대한흉부영상의학회 Weekly Chest Cases

Case No : 790 Date 2012-12-17

Courtesy of Sung Ho Hwang, Yoo Jin Hong. / Severance Hospital, Yonsei University College of Medicine
Age/Sex 52 / F
Chief ComplaintIncidentally founded lung mass on the health check up.

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Figure 1.

Diagnosis With Brief Discussion

Diagnosis: Inflammatory myofibroblastic tumor.
Radiologic Findings: Posteroanterior chest radiograph shows a well-defined opacity in the retro cardiac area. Contrast-enhanced CT images show a well-defined mass with heterogeneous enhancement and adjacent engorged vessels in the left lower lobe. On FDG-PET, it reveals slightly high FDG uptake. She underwent left lower lobectomy.
Brief Review: Inflammatory myofibroblastic tumor refers to an unusual inflammatory reaction with a variable histologic appearance. Histologically, it consists of a mixture of inflammatory cells, myofibroblastic spindle cells, and plasma cells. Radiologic manifestations consist of either a solitary pulmonary nodule or a focal area of consolidation. On CT, inflammatory myofibrolastic tumor has smooth, lobulated margins, homogeneous or heterogeneous attenuation following intravenous administration of contrast medium. On PET, it usually shows high uptake indicating a high degree of metabolic activity. The radiologic differential diagnosis includes primary or secondary neoplasm and granuloma. The biologic potential of inflammatory myofibroblastic tumor varies. Complete surgical resection is the treatment of choice. Local recurrence may occur in some cases even after complete surgical resection.
References: 1. Kovach SJ, Fischer AC, Katzman PJ, Salloum RM, Ettinghausen SE, Madeb R, Koniaris LG. Inflammatory myofibroblastic tumors. J Surg Oncol. 2006 Oct 1;94(5):385-91.
2. Coffin CM, Hornick JL, Fletcher CD. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases. Am J Surg Pathol. 2007 Apr;31(4):509-20.
3. Gim챕nez A, Franquet T, Prats R, Estrada P, Villalba J, Bagu챕 S. Unusual primary lung tumors: a radiologic-pathologic overview. Radiographics. 2002 May-Jun;22(3):601-19.
4. Takeda S, Onishi Y, Kawamura T, Maeda H. Clinical spectrum of pulmonary inflammatory myofibroblastic tumor. Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):629-33.
Please refer to: Case 94 Case 489 Case 516
Keywords: lung, benign tumor,

No. of Applicants : 79

▶ Correct Answer : 5/79, 6.3%

- UWO , Canada S Lee
- Radnet Teleradiology Istanbul , Turkey Armagan Sarac
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Asan Medical Center , Korea (South) Ji Eun Kim
- All India Institute of medical sciences , India Justin Moses

▶ Correct Answer as Differential Diagnosis : 15/79, 19.0%

- GM InHospital , Korea (South) Ju Won Lee
- Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- Yangsan Pusan National Hospital , Korea (South) JOOYEON JANG
- Myongji hospital , Korea (South) Ji Ye Lee
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Himeji St.Mary Hospital , Japan Yuichiro Kanie
- Hanyang University Hospital , Korea (South) Yo Won Choi
- China Medical University , Ditmanson Medical Foundation Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Homs National Hospital , Syria Rami Abou Zalaf
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- CAC Rennes , France nicolas gautier
- Fortis hospital , Mohali , India Shaleen Rana

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 790 Date 2012-12-17

Discussion

No. of Applicants : 79