Combined liver transplant and pancreaticoduodenectomy for inflammatory hilar myofibroblastic tumor: Case report and review of the literature

Abstract

IMT, previously known as IPT, is a relatively rare tumor that was originally described in the lungs, but case reports have reported the tumor in almost every organ system. Surgical resection is typically the mainstay of therapy; however, tumors have also been shown to respond to chemotherapy or anti-inflammatory therapy and some have spontaneously regressed. We present a literature review and case report representing the first documentation to date of liver transplant combined with PD for surgical resection of a myofibroblastic tumor non-responsive to medical therapy.

Complicated course of biliary inflammatory myofibroblastic tumor mimicking hilar cholangiocarcinoma: A case report and literature review

“…Despite reported successful treatment, complete reduction and tumor regression using a conservative approach (corticosteroids, NSAIDs, antibiotics, chemotherapy), tumors identified as IMTs by histopathology are locally progressive and often need surgical resection, especially if medical therapy is not effective[ 36 , 37 ]. Although there are no approved recommendations for operative hepatobiliary IMTs treatment, the literature suggests that patients with resectable IMTs should be managed with radical surgical resection when it is anatomically and physiologically feasible[ 5 , 35 - 37 ].…”

“…Despite reported successful treatment, complete reduction and tumor regression using a conservative approach (corticosteroids, NSAIDs, antibiotics, chemotherapy), tumors identified as IMTs by histopathology are locally progressive and often need surgical resection, especially if medical therapy is not effective[ 36 , 37 ]. Although there are no approved recommendations for operative hepatobiliary IMTs treatment, the literature suggests that patients with resectable IMTs should be managed with radical surgical resection when it is anatomically and physiologically feasible[ 5 , 35 - 37 ]. The selection of liver resection candidates must be based on the patient’s condition, tumor location, size and extension, the functional reserve capacity, and a sufficient liver remnant assessed by clinical and biochemical measures and by hepatic volume in cases of major hepatectomy[ 38 , 39 ].…”

‘Always biopsy the abscess and culture the tumour’: An unusual cause of fever in a paediatric patient

“…6,8 Localising features seen in hepatic IMTs include upper abdominal pain, a palpable upper abdominal mass and jaundice. 9 In cases which have been definitively identified as IMTs rather than IPTs, surgical excision with negative margins is the mainstay of treatment. Previous reports of similar tumours regressing after treatment with corticosteroids, antibiotics or anti-inflammatories can be attributed to failure to distinguish IMTs from less aggressive IPTs with infective aetiology.…”

“…Previous reports of similar tumours regressing after treatment with corticosteroids, antibiotics or anti-inflammatories can be attributed to failure to distinguish IMTs from less aggressive IPTs with infective aetiology. 3,9 For IMTs with evidence of an ALK rearrangement, targeted ALK inhibitors have emerged as promising neoadjuvant or adjuvant therapy for patients in whom definitive surgical excision is not feasible, or patients with recurrent disease. 10 Early reports assessing the response of IMTs to crizotinib in the adjuvant setting demonstrated sustained partial responses.…”

“…Hepatic IMTs in particular appear to present with fever, lethargy, weight loss and nausea and vomiting rather than organ‐specific complaints 8. Localising features seen in hepatic IMTs include upper abdominal pain, a palpable upper abdominal mass and jaundice 9…”