogenic cholangitis [4,26] or sclerosing cholangitis is also important [25].…”

“…IPT is an uncommon hepatic lesion considered as a benign condition usually with good prognosis, however, aggressive behavior has been occasionally reported [3,18]. They may sporadically recur usually as a consequence of incomplete resection [14,18].…”

“…Many mechanisms and hypothesized etiologic factors like infections, trauma, autoimmunity reactions, radiotherapy, and local reaction to changes in the walls of bile ducts are suggested [1][2][3][4][5][6][7]10,13,[18][19][20][21][22][23][24][25][26]. Some microorganisms that access the portal vein including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Gram-positive cocci and Actinomyces were regarded as causative agents.…”