Tuberc Respir Dis.  2013 Oct;75(4):165-169.

A Case of Recurrent Pulmonary Inflammatory Myofibroblastic Tumor with Aggressive Metastasis after Complete Resection

• Moon CH
• Yoon JH
• Kang GW
• Lee SH
• Baek JS
• Kim SY
• Kim HR
• Kim CH

Abstract

An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs. It is thought to be a neoplastic or reactive inflammatory condition, controversially. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. The optimal treatment method is not well-known for patients ineligible for surgery. We report a 47-year-old patient with aggressive recurrent IMT of the lungs. The patient had been admitted for an evaluation of back-pain two years after a complete resection of pulmonary IMT. Radiation therapy was performed for multiple bone recurrences, and the symptoms were improved. However the patient presented again with aggravated back-pain six months later. High-dose steroid and non-steroidal anti-inflammatory drugs were administered, but the disease progressed aggressively, resulting in spinal cord compression and metastasis to intra-abdominal organs. This is a very rare case of aggressively recurrent pulmonary IMT with multi-organ metastasis.

Keyword

Lung Neoplasms; Myofibroblasts; Lung; Recurrence; Neoplasm Metastasis

MeSH Terms

Humans
Lung
Lung Neoplasms
Middle Aged
Myofibroblasts*
Neoplasm Metastasis*
Rare Diseases
Recurrence
Spinal Cord Compression

Figure

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  Figure. 1 Simple chest radiography (A) and contrast-enhanced computed tomography (CT) (B) taken before the operation. Chest CT shows a 3-cm sized, well-marginated oval mass in the left upper lobe of lung.

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  Figure. 2 Pathologic findings of resected specimens from the patient. (A) Grossly, there is a solitary mass with a yellowish-gray color and rubbery consistency. (B) Tumor contains a mixture of spindle cells and infiltrating inflammatory cells containing lymphocytes and plasma cells (H&E stain, ×500). (C) Immunohistochemical staining result for anaplastic lymphoma kinase-1 shows focal positivity in cytoplasm of tumor cells (×1,000).

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  Figure. 3 (A) Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) images obtained before the first radiation therapy. PET/CT shows abnormal metabolic activity with a high standardized uptake value in the right 3rd rib, the thoracic 12th vertebra and the left sacroiliac bone. (B) PET/CT performed before the second radiation therapy. PET/CT shows remarkably increased number of metastatic lesions with increased fluorodeoxyglucose uptake at multiple bones during the time interval.

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