Mesenteric inflammatory pseudotumor: A difficult diagnosis. Case report

IntroductionA mesenteric inflammatory myofibroblastic tumor (IMT) is a rare solid tumor of intermediate malignant potential that affects children, adolescents, and young adults predominantly. IMT is mostly encountered in the lung. We report a case of malignant jejunal mesenteric IMT in a 61-year-old male patient who presented with vague abdominal pain and generalized weakness. CT scan revealed a mesenteric mass displacing the attached jejunum. Surgical resection was curative.DiscussionAn extensive literature review was performed to update and further analyze the already available data. A total of 35 cases with mesenteric IMT were reported previously. Only five cases of jejunal mesenteric IMT were reported. Mesenteric IMT demands vast effort to reveal the diagnosis due to its vagueness in the clinical presentation. Mesenteric IMT resembles each other in plenty of pathological and immunohistochemical characteristics.ConclusionTo the best of our knowledge, this is the first case of malignant jejunal mesenteric IMT in the elderly. Surgical resection was curative.

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“…Notably, 15% of cases emphasized the vascularity of this tumor. Infrequent features included a calcified thickened wall ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…(19) 57 years/male CT scan: single, round, and huge mass with heterogeneous density. Calcified and thick wall.…”

mentioning

confidence: 99%

An extremely rare case of malignant jejunal mesenteric inflammatory myofibroblastic tumor in a 61-year-old male patient: A case report and literature review

et al. 2022

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“…These lesions can behave aggressively with local invasion and can recur after resection, mimicking true malignancies 1. They have been reported by a variety of names, including inflammatory myofibroblastic tumour, histiocytoma, xanthoma and plasma cell granuloma 2–4…”

Section: Discussionmentioning

confidence: 99%

“…Operative resection should be the treatment of choice if the diagnosis is in question and complete resection appears feasible. Surveillance after surgery should be undertaken due to the high rate of early local recurrence 3 5 6. There are no specific guidelines to dictate the frequency of surveillance; our approach is a history and physical exam every 6–12 months for 2 years, supplemented with cross-sectional imaging if there is suspicion of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Paraduodenal inflammatory pseudotumor masquerading as malignancy

Peng

Cruise

et al. 2019

BMJ Case Rep

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A 30-year-old woman presented with severe abdominal pain and abdominal distension. CT demonstrated two intra-abdominal masses, one involving the left lateral segment of the liver and the other adjacent to the duodenum. Initial biopsies were consistent with focal nodular hyperplasia of the liver and non-specific lymphocytic infiltrate in the paraduodenal mass. Due to persistent symptoms, the patient underwent laparoscopic resection of the paraduodenal mass. Final pathology was consistent with an inflammatory pseudotumour and the patient’s symptoms subsequently resolved.

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“…Inflammatory pseudotumor is a rare benign mesenchymal neoplasm, also known as inflammatory myofibroblastic tumor or xanthomatous pseudotumor, and is most common in pediatric population. It is composed by inflammatory cells and myofibroblastic spindle cells, which can pose a difficult differential diagnosis with malignancies or infections [1] . Clinical presentation is quite unspecific, as fever, weight loss, malaise and/or abdominal pain may be present, along with nonspecific laboratory results.…”

Section: Introductionmentioning

confidence: 99%

Ileal inflammatory pseudotumor in adolescent male patient with prior Burkitt lymphoma: A challenging diagnosis

Mainolfi

D’Antonio

Mango

et al. 2021

Radiology Case Reports

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Inflammatory pseudotumor is a rare benign mesenchymal pediatric neoplasm, that can mimic tumoral residue or relapse at metabolic imaging with nonspecific clinical presentation and difficult diagnosis. We present the case of a 14year old male patient with fever of unknown origin and large ileal mass, diagnosed with and treated for Burkitt lymphoma, who performed several 18-fluoro-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) scans, during and after first line chemotherapy, showing persistent and focal uptake, while ileal mass volume decreased dramatically and the patient was clinically asymptomatic. Histopathological analysis of residual ileal mass was suggestive for xanthomatous pseudotumor, a type of inflammatory pseudotumor. No more treatment was performed and a short-term follow up with 18F-FDG PET/CT showed tracer uptake intensity decreasing progressively over the next few months. This case reports an uncommon presentation of a rare disease, inflammatory pseudotumor of the small bowel developed at the site of treated Burkitt lymphoma, underscoring the potential role of 18F-FDG PET/CT imaging in the diagnosis and management of these rare neoplasms, particularly in asymptomatic patients.

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Mesenteric inflammatory pseudotumor: A difficult diagnosis. Case report

Abstract: HighlightsInflammatory pseudotumor is a very rare benign neoplasm.Definitive diagnosis is usually made only after surgery.Mesenteric location is rare.Surgical resection can cure the disease.Close follow-up is advised to identify recurrences.

Cited by 7 publications

References 11 publications

An extremely rare case of malignant jejunal mesenteric inflammatory myofibroblastic tumor in a 61-year-old male patient: A case report and literature review

An extremely rare case of malignant jejunal mesenteric inflammatory myofibroblastic tumor in a 61-year-old male patient: A case report and literature review

Paraduodenal inflammatory pseudotumor masquerading as malignancy

Ileal inflammatory pseudotumor in adolescent male patient with prior Burkitt lymphoma: A challenging diagnosis

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