A Pancreatic Inflammatory Myofibroblastic Tumor With Spontaneous Remission: A Case Report With A Literature Review
Matsubayashi, H., Uesaka, K., Sasaki, K., Shimada, S., Takada, K., Ishiwatari, H., & Ono, H. (2019). A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review. Diagnostics (Basel, Switzerland), 9(4), 150. https://doi.org/10.3390/diagnostics9040150
View Original Source →Abstract
The inflammatory myofibroblastic tumor (IMT) is a rare tumor that can develop in any systemic organ. Its features are generally benign, but it often resembles malignancies and is treated surgically. Our patient was an 82-year-old female complaining of abdominal discomfort. Computed tomography demonstrated a 5 cm, ill-enhanced mass at the pancreas head. Upper gastrointestinal endoscopy revealed a duodenal submucosal tumor with apical erosion. Endoscopic ultrasonography (EUS) demonstrated a heterogeneous, low-echoic pancreas mass without clear margins. Fine-needle aspiration biopsy (FNAB) demonstrated spindle myofibroblastic tissues with lymphoplasmacyte and eosinophil infiltration, confirming an IMT diagnosis. Surprisingly, the tumor spontaneously regressed in one month without medication. Histological diagnosis using EUS-FNAB is essential for the rare pancreatic solid tumor like IMT.
Case Details
Disease Location
Pancreas
Personal Characteristics
82-year-old japanese female. History of hypertension
Clinical Characteristics
Referred after a month of complaints of upper abdominal discomfort. Upper gastrointestinal endoscopy revealed multiple erosions and an extrinsic compression at the posterior pylorus. Medication had been initiated using nizatidine, rebamipide and oxetacaine, but it was not effective. Blood tests showed modestly elevated IGG, and c-reactive protein. CT demonstrated an ill-defined mass, 5 cm in size but with unclear margins, located at the pancreas head. Upper gastrointestinal endoscopy revealed a submucosal tumor (smt) with an atypical erosion approximately 1.5cm in size at the duodenal bulbs. Eus-guided fine needle aspiration biopsy (fnab) showed abundant spindle myofibroblast tissues with eosinophilic and lymphoplasmacytic cell infiltration. The findings led to the diagnosis of inflammatory myofibroblastic tumor (imt).
Remission Characteristics
Ten days after fnab, positron emission tomography showed that the pancreatic lesion seemed to have shrunk to 2.5 cm in size. The images obtained in the next two months showed that the tumor had almost vanished
Treatment & Mechanisms
Clinical Treatment
Biopsy nizatidine, rebamipide and oxetacaine