Sana Aslam


The inflammatory myofibroblastic tumor is also known as inflammatory pseudotumor is a rare benign lesion, though becomes invasive and recur after excision. It accounts for 0.7% of lung tumors. We report a case of a young female 18 yrs of age who presented in our hospital with complaints of cough, chest pain, shortness of breath, intermittent fever, and undocumented weight loss for 1 year. She had a previous history of lung infection. Chest auscultation revealed reduced air entry on the right side. Laboratory tests showed an increased erythrocyte sedimentation rate of 130. A chest radiograph was done which showed homogenous opacity invading the right hemithorax. Contrast tomography of the thorax was performed which reported a large heterogeneously enhancing tumor of 13 x 10 x 12 cm with central necrosis occupying the right hemithorax practically collapsing the right hemithorax partially with left hemithorax without any alterations.No internal calcification was appreciated. It was causing compression on the trachea and esophagus and complete obliteration of the right main bronchus. The tumor showed distinct fat planes with surrounding structures. Mild right-sided pleural effusion was seen.  CT-guided biopsy was done. Microscopic examination revealed linear cores of a tumor comprising proliferating spindle cells and scattered epithelioid cells with eosinophilic nucleoli admixed with abundant lymphocytes and plasma cells. Immunohistochemical analysis showed positive staining for ALK-1, smooth muscle actin(SMA), desmin, and pan -CK. In contrast tumor, cells were non-reactive to S-100. Based on this data, a diagnosis of inflammatory myofibroblastoma was retained. The purpose of this report was to highlight the rare disease with its CT features. Despite being a benign lesion its potential for local invasion and recurrence requires surgical resection.

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