!"# $ 23 6.'" &'() '% CD ) E % 0F G! 6-

Transcription

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siamak_shariat@yahoo.com :&&B C+!?@63>>=7??8 : A?@63>>=7??83= :;<#0 D! "#$ % &! & EFB- - / G H! "#$ % &! & /,./ - / I -! "#$ % &! & A- JJK0 / A$ L! '

2 C D E $ 9F " 6 8 'V $+ :( -1" <'",-) T1" &( C6/ 10 % + 0F & :". % 63 V." '39 V% $9. V T1" S &." % T1" )! 2V 1-5!- k5.^q $9,B W'" O 63 V 4".'" -!- 5 1 Ci( 9 $ (./6 % + $' (Hb:12 g/dl MCV:74/8) 0F G! C- &'" CL 6-." CD C 2F ' 6'"3 HS % 01") '" &'() Q??B Y? :-5 &( 0 AK L ' T1" 6.( ^Q Q AK 2 ' J CD ; Y? r2,!x( W Q q'v " '" &'() &'%?B Y? :-5 &(.(1 01") gn CA!?@ AB "9: ;9$4<- = ;. 7> 5 (IMT) * C( 6 03 / 23 ** &'"!" 5 C >/? $ $% ) -,-.(5-1) &'" 456 ]Y? - J 1, '! 6 '" 46 &G 0^,--" $.(6 3-1) SSV T3U - IMT $SS^ SR % &,- =aa NF SR +!(!" '! BV.V.(9-7) ' C ( % "' $+ & F d 'V (T3U SQ IMT $?.(10) &'"./ 3 g) - IMT 311 (f 3 (6 '( $) 03 + h(.6 F F H?) i9 )." &'- IMT Y?) k5 (./ <-B + j ' % /.(421) ' - - 1" 0 IMT - S,- CD + -2F G! L- 15 $% $'"M L! V% + O3 " '-6 ' J AK L CD J AK L +9 D + O3 $'" PQ n R.V &'-;9 '.'" G3 H TDR $ %&".!" (./) ' ()*$ +,-./ 01 23" ' (-78!,7-9: ) * Inflammatory Myofibroblastic Tumor Cellular Inflammatory Pseudotumor Plasma cell Granuloma Mixed Hamartom ** Inflammatory Fibrosarcoma Intermediate Neoplasms Plasmocytoma M

3 (%&' #$ "!! ) &'" 456 O-'39 $ C1 &'.( ) $- + O-'39 C IMT 5 ' + 1- BV 456.(13) &'" 456,-." 456 CD :( ; 0" u-" TDR.' KY <(= 0^ 2 TDR + &'^ &( $+ '! 01) H?) L 6.(1164-1) '- &6 "53 '.,? < = < = >6" AB= 2 C,* ' Muscularis Propria &G' H)=I/J&? < = - E")F >6" D.(= < = G 31'9 CA! $ /1 Postbulbar G! '" CL F 46 &G CL CD C 2F + 23 $5(.'" 456.' * KY s,5 n '" CD V % 6 " 3 3 & -.6 F 3 V% ^ CD C 2F! % :? L! & +'%.'" &'() CD 6'!2I W'-6 ' J AK L CD $'" M +9 D D -.'" CL &'-;9 ' J AK L 01" (./ -+ &!";9 T g) G Bland-Looking '" &'() 0 3 ^% (./ 01") '!" 426 jr - CD &- H?),-.(3 2." SN O3 '" PQ V% 0R + O3 TDR n R.V $ 2 + A( + + O3 5 -#-! G3.'-6 H ') &'() R + ) G3. (3 2 01") "' -1" ,!, ;/s IMT 2 T1" $9 + I 6 W(5-1) " &'(),- - J 1,--" uf '" 46 &G $ ]Y?.(6 3-1) & 5,- 1" 0 T( " 6 k5 & - - * Non-specific chronic inflammatory Extrinsic N

