Journal List > Korean J Gastroenterol > v.72(1) > 1099108

Park, Kim, Park, Kahng, Lee, and Park: Case of an Inflammatory Myofibroblastic Tumor of the Duodenum

Abstract

An inflammatory myofibroblastic tumor (IMT) is a rare disease that can occur in a variety of locations, including the lung, orbit, parotid, pleura, and stomach. Despite multiple reports in various organs, a duodenal IMT is rare with limited case reports. We encountered a case of a 49-year-old male with a duodenal IMT. The patient underwent a laparoscopic wedge resection under the impression of a duodenal mesenchymal tumor, such as gastrointestinal stromal tumor, but the final diagnosis was a duodenal IMT. The patient was treated successfully with an oral nonsteroidal anti-inflammatory drug for the residual lesions. He was free of recurrence during the 12 month follow-up period.

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Fig. 1.
(A) Endoscopic finding. Endoscopy reveals a 2-cm-sized subepithelial tumor with central ulcer in the second portion of the duodenum.(B) Endoscopic ultrasonography. On endoscopic ultrasonography, the tumor is a heterogeneous hypoechoic mass with unclear border, originating from the deep mucosal and submucosal layers.
kjg-72-28f1.tif
Fig. 2.
Abdominal computed tomography (CT) reveals a 1.7-cm-sized hypervascular solid mass in the second portion of the duodenum (red arrows). (A) CT transverse view. (B) CT coronal view.
kjg-72-28f2.tif
Fig. 3.
(A) Gross finding. Resected specimen shows a relatively well-defined, yellowing subepithelial mass. (B) Microscopic finding reveals spindle cell tumors (red arrows), scattered inflammatory cells (blue arrows), epithelial cells (yellow arrows), and stellate cells (green arrow)(H&E,×400). (C-F) Immunohistochemical stain. Positive for SMA (C, ×400), and negative for S-100 (D, ×100), C-kit (E, ×400), ALK (F, ×200). SMA, smooth muscle actin; ALK, anaplastic lymphoma kinase.
kjg-72-28f3.tif
Table 1.
Summary of Previous Reported Cases of Inflammatory Myofibroblastic Tumors in the Duodenum
Authors (publish year) Sex Age (yr) Symptoms Segment of duodenum Size a (cm) Treatment Recurrence 2nd treatment/2nd recurrence
Stringer et al. (1992)8 F 5 Vomiting Second 7.0 Resection None
Mattei et al. (2008)9 M 13 Asymptomatic First, second NSAIDs/Resection None
Kim et al. (2008)4 M 9 Multiple Mass partial excision
  M 14 Multiple No operation
Wynn et al. (2008)10 M 16 Epigastric pain First 6.0 Resection Recurrence Steroid and azathioprine/none
Kim et al. (2009)11 M 10 Abdominal pain Multiple 6.0 Open biopsy  
  M 15 Abdominal pain Multiple 9.8  
Kwak et al. (2010)12 F 65 Epigastric pain Ampulla of vater 2.3 Endoscopic papillectomy None
Mirshemirani et al. (2011)13 M 13 Weight loss First Resection
Fong et al. (2012)5 F 57 Obstruction Second, third 3.6 Resection None
Xiang et al. (2012)14 M 20 Epigastric pain Multiple 7.0 Resection None
Petrovic et al. (2016)1 M 58 Epigastric pain Fourth 15.5 Resection None
González et al. (2016)15 F 14 Epigastric pain Third Resection
Sinha et al. (2017)16 F 36 Abdominal bloating Multiple Resection
Present case M 49 Asymptomatic Second 2.7 Resection None NSAIDs due to incomplete resection

yr, year; F, female; M, male; NSAIDs, non-steroidal anti-inflammatory drugs.

a Size, the longest length.

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