Inflammatory myofibroblastic tumor of the terminal ileum

A 37-year-old male was admitted to our hospital due to weight loss and passage of tarry stools. Upper gastrointestinal panendoscopy showed only gastritis. Abdominal computed tomography revealed one mass-like lesion with wall thickening of the ileum ([Fig. 1 a]).

Fig. 1 Upper gastrointestinal images of a 37-year-old male presenting with weight loss and melena. a Abdominal computed tomography revealed one soft-tissue mass with wall thickening of the ileum (arrow). b Single-balloon enteroscopy showed one well-defined round tumor within the terminal ileum (arrow). c The base of the tumor showed hyperemic swollen mucosa with ulceration (arrow). d Representative hematoxylin and eosin-stained histological sections of the tumor (original magnification × 100 and × 400).

Single-balloon enteroscopy revealed one well-defined round tumor ([Fig. 1 b]; [Video 1]), measuring about 4 × 4 × 5 cm in the terminal ileum, up to 30 cm from the ileocecal valve. The base of the tumor showed swollen mucosa with ulceration ([Fig. 1 c]).

Video 1 Anal approach single-balloon enteroscopy showed one round tumor (about 4 × 4 × 5 cm in size) within the terminal ileum.

The patient underwent laparotomy with segmental resection of the ileum on the day after enteroscopy. Histologic features of the tumor showed myofibroblastic proliferation in an inflammatory background ([Fig. 1 d]); immunohistochemical staining for S100 and c-Kit revealed negative results. The pathologic result demonstrated inflammatory myofibroblastic tumor (IMT).

Gastrointestinal IMT can occur in the alimentary tract or mesentery/omentum [1]. The most common sites of alimentary tract IMT have been noted in ileal locations [1]. The majority of cases have been reported in childhood and early adulthood [1] [2] [3]; it is very rare in adults. This is the first reported case of an adult with ileal IMT, which was viewed clearly by single-balloon enteroscopy. Due to a high recurrence rate, the mainstay of therapy is surgical resection [4].

Endoscopy_UCTN_Code_CCL_1AC_2AC

References

• 1 Demirkan N C, Akalin T, Yilmaz F et al. Inflammatory myofibroblastic tumor of small bowel wall in childhood: report of a case and a review of the literature.  Pathol Int. 2001;  51 47-49
• 2 Coffin C M, Watterson J, Priest J R, Dehner L P. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases.  Am J Surg Pathol. 1995;  19 859-872
• 3 Biselli R, Ferlini C, Fattorossi A et al. Inflammatory myofibroblastic tumor (inflammatory pseudotumor): DNA flow cytometric analysis of nine pediatric cases.  Cancer. 1996;  77 778-784
• 4 Difiore J W, Goldblum J R. Inflammatory myofibroblastic tumor of the small intestine.  J Am Coll Surg. 2002;  194 502-506