4 C D E $ 9F.(1121) '' 3U (./ "2(- (" % G- -B 'D x3 " & a IMT + '- 'D x3 $SS^ SR.(14) IMT ( &G &'() k5 I & $9 + ' &' ).(15) " $+!" '! BV.V I 6 IMT $? C ( % "' &'" & F d 'V (T3U SQ 2 &'"!" +!( (,- 5#3 #.(141091) &'"'-') - % y3 ''S $SS^ + j W(16),- $'9 % /R V% 5 AR V -#- ('!-,!X( h( BV.(831) &'" gn &,- W' ) $ ) ') CL 5 - KY )-+9 '!I(.' -# (,- '!2( /^ ) % 2 j V T1" - v '! PQ?.(6431) ' V% u " + &'2I L! CD &- 6'!2I 5,- +'%,V AK L CD $'"M L +9 D D - &.'-6 AK + 0K R + ' <"56 Coffin.(1461) % z zq! IMT 84 N $1( +J V% 64 ' $' 13 $,-! G3. &'" CL Inflammatory Fibroid Polyp Intermediate Neoplasms?@ AB "9: ;9$4<- = ;. 7> V 1" 0 6 /R BV V <'",-) T1" CD TDR & $J + ' + -1".'" PQ 9 0" u-" (G)-+9 (-!/ 3!/66i( + 1 Ci( 9 &'"456 (11641) ESR,- 9 NF /R.'" &'() + $',- " Y.2," +!( $ " ',(9,-A2.Y % - :-5 (./ O-+3-,(9 L.(3) 6 F,- KY 6- '( $) %,1 '!I( W &') 5,-.(11421) '! gn '.V Y &'"&'() G! :-5 &( ; Y? r2 CD V. gn ' CA! " &'%?B $5( 46 &G IMT &'" * w B./ CA! 0v G- -.(6) '& $) "2(- <N.'!2( IMT ;s (./ &'() Y?) + h( 1" IMT ' % / T2i9 ) " &'() - 9.s (./ <-B." ( /3 g) 01) 3 +,- F H?),/6- IMT " = '- W'! '( $) T2i/3 / 0 &L+ * Mature B Cell Lymphoma Polytypism O

