A case of pulmonary inflammatory myofibroblastic tumor treated with bronchoscopic therapy plus lobectomy

Abstract

Background: Inflammatory myofibroblastic tumor (IMT) is a rare tumor with malignant potential. We presented a case of a young adult who was diagnosed with IMT and treated with loop electrocautery therapy to relieve airway obstruction, followed by lobectomy to complete resection. Recent studies have supported the use of such interventional resection methods.

Case presentation: A non-smoking 30-year-old woman presented with a 1-month history of progressive dyspnea and productive cough. The Chest X-ray showed a homogenous opacity invading the entire left hemithorax, and the mediastinum content was attracted to the left side. In an effort to avoid pneumonectomy and afford rapid palliation of dyspnea, loop electrocautery was selected as the most appropriate therapy. The left upper lobectomy by thoracoscopy was performed instead of left upper lobe sleeve resection in order to better prevent the recurrence of lung atelectasis. After 6 years of follow-up, no evidence of recurrence has been found till now.

Conclusion: Interventional bronchoscopy coupled with surgical resection serves not only as a palliative management to bronchial obstruction but also a way to avoid pneumonectomy.

Keywords: Atelectasis; Inflammatory myofibroblastic tumor; Interventional bronchoscopy; Lung neoplasm; Surgery and oncology.

Fig. 1

Pulmonary mass. a: Left lung atelectasis was established by chest X-ray test. b: Chest X-ray showed a re-expansion of the left lung and a mass in the left upper lobe after interventional therapy. c: Bronchoscopy showed a tumor that completely obstructed the left main bronchus. d: The interventional therapy fully re-opened the obstructed left main bronchus and the lower subsegment of the left lower lobe. e: The lesion was partially resected by loop electrocautery via flexible bronchoscopy. f: Chest CT scan showed a tumor on the left upper lobe. g: Coronal CT after loop endoscopically resection on the left upper lobe. h: Chest CT scan showed the residual scar tissue after surgery a week later. i: CT demonstrated no relapse after a 6-year follow-up in 2019.12

Fig. 2

Inflammatory myofibroblastic tumor. a: Low power view demonstrating intersecting fascicles of spindle cells in lung tissue associated with abundant vessels. b: Note abundant blood vessels in a myxoid stroma with loosened spindle cells, scattered lymphocytes and plasma cells. c: High power view showed spindle tumor cells with eosinophilic cytoplasm lack prominent nuclear atypia, though mitoses could be found. Tumour cells showed immunoreactivity for d: smooth muscle actin; e: Vimentin; and negativity for f: ALK