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Case Reports
. 2020 Dec 9;13(12):e236056.
doi: 10.1136/bcr-2020-236056.

Colonic inflammatory myofibroblastic tumour presenting as 'pyrexia of unknown origin': report of a rare disease and its unique presentation

Victor Vijay Coelho  1 , Suraj Surendran  2 , Beulah Roopavathana  3 , Suchita Chase  3
Affiliations
Case Reports

Colonic inflammatory myofibroblastic tumour presenting as 'pyrexia of unknown origin': report of a rare disease and its unique presentation

Victor Vijay Coelho et al. BMJ Case Rep. .

Abstract

An intra-abdominal inflammatory myofibroblastic tumour (IMT) belongs to a rare group of diseases initially described as an inflammatory pseudotumour. Even though it is seen more often in children, its incidence in adults is even rarer. Clinical presentations can vary depending on its site and inherent tumour properties. The colon is an uncommon site for IMT and pyrexia of unknown origin (PUO) as its dominant clinical presentation is even rarer. A 27-year-old woman presented with PUO. She was evaluated under the department of internal medicine before undergoing an 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan. This showed an intensely enhancing descending colon mass. An image-guided biopsy of this lesion was reported as IMT. She underwent a left hemicolectomy and complete excision of the tumour, following which her symptoms resolved completely. The patient has been disease-free at a 6-month follow-up and is asymptomatic at 1 year.

Keywords: colon cancer; pathology; surgery; surgical oncology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
18F-fluorodeoxyglucose positron emission tomography scan showing an intensely enhancing retroperitoneal mass in the left lumbar region.
Figure 2
Figure 2
Contrast-enhanced computed tomography scan of the abdomen/pelvis showing a well-defined, intensely enhancing lesion in the left lumbar retroperitoneal region, indenting the proximal descending colon.
Figure 3
Figure 3
(A–C) H&E slides showing sheets of polygonal cells with moderate nuclear pleomorphism, vesicular chromatin, prominent nucleoli and moderate amounts of eosinophilic cytoplasm and admixed lymphocytes, plasma cells, eosinophils and foamy histiocytes.
Figure 4
Figure 4
Immunohistochemistry slide (40×) showing tumour cells with anaplastic lymphoma kinase-1 (ALK-1) positivity.
Figure 5
Figure 5
Immunohistochemistry slide (40×) showing tumour cells with desmin positivity.
Figure 6
Figure 6
A cut section of the surgical specimen showing a fleshy tumour.
See this image and copyright information in PMC

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