A CASE STUDY OF 41YR OLD LADY WITH RIGHT LUNG SOL

1. INFLAMMATORY
MYOFIBROBLASTIC
TUMOUR OF LUNG
– A CASE REPORT
DR.SAUMIK SAHA. RMO-CTVS MCH-
KOLKATA.

2. CASE REPORT
 41yrs / F / hypertensive - referred from chest
dept. with diagnosis of SOL in rt upper lobe of
lung.
 Recurrent LRTI, diffuse Rt sided chestpain and
occassional haemoptysis x 1 year.
 Pulmonary tuberculosis was ruled out by routine
investigation.

4. Bronchoscopy
 Partial occlusion of right main bronchus by the
extraluminal mass

5. CECT thorax
 Right upper lobe hetrogenously
enhancing SOL (70mm x60mm x60mm)
with adjoining pleural thickening.

7. FNAC - few inflammatory cells with
alveolar macrophages and spindle
cells, with no malignant cells.
 CT guided trucut biopsy -
Proliferation of regular spindle cells
aligned in fascicles, mixed with
lymphocytes, plasma cells ,eosinophils

8. Immunohistochemical analysis -
positive staining for
ALK1,andVimentin.

9.  IgG/ IgM/ IgA for Echinococcus antibody was
negative.

10. D/D
 Hydatid cyst of lung
 IMT
 Organized pneumonia
 Lymphoma
 Solitary fibrous tumor
 Desmoid fibromatosis
 Angio myofibroblastoma
 Fibrosarcoma
 Leiomyoma
 Malignant fibrous histiocytoma
 Because of similar morphology of theses lesions, only
immunohistochemical investigations allowed the correct final
diagnoses.
Mode of tumor growth, the low mitotic index, the polyclonality of
lymphoid markers and the negativity of CD34 usually remove most of
these diagnoses

11.  Based on these data, the
diagnosis of IMT was made, and after
consultion withThe Oncology dept. surgical
resection was planned.
OT
After routine preoperative investigations
and optimization patient underwent Right
upper and middle lobectomy through standard
Right posterolatral thoracotomy through
5th ICS.

15. HPE
 Made of myofibroblastic spindle cells:
A variable mixture of
collagen, inflammatory cells, and usually
cytologically bland spindle cells showing
myofibroblastic differentiation.
Post operative histopathological
report confirmed the preoperative
diagnosis.

19. DISCUSSION
 The IMT is a very rare benign tumor representing
0.7% of all lung tumors. Having intermediate
malignant potential.
 Histology: Myofibroblastic spindle cells.There
rare 3 histological subtypes.
 Recurrence rates : 15% to 37%.
 30% of cases of IMT are closely related to
recurrent respiratory infections

20.  HISTORY
 IMT was first described in the lung by Brunn in
1939
 Völker reported a laryngeal IMT and compared it
with spindle cell carcinoma.
 IMT in the urinary bladder was 1st reportd by
Lekas
 Al-Jabri reported another case in the liver
 PATHOGENESIS- Uncertain
-Translocation of ALK gene .
-Immunogenic response to an infective or non
infective agent.

21.  Immunohistochemistry :
Reactivity for vimentin (99% sensitive for IMT)
and smooth muscle actin (SMA). Immunohistochemical
positivity for ALK (Anaplastic Lymphoma Kinase gene)
(99% specificity & 50% sensitivity)is detectable in just over
half of the cases with cytoplasmic staining. H-caldesmon
and PS100(Phosphatidyle Serine) estimation is also
useful in the diagnosis.
 Age/sex predominance : Both sexes
Children and young adults mostly.
 Recurrence rate: 4% in cases of incomplete resection.
 Survival rate: post surgical resection 5-year survival is
91.3%.

22. CONCLUSION
 IMT is a rare benign tumor. Clinical and
radiological presentation is variable and
nonspecific and the diagnosis is rarely made
before surgical management.Only histological
and immunohistochemical study can confirm the
diagnosis.
 Despite being a benign lesion, its potential for
recurrence and local invasion requires complete
surgical resection.