Inflammatory myofibroblastic tumor causing ileoileal intussusception: an unusual cause of an unusual neoplasm in an adult, with a clinicopathological review of the literature

Abstract

An inflammatory myofibroblastic tumor (IMT) of the ileum is a very rare lesion of the gastrointestinal tract. A 36-year-old female presented with abdominal fullness and colicky pain of 5 days' duration. Plain abdominal radiography showed an intestinal obstruction with dilated jejunal loops. Abdominal computed tomography and ultrasonography demonstrated a well-defined intraluminal solid mass surrounded by the typical mural layers of an invaginated ileum. The patient then underwent an exploratory laparotomy under a clinical diagnosis of intussusception caused by a small bowel tumor. The surgical findings revealed a large mass leading to an ileoileal intussusception, with regional lymph node enlargement and a small bowel resection accompanied by lymph node dissection was performed. The definitive diagnosis of IMT was confirmed by both conventional histopathology and minute immunohistochemistry.

Case Report: Inflammatory myofibroblastic tumor causes formation of an ileal conglomerate in a patient previously treated for Wilms’ tumor

“…A previous study has reported that only 1.2% of IMTs arise from the small intestine 3 . It has been described that IMTs in the small bowel can cause intestinal obstruction due to intussusception 1 . However, in our case a conglomerate of small bowel was the cause of ileus, which to our knowledge has not been presented previously in the literature.…”

“…The tumors are widely acknowledged as benign but with a potential to recur at the primary site. Approximately 8-25% recurs locally 1,4 . Rare examples and/or with metastasis 4 .…”

“…Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms composed of proliferating myofibroblastic spindle cells, and an accompanying inflammatory -usually chronicinfiltrate 1 . The etiology of IMTs is unknown, but an association with Wilms' tumor, the most common primary renal malignancy in children, has been suggested 2,3 .…”

“…Furthermore, theories suggesting a link to infectious agents, tumor associated factors, and cytokines have been proposed 4 . IMTs are most commonly seen in children and young adults 1 . IMTs were initially considered a pulmonary tumor 2 , but the lesions have subsequently been reported in various extrapulmonary organs including the mesentery and gastrointestinal tract 4 .…”

Case Report: Inflammatory myofibroblastic tumor causes formation of an ileal conglomerate in a patient previously treated for Wilms’ tumor

“…Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms composed of proliferating myofibroblastic spindle cells, and an accompanying inflammatory -usually chronicinfiltrate 1 . The etiology of IMTs is unknown, but an association with Wilms' tumor, the most common primary renal malignancy in children, has been suggested 2,3 .…”