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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 585-587
Inflammatory myofibroblastic tumor of the pancreas: A rare entity


1 Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India
2 Department of Surgery, Kasturba Medical College, Mangalore, Karnataka, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Lobo FD, Sinha R, Pai RR, Prabhu S. Inflammatory myofibroblastic tumor of the pancreas: A rare entity. Indian J Pathol Microbiol 2010;53:585-7

How to cite this URL:
Lobo FD, Sinha R, Pai RR, Prabhu S. Inflammatory myofibroblastic tumor of the pancreas: A rare entity. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Aug 1];53:585-7. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/585/68261


Sir,

Inflammatory myofibroblastic tumor (IMT) is an extremely rare tumor of the pancreas that causes diagnostic dilemma. The biologic behavior of this uncommon lesion is still unknown. In this report, we hereby present the morphological and immunohistochemical analysis of one such case.

A 46-year-old female presented with complaints of pain of the abdomen of 2 months duration.

On per abdomen examination, a firm and tender mass was felt in the left hypochondriac and epigastric region. A computed tomography scan of the abdomen revealed a well-defined large heterogenous mass involving the body and tail of the pancreas [Figure 1]. The liver and spleen were normal. There was no lymphadenopathy. A preoperative diagnosis of pancreatic carcinoma was offered. The entire pancreatic mass was excised along with a portion of the body of the pancreas. Grossly, the excised specimen was dumbbell-shaped, measuring 14 cm Χ 13 cm Χ 5 cm. The outer surface was capsulated. The cut-section was predominantly solid and yellow to red, with peripheral cystic spaces. Microscopic examination of the hematoxylin and eosin sections showed a tumor composed of mildly pleomorphic spindle to polygonal cells with dense mixed inflammatory cell infiltrate and obliterative phlebitis [Figure 2]a. Some of the tumor cells had prominent nucleoli and scattered multinucleate giant cells were also seen [Figure 2]b. Occasional atypical mitoses were found. The stroma was collagenous, with dense inflammatory infiltrate composed of lymphocytes, plasma cells, eosinophils and neutrophils. The adjacent pancreas revealed atrophic pancreatic lobules with dense lymphoplasmacytic aggregates, histologically consistent with chronic pancreatitis. Immunohistochemical staining showed diffuse positivity for vimentin and focally for smooth muscle actin.
Figure 1: Computed tomography scan of the abdomen showing a mass involving the body and tail of the pancreas

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Figure 2: (a) Secti on of the lesion showing polygonal to spindle cells, obliterati ve phlebiti s, plasma cells, lymphocytes and eosinophils (H and E, ×100). (b) High-power view of the tumor showing pleomorphic cells with multi ple nuclei and prominent nucleoli (H and E, ×400)

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IMT, although originally described in the pulmonary system, is being reported in different anatomical locations, but uncommonly in the pancreas. IMTs are mass lesions characterized microscopically by myofibroblastic proliferation and a lymphoplasmacytic infiltrate admixed with eosinophils. Many abdominal spindle cell neoplasms can have a conspicuous inflammatory infiltrate. These include inflammatory fibrosarcoma, inflammatory malignant fibrous histiocytoma, inflammatory leiomyosarcoma and fibrosing liposarcoma. Most of these lesions can be differentiated based on careful histological and immunohistochemical studies. The exact etiology of IMT is unknown. Some authors have suggested a relationship with Epstein-Barr virus.[1 ] Our case showed features of chronic pancreatitis. Autoimmune pancreatitis is a distinct type of chronic pancreatitis characterized by periductal and acinar lymphoplasmacytic infiltrate, fibrosis and obliterative phlebitis. There have been published reports that document IMT associated with obliterative phlebitis. [2] The biologic behavior of IMT is still undecided. An exaggerated response to tissue injury with reactive inflammation is postulated. [3] Although the majority of myofibroblastic tumors are benign, sarcomatous changes have been documented in cases of pulmonary, hepatic and soft tissue IMT. [4] In a series of 38 cases of retroperitoneal and mesenteric IMT, both local as well as distant metastasis have been reported. [5] Even with complete and thorough histologic and immunophenotypic workup, it is not possible to predict the course of IMT in a given case and long-term follow-up is necessary in all cases diagnosed as IMTs. [4]

To conclude, IMT of the pancreas is an unusual neoplasm that poses diagnostic dilemma preoperatively. Thus, surgical exploration and histopathological examination is mandatory to confirm this neoplasm.

 
   References Top

1.Shek TW, Ho FC, Ng IO, Chan AC, Ma L, Srivastava G. Follicular dendritic cell tumor of the liver. Evidence for an Epstein-Barr virus related proliferation of follicular dendritic cells. Am J Surg Pathol 1996;20:313-24.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Wreesmann V, van Eijck CH, Naus DC, van Velthuysen ML, Jeekel J, Mooi WJ. Inflammatory pseudotumour (inflammatory myofibroblastic tumour) of the pancreas: A report of six cases associated with obliterative phlebitis. Histopathology 2001;38:105-10.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Czauderna P, Schaarschmidt K, Komasara L, Harms D, Lempe M, Vorpahl K, et al. Abdominal inflammatory masses mimicking neoplasia in children: Experience of two centers. Pediatr Surg Int 2005;21:346-50.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Walsh SV, Evangelista F, Khettry U. Inflammatory myofibroblastic tumor of the pancreaticobiliary region. morphologic and immunocytochemical study of three cases. Am J Surg Pathol 1998;22:412-18.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Meis JM, Enzinger FM. Inflammatory fibrosarcoma of the mesentery and retroperitoneum. A tumor closely simulating inflammatory pseudotumor. Am J Surg Pathol 1991;15:1146-56.  Back to cited text no. 5  [PUBMED]    

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Correspondence Address:
Ruchi Sinha
Department of Pathology, Kasturba Medical College, Light House Hill Road, P. O. Box 53, Mangalore - 575 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68261

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