A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review

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. CT demonstrated an ill-enhanced mass, 5 cm in size, located at the pancreas head. Eus-guided fine needle aspiration biopsy showed abundant spindle myofibroblast tissues with eosinophilic and lymphoplasmacytic cell infiltration

Remission Characteristics

Ten days after fnab the pancreatic lesion seemed to have shrunk to 2.5 cm in size. A subsequent CT, conducted one month after the fnab, revealed further minimization of the pancreatic mass

Treatment & Mechanisms

Clinical Treatment

Nizatidine, rebamipide, and oxetacaine, biopsy