Case Report: Inflammatory Myofibroblastic Tumor of the Duodenum
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Case Report: Inflammatory Myofibroblastic Tumor of the Duodenum G. R. Wynn & A. Giles & A. S. Steger & M. L. Wilkinson
Published online: 14 January 2009 # Humana Press Inc. 2009
Abstract Introduction We report a very rare case of inflammatory myofibroblastic tumor of the duodenum. A 16-year-old boy underwent esophagogastroduodenoscopy for intermittent epigastric pain, night sweats, and malaise. Case Report An exophytic mass lesion was found in the first part of the duodenum, but biopsies were nondiagnostic. Computed tomography confirmed a 60-mm mass with no lymphadenopathy, and the patient underwent surgical resection. Histology revealed spindle cells with the morphological and immunophenotypical profile of myofibroblasts on a background of mixed inflammatory infiltrate, typical of inflammatory myofibroblastic tumor. Six months after surgery, the patient developed a recurrence, and this was successfully treated by immunosupression. Currently, the patient is asymptomatic, and there is no radiological or pathological evidence of disease.
Introduction
Keywords inflammatory . tumor . duodenum
Case Report
G. R. Wynn (*) Department of Surgery, St Thomas’ Hospital, 1st Floor, North Wing, London SE1 7EH, UK e-mail: [email protected] M. L. Wilkinson Department of Gastroenterology, St Thomas’ Hospital, London, UK A. Giles Department of Pathology, University Hospital Lewisham, London, UK A. S. Steger Department of Surgery, University Hospital Lewisham, London, UK
Inflammatory myofibroblastic tumors (IMFT) are rare mass lesions that can occur at virtually any anatomical location, although the lung is most commonly affected. These lesions are of unknown etiology, usually arising in children or young adults and are characterized by proliferation of spindle cells of myofibroblastic origin in association with a heavy inflammatory infiltrate of mixed composition usually involving mature lymphocytes and plasma cells. IMFT of the gut are an uncommon subset of these lesions and those of the duodenum especially rare. To our knowledge, this is only the second report of duodenal IMFT and the first to show endoscopic pictures that may be helpful to gastroenterologists performing esophagogastroduodenoscopy (OGD).
A 16-year-old boy was referred to our hospital complaining of intermittent epigastric pain, night sweats, and malaise. Physical examination was largely unremarkable, and laboratory tests revealed iron deficiency anemia (hemoglobin 10.2 g/dl; mean corpuscular volume 65 fl), thrombocytosis (platelets 620×109/l), hypoalbuminemia (albumin 31 g/l), and mildly raised inflammatory markers. Initial findings at OGD were of moderate antral gastritis and atypical appearances of duodenal ulcer (see Fig. 1a). Clotesting was negative. He was subsequently put on proton pump inhibition without resolution of his symptoms. A further OGD revealed the presence of a smooth, pale mass lesion in the first part of the duodenum (see Fig. 1b), but biopsies were indeterminate. Computed tomography (CT) scan identified a mass arising from the first par
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