Thorac Cardiovasc Surg 2009; 57(6): 343-346
DOI: 10.1055/s-0029-1185574
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Multiple Inflammatory Myofibroblastic Tumors Involving Lung and Mediastinum: A Rare Clinical Entity

K. Athanassiadi1 , F. Laenger2 , N. Dickgreber3 , A. Haverich1
  • 1Thoracic and Cardiovascular Surgery, Medical School of Hannover, Hannover, Germany
  • 2Pathology, Medical School of Hannover, Hannover, Germany
  • 3Pneumonology, Medical School of Hannover, Hannover, Germany
Further Information

Publication History

received Dec. 10, 2008

Publication Date:
25 August 2009 (online)

Abstract

Objective: Inflammatory myofibroblastic tumors (IMT) are a rare clinical entity. We retrospectively reviewed the clinicopathological characteristics and prognosis for all patients with surgically resected IMTs of the lung at our institution. Material and Method: From January 1995 through February 2007, 16 patients, 9 men and 7 women ranging in age from 18 to 64 years with a median age of 46 years, were admitted to our hospital for IMT of the lung, mediastinum and thoracic outlet. Nine of them (56.3 %) had a history of pneumonia, while in the rest it was documented as an incidental finding on chest X‐ray. Five of our patients (31.3 %) were under immunosuppressive therapy. CT scan was the diagnostic tool routinely used and PET performed turned out to be positive in 5 cases. Wedge resection was performed in the majority of cases along with 2 lobectomies and 2 segmentectomies. The resected lesions were studied histologically and immunohistochemically. There were no operative deaths. Follow-up was complete in all patients and ranged from 9 months to 135 months. No recurrence was observed. Results: Overall 5-year survival was 93.8 %. Fifteen patients are still alive and the cause of death in one case was not related to the pseudotumor. Cox regression analysis was performed for different factors such as age, sex, previous pneumonia and immunosuppression. None of them was found to play a role in the development of an IMT. The type of intervention also did not seem to affect the prognosis in our series. Conclusion: IMTs are a rare clinical entity. An accurate preoperative diagnosis is difficult and complete resection remains the treatment of choice and leads to an excellent survival.

