ABSTRACT
Background: Inflammatory myofibroblastic tumor (IMT) is a rare disease, usually benign, although with possible progression to malignancy. The clinical features depend on its location. If the resection is completed, surgery is curative, but recurrence is possible. The diagnosis is always histopathological. Case report: We report a 20 years old female admitted for a progressive abdominal pain lasting 24 hours. The patient was subjected to an appendectomy but in the postoperative period she continued with nausea and vomiting. The patient was operated again, finding a small bowel tumor with multiple adhesions, occluding the intestinal lumen and a Meckel diverticulum. The pathological study of the tumor reported the presence of an inflammatory myofibroblastic tumor. The patient had an uneventful postoperative outcome.
Introducción: El tumor miofibroblástico inflamatorio (TMI) es una enfermedad poco frecuente, en general benigna, aunque con posible evolución a malignidad. Las características clínicas dependen del lugar en el que esté ubicado. La cirugía es curativa siempre y cuando la resección sea total; aunque no se excluye la posibilidad de recidivas. El diagnóstico siempre es histopatológico. Dadas sus características clínicas y sitios de presentación se ha denominado de distintas formas e incluso sigue siendo motivo de estudio a fin de entender completamente su fisiopatología. Caso clínico: Presentamos un caso de esta rara entidad con un cuadro clínico de un abdomen agudo.
Subject(s)
Humans , Adult , Female , Intestinal Diseases/surgery , Intestinal Diseases/complications , Granuloma, Plasma Cell/surgery , Granuloma, Plasma Cell/complications , Abdomen, Acute/etiology , Meckel Diverticulum/surgery , Meckel Diverticulum/complicationsABSTRACT
Inflammatory myofibroblastic tumor (IMT) is a rare benign lesion of unknown etiology reported in numerous anatomic sites. Hepatic IMT is rare. It is composed of a dominant spindle cell proliferation with a variable inflammatory component that has unique histological appearance. The tumor is more common in women, who often present with fever of unknown origin or other vague, nonspecific symptoms. A 74-year-old female presented with fever of unknown origin. Abdominal CT-Scan showed focal mass effect with luminal narrowing at the distal sigmoid colon, highly suggestive of a sigmoid neoplasm as well as numerous hypodense lesions scattered throughout the liver, likely representing metastatic disease. Liver biopsy revealed an IMT. Patient was treated conservatively and remained without symptoms. It is extremely difficult to differentiate an IMT from neoplastic disease. Most cases require complete resection to obtain an accurate diagnosis. This entity should be considered in the differential diagnosis in patients with hepatic lesions to avoid unnecessary surgical procedures.
Subject(s)
Biopsy , Fever of Unknown Origin/etiology , Granuloma, Plasma Cell/diagnosis , Liver Diseases/diagnosis , Liver/pathology , Aged , Anemia/complications , Diabetes Mellitus, Type 2/complications , Diagnosis, Differential , Female , Granuloma, Plasma Cell/complications , Granuloma, Plasma Cell/diagnostic imaging , Granuloma, Plasma Cell/pathology , Heart Failure/complications , Humans , Hypothyroidism/complications , Kidney Failure, Chronic/complications , Liver Abscess/diagnosis , Liver Diseases/complications , Liver Diseases/diagnostic imaging , Liver Diseases/pathology , Liver Function Tests , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Sigmoid Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Intussusception in an adult must make us suspect the presence of a tumor (benign or potentially dangerous) as the most frequent cause. Accurate diagnosis is of great importance in order to provide appropriate treatment and improve patient prognosis. CLINICAL CASE: We report the case of a 42-year-old male with abdominal pain. We performed a CT and found a small bowel intussusception. Definitive diagnosis according to the surgical specimen was inflammatory fibroid polyp (Vanek's polyp). CONCLUSIONS: Vanek's polyp is a benign lesion that occurs most frequently in the stomach and secondarily in the small bowel. Generally, it is uncommon, and its etiology is not completely known. Accurate diagnosis is done with immunohistochemistry. Because of the consequences that depend on the size and location of the lesion, it may be considered a malignant lesion. Treatment is resection.
Subject(s)
Eosinophilic Granuloma/diagnosis , Granuloma, Plasma Cell/diagnosis , Ileal Diseases/diagnosis , Intestinal Polyps/diagnosis , Intussusception/etiology , Abdomen, Acute/etiology , Actins/analysis , Adult , Biomarkers , Desmin/analysis , Diagnostic Errors , Eosinophilic Granuloma/complications , Eosinophilic Granuloma/diagnostic imaging , Eosinophilic Granuloma/metabolism , Eosinophilic Granuloma/surgery , Gastroenteritis/diagnosis , Granuloma, Plasma Cell/complications , Granuloma, Plasma Cell/diagnostic imaging , Granuloma, Plasma Cell/metabolism , Granuloma, Plasma Cell/surgery , Humans , Ileal Diseases/diagnostic imaging , Ileal Diseases/etiology , Ileal Diseases/metabolism , Ileal Diseases/surgery , Intestinal Polyps/complications , Intestinal Polyps/diagnostic imaging , Intestinal Polyps/metabolism , Intestinal Polyps/surgery , Intussusception/diagnostic imaging , Intussusception/surgery , Laparoscopy , Male , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Intussuception is an uncommon condition in adults. It is usually secondary to an organic lesion that may be malignant. The most common clinical presentation is as a partial bowel obstruction that requires surgical management. Preoperative diagnosis remains difficult; therefore, this paper presents a case report and a brief review of adult intussusception. CLINICAL CASE: We present the case of a 24-year-old female with a 36-h evolution of lower abdominal pain with nausea, vomiting and diarrhea and a previous episode 8 days earlier. Pneumoperitoneum was observed on chest x-ray and surgery was decided upon. Peritonitis due to ileoileal intussusception was found, caused by an inflammatory fibroid polyp with microperforations. Small bowel resection with end-to-end anastomosis was performed and the patient had an uneventful recovery. CONCLUSIONS: Adult intussusception is an infrequent condition with nonspecific symptoms such as pain, nausea and vomiting. With more frequent use of tomography in patients with abdominal pain, correct diagnosis can be achieved. Treatment requires resection of the involved bowel without attempted reduction.
