Inflammatory myofibroblastic tumor directly invading the right first rib treated with oral steroids: a case report

Abstract

Background: We present a case of an inflammatory myofibroblastic tumor cured with a short period of steroid administration, a treatment previously unreported for such cases.

Case presentation: A 49-year-old man had a chief complaint of chest pain for more than 3 days. Computed tomography (CT) revealed a tumoral lesion suspected to have infiltrated into the right first rib and intercostal muscles, with changes in lung parenchymal density around the lesion. The maximal standardized uptake value on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography was high (16.73), consistent with tumor presence. CT-guided biopsy revealed an inflammatory myofibroblastic tumor with no distant metastases. Surgery was indicated based on the disease course. However, he had received an oral steroid before the preoperative contrast-enhanced CT scan due to a history of bronchial asthma, and subsequent CT showed that the tumor shrank in size after administration; he has been recurrence-free for more than a year.

Conclusions: Surgery is still the first choice for inflammatory myofibroblastic tumors, as the disease can metastasize and relapse; however, this condition can also be cured with a short period of steroid therapy.

Keywords: Anaplastic lymphoma kinase; Asthma; Corticosteroid; Inflammatory myofibroblastic tumor.

Fig. 1

(A) Computed tomography on the 12th day post-admission shows a tumoral lesion suspicious of infiltration into the right first rib and intercostal muscles, with changes in the density of the lung parenchyma around the tumor. These findings are suggestive of extension of the lesion along the lymphatic vessels and stroma. (B) 8 F-Fluorodeoxyglucose positron emission tomography-computed tomography on the 17th day post-admission shows a tumoral lesion with a high degree of accumulation with a maximum standardized uptake value = 16.73

Fig. 2

Clinical course. Computed tomography on the 12th day post-admission shows a tumoral lesion suspicious of infiltration into the right first rib and intercostal muscles (A). On the 47th day post-admission, computed tomography shows that the mass had shrunk and flattened since the previous 8 F-Fluorodeoxyglucose positron emission tomography-computed tomography (B). On the 176th day post-admission, computed tomography shows that the right lung S1 segment has a scar-like appearance (C)

Fig. 3

Photomicrographs of a computed tomography-guided percutaneous lung biopsy specimen. (A) Hematoxylin and eosin staining. The main component is collagenous fibrous tissue, which contains abundant inflammatory cells. Inflammatory cells are diverse, including neutrophils and lymphocytes. The fibrous tissue is partially vitiligo-like. In the areas with abundant fibroblast-like spindle-shaped cells, there is a mat-like appearance and no atypia. Immunostaining for vimentin (B) and α-smooth muscle actin (C) were positive, and immunostaining for Anaplastic lymphoma kinase with a D5F3 antibody reveals a faint positive image in half of the spindle-shaped cells (D)