References

  • 1 Matsubara O, Tan-Liu N S, Kenney R M, Mark E J. Inflammatory pseudotumors of the lung: progression from organizing pneumonia to histiocytoma or to plasma cell granuloma in 32 cases.  Hum Pathol. 1988;  19 807-814
  • 2 Gimenez A, Franquet T, Prats R, Estrada P, Villalba J, Bague S. Unusual primary lung tumors: a radiologic-pathologic overview.  Radiographics. 2002;  22 601-619
  • 3 Corneli G, Alifano M, Forti Parri S, Lacava N, Boaron M. Invasive inflammatory pseudotumor involving the lung and mediastinum.  Thorac Cardiovasc Surg. 2001;  49 124-126
  • 4 Weiss S W. Histological typing of soft tissue tumors. 2nd ed. Berlin; Springer Verlag 1994: 48
  • 5 Sakurai H, Hasegawa T, Watanabe S, Suzuki K, Asamura H, Tsuchoya R. Inflammatory myofibroblastic tumor of the lung.  Eur Cardiothorac Surg. 2004;  25 155-159
  • 6 Copin M-C, Gosselin B H, Ribet M E. Plasma cell granuloma of the lung: difficulties in diagnosis and prognosis.  Ann Thorac Surg. 1996;  61 (5) 1477-1482
  • 7 Cerfolio R J, Allen M S, Nascimento A G, Deschamps C, Trastek V F, Miller D L, Pairolero P C. Inflammatory pseudotumors of the lung.  Ann Thorac Surg. 1999;  67 933-936
  • 8 Umiker W O, Iverson L C. Postinflammatory tumor of the lung: report of four cases simulating xanthoma, fibroma or plasma cell granuloma.  J Thorac Surg. 1954;  28 55-62
  • 9 Pettinato G, Manivel J C, De Rosa N, Dehner L P. Inflammatory myofibroblastic tumor (plasma cell granuloma): clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations.  Am J Clin Pathol. 1990;  54 538-546
  • 10 Bahadori M, Liebow A A. Plasma cell granulomas of the lung.  Cancer. 1973;  31 191-208
  • 11 Mountney J, Syvarna S K, Brown P W G, Thorpe J A C. Inflammatory pseudotumor of the lung mimicking thymoma.  Eur J Cardiothorac Surg. 1997;  12 801-803
  • 12 Narla L D, Newmann B, Spottswood S S, Narla S, Kolli R. Inflammatory pseudotumor.  Radiographics. 2003;  23 719-729
  • 13 Coffin C M, Dehner L P, Meis-Kindblom J M. Inflammatory myofibroblastic tumor, inflammatory fibrosarcoma and related lesions: an historical review with differential diagnostic considerations.  Semin Diagn Pathol. 1998;  15 (2) 102-110
  • 14 Priebe-Richter C, Ivanyi P, Buer J, Laenger F, Lotz J, Hertenstein B, Ganser A, Franzke A. Inflammatory pseudotumor of the lung following invasive aspergillosis in a patient with chronic graft-vs.-host disease.  Eur J Haematol. 2005;  75 (1) 68-72
  • 15 Agrons G A, Rosado-de-Christenson M L, Conran R M, Stocker J T. Pulmonary inflammatory pseudotumor: radiologic features.  Radiol. 1998;  206 511-518
  • 16 Snyder C S, Dell'Aquilla M, Haghighi P, Baergen R N, Kyung Suh Y, Yi E S. Clonal changes in inflammatory pseudotumor of the lung.  Cancer. 1995;  76 (9) 1545-1549
  • 17 Cook J R, Dehner L P, Collins M H, Ma Z, Morris S W, Coffin C M, Hill D A. Anaplastic lymphoma kinase (ALK) expression in the inflammatory myofibroblastic tumor: a comparative immunohistochemical study.  Am J Surg Pathol. 2001;  25 1364-1368
  • 18 Meiss-Kindblom J M, Kjellstrom C, Kindblom L G. Inflammatory fibrosarcoma: update, reappraisal and perspective in its place in the spectrum of inflammatory myofibroblastic tumors.  Semin Diagn Pathol. 1998;  15 133-143
  • 19 Meloni G, Carretta A, Ciriaco P, Arrigoni G, Fieschi S, Rizzo N, Bonacina E, Augello G, Belloni P A, Zannini P. Inflammatory pseudotumor of the lung in adults.  Ann Thorac Surg. 2005;  79 (2) 426-432
  • 20 Corneli G, Alifano M, Forti Parri S, Lacava N, Boaron M. Invasive inflammatory pseudotumor involving the lung and mediastinum.  Thorac Cardiovasc Surg. 2001;  49 (2) 124-126
  • 21 Gomez-Roman J J, Sanchez-Velasco P, Ocejo-Vinyals G, Hernadez-Nieto E, Leyva-Cobian F, Val-Bernal J F. Human herpesvirus-8 genes are expressed in pulmonary inflammatory myofibroblastic tumor.  Am J Surg Pathol. 2001;  25 (5) 624-629
  • 22 Topçu S, Tastepe I, Alper A, Özdülger A, Albayrak M, Bozkurt D, Liman T, Çetin G. Inflammatory pseudotumors of the lung: a clinical study of eleven patients.  J Thorac Cardiovasc Surg. 2000;  119 180-182
  • 23 Kim J H, Cho J H, Park M S, Chung J H, Lee J G, Kim Y S, Kim S K, Kim S K, Shin D H, Choi B W, Choe K O, Chang J. Pulmonary inflammatory pseudotumor – a report of 28 cases.  Korean J Intern Med. 2002;  17 (4) 252-258
  • 24 Lee H J, Kim J S, Choi Y S, Kim K, Shim Y M, Han J, Kim J. Treatment of inflammatory myofibroblastic tumor of the chest: the extent of resection.  Ann Thorac Surg. 2007;  84 221-224
  • 25 Demmy T L, Krasna M J, Detterbeck F C, Kline G G, Kohman L J, DeCamp Jr M M, Wain J C. Multicenter VATS experience with mediastinal tumors.  Ann Thorac Surg. 1998;  66 187-192
  • 26 Bando T, Fujimura M, Noda Y, Hirose J, Ohta G, Matsuda T. Pulmonary plasma cell granuloma improves with corticosteroid therapy.  Chest. 1994;  105 1574-1575

Dr. Kalliopi Athanassiadi Consultant Cardiothoracic Surgeon

Thoracic and Cardiovascular Surgery
Medical School of Hannover

Carl-Neuberg-Str. 1

30625 Hannover

Germany

Phone: + 49 (0) 51 15 32 65 87

Fax: + 49 (0) 51 15 32 54 04

Email: kallatha@otenet.gr