Inflammatory Myofibroblastic Tumor of the Gallblader

Abstract

Background: Inflammatory myofibroblastic tumors are rare benign tumors that can mimic malignancy. Their precise aetiology is unknown. They are seen more frequently in childhood and the most common involvement is seen in the lungs. Primary inflammatory myofibroblastic tumors of the gallbladder are rather infrequent. The present knowledge is based on case reports. Case Report: A 66 year-old male patient presented to the hospital with complaints of abdominal pain, nausea and vomiting. Upon physical examination, a clinical picture of abdominal tenderness on the right upper quadrant of the abdomen was identified. Laboratory examinations revealed leukocytosis and hypochromic microcytic anaemia with an increased erythrocyte sedimentation rates and C-reactive protein levels. A mass almost completely filling the gallbladder was detected by imaging studies. The patient was operated on with a malignant preoperative diagnosis and underwent a liver resection of segments 4 and 5, which included a cholecystectomy. The histopathological examination of the surgical specimen revealed an inflammatory myofibroblastic tumor including many histiocytes stained positively with CD 68. Conclusion: Inflammatory myofibroblastic tumors can be localised in the gallbladder mimicking gallbladder cancer. Turkish Başlık: Safra Kesesinin Primer Inflamatuvar Myofibroblastik Tümörü Anahtar Kelimeler: Inflamatuar myofibroblastik tümör, safra kesesi, safra kesesi kanserleri Arkaplan: İnflamatuvar myofibroblastik tümör nadir rastlanan maligniteyi taklit edebilen benign tümörlerdir. Etiyolojisi kesin olarak bilinmemektedir. Çocukluk yaş grubunda sık görülmekle birlikte en sık akciğeri tutmaktadır. Safra kesesinin primer inflamatuvar myofibroblastik tümörlerine oldukça nadir rastlanmaktır. Mevcut bilgiler olgu sunumlarından ibarettir. Olgu Sunumu: 66 yaşında erkek hasta, karın ağrısı, bulantı ve kusma şikâyetleri nedeniyle başvurdu. Fizik muayenesinde karın sağ üst kadranda periton hassasiyet tablosu saptandı. Laboratuar incelemelerinde lökositoz ve hipokrom mikrositer aneminin yanı sıra eritrosit sedimantasyon hızı ve c-reaktif protein hızında artmış saptandı. Görüntüleme yöntemlerinde safra kesesi içerisinde keseyi tama yakın dolduran kitle imajı saptandı. Malignite ön tanısıyla ameliyata alınan hastanın safra kesesi segment 4 ve 5 ‘in dâhil edildiği segmenter karaciğer rezeksiyonu ile rezeke edildi. Ameliyat materyalinin histopatolojik incelemesi sonucunda CD 68 pozitif boyama gösteren çok sayıda histiositlerin bulunduğu inflamatuvar myofibroblastik tümör saptandı. Sonuç: İnflamatuar myofibroblastik tümörlerin safra kesesinde lokalize olabileceği ve safra kesesi kanserini de taklit edebileceği akılda tutulmalıdır.

Keywords

• Inflammatory myofibroblastic tumor, gallbladder, gallbladder tumor

Inflammatory Myofibroblastic Tumor of the Gallblader

Öz

References

1. Pettinato G, Manivel JC, De Rosa N, Dehner LP. Inflammatory myofibroblastic tumor (plasma cell granuloma). Clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations. Am J Clin Pathol 1990;94:538-46.
2. Wick MR, Humphrey PA, Ritter JH. Pathology of Pseudoneoplastic lesions. Lippincort-Raven Publisher New York, 1997.
3. Sawant S, Kasturi L, Amin A. Inflammatory myofibroblastic tumour. Indian J Pediatr 2002;69:1001-2. [CrossRef]
4. Ikeda H, Oka T, Imafuku I, Yamada S, Yamada H, Fujiwara K, et al. A case of inflammatory pseudotumour of the gallbladder and bile duct. Am J Gastroenterol 1990;85:203-6.
5. Makimoto Y, Nabeshima K, Iwasaki H, Ishiquro A, Miyoshi T, Shiraishi T, et al. Inflammatory myofibroblastic tumor of the posterior mediastinum: an older adult case with anaplastic lymphoma kinase abnormalities determined using immunohistochemistry and fluorescence in situ hybridization. Virchows Arch 2005;446:451-55. [CrossRef]
6. Wang TY, Chou JW, Shih YS, Hsieh TC. Inflammatory myofibroblastic tumor mimicking adrenal incidentaloma. Intern Med 2011;50:165-6. [CrossRef]
7. Meis-Kindblom JM, Kjellström C, Kindblom LG. Inflammatory fibrosarcoma: update, reappraisal, and perspective on its place in the spectrum of inflammatory myofibroblastic tumors. Semin Diagn Pathol 1998;15:133-43.
8. Fletcher CD. Myofibroblastic tumours: an update. Verh Dtsch Ges Pathol 1998;82:75-82.

9. Coffin CM, Watterson J, Priest JR, Dehner LP. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol 1995;19:859-72. [CrossRef]
10. Karahan OI, Işin S, Baykara M, Coşkun A. Case report: Inflammatory pseudotumor of the liver with target-like appearance. Tani Girisim Radyol 2003;9:75-7.
11. Firat O, Ozturk S, Akalin T, Coker A. Inflammatory myofibroblastic tumour. Can J Surg 2009;52:E60-1.
12. Coffin CM, Dehner LP, Meis-Kindblom JM. Inflammatory myofibroblastic tumour, inflammatory fibrosarcoma and related le325 Balkan Med J 2013; 30: 323-26 Özsan et al.
13. Inflammatory Myofibroblastic