Clinical diagnosis and treatment of abdominal inflammatory myofibroblastic tumors

Abstract

Objective: This study aims to summarize the clinicopathological characteristics, treatment methods, and prognosis of these patients. The goal is to enhance our understanding of the disease and provide insights for the standardized diagnosis and treatment of abdominal inflammatory myofibroblastic tumors(IMT).

Methods: This retrospective cohort study included clinical data of 26 patients with abdominal IMT admitted to the First Hospital of Jilin University between January 2015 and December 2023. The clinical manifestations, pathological features, treatment methods, and prognoses were analyzed.

Results: Among 26 patients, 6 had hepatic IMT, 2 splenic IMT, and 1 abdominal wall IMT, all detected incidentally as painless masses during routine exams. Six patients with mesenteric IMT reported abdominal distension, pain, nausea, vomiting, and low-grade fever. Of five patients with gastric IMT, three had gastrointestinal bleeding, one had distension and fever, and one had dysphagia. Four small intestine cases included one asymptomatic and three with obstruction symptoms. The colon and rectal cases presented with intermittent hematochezia. Surgery was performed in 24 patients, and 2 with metastases received palliative therapy. During follow-up, five patients relapsed; three received palliative therapy, and two had surgery. At last follow-up, 20 patients were disease-free, 3 were living with tumors, and 3 had died.

Conclusions: Abdominal IMTs are rare, low-grade tumors with favorable prognoses. Pathological examination is essential for diagnosis, and surgery is the primary treatment. Adjuvant therapy depends on tumor location and risk factors. Close follow-up is necessary due to the potential for recurrence and metastasis.

Keywords: Abdominal tumors; Adjuvant therapy; Diagnosis; Inflammatory myofibroblastic tumor; Pathology; Surgery; Tumor location.

Fig. 1

Ultrasound findings of hepatic IMT. A A heterogeneous mass in the liver, approximately 15.0 × 8.9 cm, with clear boundaries; B CDFI shows no obvious blood flow signal

Fig. 2

CT manifestations of mesenteric IMT. A A round soft tissue shadow is seen in the mesenteric region of the right mid-abdomen, with homogeneous density; B Enhancement scan shows moderate arterial phase enhancement

Fig. 3

MRI findings of hepatic IMT. A A round abnormal signal is observed in the left lobe of the liver; DWI shows a high signal; B T1 WI shows a slightly hypointense signal; C T2 WI shows a slightly hyperintense signal; D Enhancement scan shows marginal nodular enhancement in the arterial phase; E, F No expanded enhancement in the venous and delay phase

Fig. 4

Endoscopic presentation of gastric IMT. A Esophagus—smooth mucosa with normal color, no erosions, ulcers or protuberant lesions; B Cardia—smooth mucosa with good opening and closing, dentate line visible; C Antrum—smooth mucosa with normal color, no erosions, ulcers or protuberant lesions; D, E Duodenum (bulb and descending)—smooth mucosa with normal color, no erosions, ulcers or protuberant lesions; F Gastric angle—smooth mucosa with normal color, no erosions, ulcers or protuberant lesions; G Fundus—localized mucosal thickening; H Gastric body—localized mucosal thickening, with poor expansion and contractility, and visible erosion

Fig. 5

Pathological examination of a patient with mesenteric IMT. A HE × 20; B HE × 40; C ALK (+) × 40; D CD117 (−) × 40; E Desmin (+) × 40; F DOG-1 (−) × 40; G S100 (-) × 40; H SMA (+) × 40; I Vimentin (+) × 40; J Ki-67 approximately 5% × 4