5 (%&' #$ "!! ) $9 % " 6 = &S T3U - $!R F $V% $,YY? % ) 1" & 9 F H?) $!R 6!" <KY %,!X( W'" = X9 '! $9 %.V % T 4! <' '!/ G3 ( '" &'(),-.'( $) $ #- '!/ G3,-! W(11) '!" R & 24 1.Q ' BV 456. C+ $,- C <' &'() R + ) G3. +.') 958 R BV.V IMT SSV,- % ::$ 1- Coffin C, Dehner L, Meis-Kindblom J. Inflammatory myofibroblastic tumor, inflammatory fibrosarcoma, and related lesions: an historical review with differential diagnostic considerations. Semin Diagn Pathol. 1998; 15(2) : Demirkan N, Akalin T, Yilmaz F, Ozgenc F, Ozcan C, Alkanat M, et al. Inflammatory myofibroblastic tumor of small bowel wall in childhood: report of a case and review of literature. Pathology Int. 2001; 51: Saleem MI, Ben-Hamida MA, Barrett AM, Bunn SK, Huntley L, Wood KM, et al. Lower abdominal inflammatory myofibroblastic tumor -an unusual presentation- a case report and brief literature review. Eur J Pediatr. 2006; 16 (3): Karnak I, Senocak ME, Ciftci AO, Caglar M, Bingol-Kologlu M, Tanyel FC, et al. Inflammatory myofibroblastic tumor in children: diagnosis and treatment. J Pediatr Surg. 2001; 36 (6): Ladd A, Grosfeld J. Gastrointestinal tumors in children and adolescents. Semin Peadiatr Surg. 2006; 15: Sanders BM, West KW, Gingalewski C, Engum S, Davis M, Grosfeld JL. Inflammatory pseudotumor of the alimentary tract: clinical and surgical experience. J Pediatr Surg. 2001; 36 (1): Dehner L. The enigmatic inflammatory pseudotumours: the current state of our understanding, or misunderstanding. J Pathol. 2000; 192: Mergan F, Jaubert F, Sauvat F, Hartmann O, Lortat-Jacob S, Révillon Y, et al. Inflammatory myofibroblastic tumor in children: clinical review with anaplastic lymphoma kinase, Epstein-Barr virus, and human herpes virus 8 detection analysis. J Pediatr Surg. 2005; 40: Hosler GA, Steinberg DM, Sheth S, Hamper UM, Erozan YS, Ali SZ. Inflammatory pseudotumor: a diagnostic dilemma in cytopathology. Diagn Cytopathol. 2004; 31 (4): Fletcher C, Mertens F. World Health Organization classification of tumors: pathology and genetics of tumors of soft tissue and bone. Lyon: IARC Press; Coffin C, Watterson J, Priest J, Dehner L. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol. 1995; 19 (8): Bronzino P, Abbo L, Bagnasco F, Barisone P, Dezzani C, Genovese AM, et al. Intra-abdominal inflammatory myofibroblastic pseudotumor: case report and review of the literature. G Chir. 2005; 26 (10): Khoddami M, Sanae S, Nikkhoo B. Rectal and appendiceal inflammatory myofibroblastic tumors. Arch Iran Med. 2006; 9 (3): Makhlouf HR, Sobin LH. Inflammatory myofibroblastic tumors (inflammatory pseudotumors) of the gastrointestinal tract: how closely are they related to inflammatory fibroid polyps? Hum Pathol. 2002; 33 (3): Savargaonkar P, Morgenstern N, Bhuiya T. Inflammatory fibroid polyp of the ileum causing intussusception: report of two cases with emphasis on cytologic diagnosis. Diagn Cytopathol. 2003; 28 (4): Hsu CH, Lee CM, Lin SY. Inflammatory pseudotumor resulting from foreign body in abdominal cavity detected by FDG PET. Clin Nucl Med. 2003; 28 (10):

6 C D E $ 9F?@ AB "9: ;9$4<- = ;. 7> Title: Abdominal Inflammatory myofibroblastic tumor, a case report Authors: SA. Mir Shemirani 1, S. Shariat Torbaghan 2, M. Pour Afkari 3, M. Emami Al-e-Agha 4, F. Seifi 5, L. Panahandeh 6 Abstract Inflammatory myofibroblastic tumor (IMT) is a rare tumor with unknown etiology which usually occurs in children and adolescents. It is composed of myofibroblastic spindle cells intermixed with inflammatory cells. Our case was a 15-year-old boy presented with fever, weight loss, anemia and epigastric mass. Radiographic studies showed periduodenal mass with duodenal compression and mild mucosal thickening. Sonography and duodenal biopsy were not contributory. In laparatomy, a peri-duodenal mass with duodenal adhesion was seen during the resection, perforation of duodenum and extrahepatic bile duct occurred. Consequently, duodenostomy and anastomosis of bile ducts were performed. On histological examination, IMT was diagnosed. Manifestation resolved after the removal of the mass and he remained free of recurrence within three years after discharge. Based on the fact that IMT is now generally considered to be a potential neoplasm, clinicians must consider it and it should be added to the list of differential diagnoses of anemia and abdominal mass. In addition, despite benign histological features, a risk of aggressive behaviors of the tumor,a long term clinical and radiological follow up of the patients is necessary. Key Words: Inflammatory myofibroblastic tumor; Inflammatory pseudotumor; Abdominal mass; Duodenum; Extrahepatic bile duct 1 Associate Professor, Department of Surgery, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Corresponding Author; Assistant Professor, Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran siamak_shariat@yahoo.com 3 Assistant Professor, Department of Radiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4 Assistant Professor, Department of Pathology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran 5 Resident of Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran 6 Physician '