Spontaneous Regression Of An Inflammatory Myofibroblastic Tumor: A Case Report And A Review Of The Literature
Medici, B., Caffari, E., Salati, M., Spallanzani, A., Garajova, I., Piacentini, F., Dominici, M., & Gelsomino, F. (2024). Spontaneous Regression of an Inflammatory Myofibroblastic Tumor: A Case Report and a Review of the Literature. Case reports in oncology, 17(1), 1208–1213. https://doi.org/10.1159/000541337
View Original Source →Abstract
INTRODUCTION: Spontaneous tumor regression is the volumetric reduction or complete disappearance of a primary tumor or metastatic sites (single or multiple) without the administration of treatments. This rare phenomenon occurs most commonly in certain types of neoplasms. CASE PRESENTATION: In this manuscript, we describe a spontaneous tumor regression in an adult patient followed at the Modena Cancer Center and affected by retroperitoneal inflammatory myofibroblastic tumor, an ultra-rare subtype of sarcoma. Finally, we will provide a concise review of the literature and try to explain the mechanisms underlying the tumor regression described in the clinical case. CONCLUSION: The etiopathogenetic mechanisms for spontaneous tumor regression are not yet fully understood and likely involve a complex interplay among immunological mechanisms, growth factors, cytokines, and hormonal factors.
Case Details
Disease Location
Lymph nodes, muscles
Personal Characteristics
77-year-old man. History of hypertension, dyslipidemia, benign prostatic hyperplasia, and previous inguinal hernioplasty.
Clinical Characteristics
Presented to the emergency room with a 2-month history of abdominal pain, weight loss, and low-grade fever. Physical examination showed a voluminous, aching, and slightly movable palpable mass on the left hemi-abdomen, with a tough consistency, prostatomegaly was palpable. Laboratory blood test revealed an increase of the white blood cell count, a reduced hemoglobin level, an increased c-reactive protein level, and mild impaired renal function. CT scan demonstrated a voluminous solid mass with diameters of 14 × 16 × 18 cm, extended from the ribs to the gluteal muscles in the left side of the abdomen, with signs of muscle infiltration. Ultrasound-guided biopsy of the mass in the left side of the abdomen, with discharge of a purulent and bloody material. Showed identified echerichia coli, and the cytological analysis identified an inflammatory necrotic material. The patient underwent antibiotic therapy. Furthermore, a transfusion support was required. CT scan was repeated a week later, revealing a notable reduction in size of the mass to diameters of 11 × 4.4 × 12.4 cm. It also showed the appearance of two lymphadenopathies in the retroperitoneal area near the left kidney, with diameters of 16 × 27 mm and 28 × 23 mm, respectively. A second biopsy of the mass confirmed the inflammatory nature of the mass. Ten days later, the CT scan was repeated with the finding once again of an increase of the diameters of the mass (12 × 7 × 12.4 cm) and of the lymphadenopathies (30 × 20 mm and 35 × 25 mm). The patient underwent exploratory laparoscopy with a biopsy of both the left retroperitoneal lesion and the solid formation on the wall of the descending colon. The histological examination made the diagnosis of inflammatory myofibroblastic tumor with a rich histiocytic component, infiltrating the colic muscle layer and the soft tissues. The immunophenotype was as follows: cd1a−, cd31−, cd34−, CD68+, cd117−, CD163+, s100−, mnf116−, actinal+/−, caldesmon+, desmin−, podoplanin−, ki-67: 10–15%. Alk rearrangement was detected by fish technique and was present in 20% of the cells analyzed.
Remission Characteristics
Subsequently, a progressive reduction in the diameters was found, despite the patient did not undergo specific treatments. After a first observation period of approximately 1 year with quarterly CT scans, the diameters of the retroperitoneal lesion were reduced up to 6 × 15 × 34 mm, and the lymphadenopathies near the left kidney shrank to a size of 17 × 11 mm and 13 × 7 mm, respectively.
Treatment & Mechanisms
Proposed Remission Mechanisms
There was an underlying infectious event at the tumor site, as purulent material was drained. This probably initiated a major immune response against inflammatory pseudotumor (ipt), thus leading to a progressive decrease in the size of the tumor mass.
Clinical Treatment
Biopsy x3, laparoscopy