An interesting case of inflammatory pseudotumour appendix presenting as appendicular perforation with peritonitis
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Hellenic Journal of Surgery (2016) 88:5, 352-355
An Interesting Case of Inflammatory Pseudotumour Appendix Presenting as Appendicular Perforation with Peritonitis Naveen Kumar
Abstract Aim-Background: Inflammatory myofibroblastic tumour (IMT) is a unique lesion of unknown aetiology. IMT
is a relatively new histopathological term describing an entity previously known as inflammatory pseudotumour. Cases of IMT involving the alimentary tract are rare. Their clinical, radiological, and pathological features may be confused with those of malignancy. Case: The author reports a case of an inflammatory pseudotumour in a 50-year-old male patient with features
suggestive of bowel perforation with peritonitis. The patient underwent exploratory laparotomy, which revealed a mass at the tip of the appendix with perforation at the base of the mass. An appendicectomy was performed. Histopathological examination established the diagnosis of inflammatory pseudotumour with appendiceal perforation. Conclusion: IMT or pseudotumour is a rare neoplastic lesion found in pulmonary and extrapulmonary sites, mostly
among children and young adults. The immunohistochemistry pattern plays a crucial role in diagnosing IMT. Complete surgical excision should be considered. An appendectomy is adequate in cases restricted to the appendix. Keywords: Appendix, inflammatory pseudotumour, inflammatory myofibroblastic tumour (IMT), anaplastic large cell lymphoma kinase (ALK) gene. Key words: Inflammatory pseudotumour; appendix perforation; peritonitis
Introduction Inflammatory myofibroblastic tumour (IMT) is a unique lesion of unknown aetiology. Although it has been referred to with several names, such as plasma cell granuloma, inflammatory pseudotumour, and myxoid hamartoma, the lesion was first described by Bahadori and Liebow in 1973 as IMT [12]. IMT is a relatively new histopathological term describing an entity previously known as inflammatory pseudotumour. It has generally been considered as a rare, benign, pseudosarcomatous, inflammatory lesion that develops in soft tissue [1]. Initially described in the lung, it later emerged that virtually any anatomic location could be involved. Cases of IMT involving the alimentary tract are rare [2]. Their clinical, radiological, and pathological features may be confused with those of malignancy. In this study, we aimed to examine the literature, as well as to describe a case that we operated on that presented as an Naveen Kumar, M.S. (General Surgery), Senior Resident, PGIMER,Dr.R.M.L Hospital, New Delhi Corresponding author: Dr. Naveen Kumar, M.S. (General Surgery), Senior Resident, PGIMER,Dr.R.M.L Hospital, New Delhi Tel.: 09968262759, e-mail: [email protected]. Received 19 May 2016; Accepted 1 July 2016 Hellenic Journal of Surgery 88
appendiceal mass obstructing the lumen of the appendix and causing acute appendicitis with appendiceal perforation with peritonitis. Upon pathological examination, the lesion was identified as an IMT.
Presentation A 50-year-old male patient presented to the emerg
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