Subject(s)
Granuloma, Plasma Cell/complications , Ileal Diseases/complications , Intestinal Perforation/etiology , Intestinal Polyps/complications , Intussusception/etiology , Peritonitis/etiology , Abdomen, Acute/etiology , Anastomosis, Surgical , Female , Granuloma, Plasma Cell/diagnosis , Granuloma, Plasma Cell/diagnostic imaging , Granuloma, Plasma Cell/surgery , Humans , Ileal Diseases/diagnosis , Ileal Diseases/diagnostic imaging , Ileal Diseases/surgery , Intestinal Polyps/diagnosis , Intestinal Polyps/diagnostic imaging , Intestinal Polyps/surgery , Intussusception/diagnostic imaging , Pneumoperitoneum/etiology , Radiography , Young AdultABSTRACT
CONTEXTO: Pseudotumor inflamatório é uma lesão benigna rara que pode se desenvolver em uma grande variedade de órgãos. Sua grande importância na prática médica reside na enorme dificuldade de distingui-lo tanto clinicamente quanto radiologicamente de condições malignas. RELATO DE CASO: Os autores relatam um caso de pseudotumor envolvendo o baço e apresentando-se concomitantemente a um carcinoma renal de células claras. Apesar da semelhança macroscópica a tumores malignos, as características inflamatórias do pseudotumor são facilmente evidenciadas à microscopia. Apesar de hipóteses terem sido formuladas, os mecanismos patogenéticos relacionados ao pseudotumor ainda não estão bem estabelecidos.
Subject(s)
Humans , Male , Aged , Carcinoma, Renal Cell/pathology , Granuloma, Plasma Cell/pathology , Kidney Neoplasms/pathology , Splenic Diseases/pathology , Carcinoma, Renal Cell/complications , Diagnosis, Differential , Granuloma, Plasma Cell/complications , Immunohistochemistry , Kidney Neoplasms/complications , Photomicrography , Splenic Diseases/complications , Tomography, X-Ray ComputedABSTRACT
The inflammatory pseudotumor of the urinary bladder or pseudosarcomatous fibromyxoid tumor is a benign proliferative mesenchymal spindle cell process, usually polypoid. This rare benign lesion in the majority of the cases have been observed in children and young adults, with only a few cases reported in patients older than 50 years; there are approximately 75 cases in the literature. We present a case of inflammatory pseudotumor verified histologically and treated by tumoral resection and left ureteral reimplantation with antireflux technique. This patient presented initially macroscopic hematuria and required transfusions of packed red cells and frozen fresh plasma. This shows the importance of the diagnosis to establish the definitive treatment as early as possible.
Subject(s)
Granuloma, Plasma Cell/complications , Hematuria/etiology , Urinary Bladder Diseases/complications , Adult , Diagnosis, Differential , Female , Granuloma, Plasma Cell/pathology , Granuloma, Plasma Cell/surgery , Hematuria/surgery , Humans , Treatment Outcome , Urinary Bladder/pathology , Urinary Bladder Diseases/pathology , Urinary Bladder Diseases/surgery , Urologic Surgical ProceduresABSTRACT
El pseudotumor inflamatorio es una lesión tumoral poco común en niños, rara vez reportada en nuestro medio, informado en la literatura bajo una variedad de términos debido a sus diversos componentes histológicos. La localización más común es un pulmón, aunque se ha informado en otros sitios anatómicos, como retroperitoneo. La presentación clínica varía de acuerdo al sito de origen, siendo constante la fiebre, la anemia hipocrómica microcítica y la pérdida de peso. Se reporta el caso de un niño de site años de edad, que presentó inicialmente un cuadro de fiebre prolongada, anemia hipocrómica microcítica, pérdida de peso y después de halló una masa retroperitoneal en el hilio esplénico, correspondiente histológicamente a un pseudotumor inflamatorio. El tratamiento es la resección quirúrgica completa de la masa, aunque se han utilizado los corticoides, radioterapia y quimioterapia. La malignidad del pseudotumor inflamatorio no ha sido demostrada, aún cuando han sido informados cambios clonales en algunos casos. Se desconoce su real incidencia en nuestro medio