Gastric inflammatory myofibroblastic tumor presented with severe anemia and inflammation: a case report

Abstract

Background: Inflammatory myofibroblastic tumor (IMT) is a rare stromal tumor, often found in children and young adults, and most commonly occurs in the lungs. Surgical resection is considered the standard treatment for localized IMT, although only limited data exist. Gastric IMT in adults is extremely rare, and there are no established guidelines for its treatment.

Case presentation: A 69-year-old male presented with persistent fatigue and weakness. Laboratory examination revealed severe anemia and inflammation. Upper gastrointestinal endoscopy at admission revealed a 40-mm type I softish tumor in the lesser curvature of the gastric body, without apparent hemorrhage. Repeated biopsies, including partial resection with snare, failed to give a definitive diagnosis. Computed tomography (CT) revealed a massive lesion at the gastric body, protruding into the gastric lumen, which was consistent with the gastric tumor. After admission, the patient developed anemia refractory to frequent blood transfusions despite the absence of apparent gastrointestinal bleeding. In addition, the patient had recurrent fevers of 38 °C or higher, and persistent high inflammatory levels. Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT 1 month after the first visit exhibited an increased FDG uptake in the gastric tumor. In addition, this CT scan revealed a rapid increase in tumor size to 75 mm. It was suspected that the undiagnosed gastric tumor caused these serious clinical symptoms, and he underwent distal gastrectomy and cholecystectomy. The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. The histopathological diagnosis was IMT. The postoperative course was uneventful, and the patient's symptoms subsided drastically, improving both anemia and systemic inflammation. The patient has shown no recurrence or relapse of the symptoms over one and a half years.

Conclusions: In this case, the tumor resection finally enabled the diagnosis of IMT and resolved the clinical symptoms. Despite its predominantly benign morphological nature, some cases of IMT present clinically adverse courses. Surgical treatment may lead to its final diagnosis and improvement of clinical symptoms.

Keywords: Anemia; Gut; Inflammation; Inflammatory myofibroblastic tumor; Surgery.

Fig. 1

A Upper gastrointestinal endoscopy at admission revealed a 40-mm type I softish tumor in the lesser curvature of the gastric antrum, without apparent tumor hemorrhage. B Bloc biopsy was performed. The tumor section was gelatinous. C Contrast-enhanced computed tomography (CT) showed a massive lesion at the gastric body, protruding into the gastric lumen (arrows). D Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT one month after the first visit exhibited an FDG uptake in the gastric body (maximum standardized uptake value 8)

Fig. 2

The left side is the contrast-applied image of the right-side image. A Endoscopic ultrasound showed heterogeneous internal echoes with partially mottled areas (arrows). B Applied contrast revealed rapid blood flow from the vessels at the stem (arrowheads), clarifying its internal structure

Fig. 3

A The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. B The stem of the semipeduncurated tumor (arrowheads)

Fig. 4

A The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. B Histopathological examination demonstrated proliferation of spindle cells and collagen fiber, and the infiltration of plasma cells and lymphocytes (HE, × 40). C The myxoid change decreased toward the central region, and inflammatory cell infiltration, including neutrophils, increased instead (HE, × 100). D ALK expression was negative (ALK, × 400). HE hematoxylin eosin, ALK anaplastic lymphoma kinase

Fig. 5

Clinical course of the present case. CRP C-reactive protein, Hb hemoglobin, RBC2U, transfusion of two units of packed red blood cells