Tracheal localization of inflammatory myofibroblastic tumor  in adults: A case report

Branislav  Oluić; Radomir  Vešović; Zlatibor Lončar; Jelena Stojšić; Nataša Mujović; Dejan Nikolić

doi:10.2298/VSP170306116O

Branislav Oluić Clinical Center of Serbia, Emergency Center, Belgrade, Serbia
Radomir Vešović Clinical Center of Serbia, Clinic for Thoracic Surgery, Belgrade, Serbia
Zlatibor Lončar University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Jelena Stojšić Clinical Center of Serbia, Service of Histopathology, Belgrade, Serbia
Nataša Mujović Faculty of Medicine, Belgrade, Serbia
Dejan Nikolić Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP170306116O

Keywords: diagnosis;, immunohistochemistry;, inflammation;, surgical procedures, operative;, thoracotomy;, tracheal neoplasms.

Abstract

Introduction: Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm. This disease, of unknown etiology, runs an unpredictable course. Its definitive diagnosis calls for detailed histopathological analysis including immunohistochemistry. Microscopically, IMT is composed of myofibroblastic spindle and inflammatory cells in different proportions. It presents infrequently in adults with nonspecific symptomatology. The presence of IMT is described in every anatomical region but the tracheal one is especially uncommon.

Case report: A 41-year-old female patient checked into our institution due to exacerbation of asthma-like symptoms such as shortness of breath, cough and exertion intolerance. She was originally treated as asthmatic patient with bronchodilator therapy with no success. Chest x-ray done during one of outpatient follow-up appointments pointed to a suspected change in the tracheal distal part. After her admission to our institution, the following diagnostic procedures were performed, spirometry, chest computerized tomography (CT) scan, chest magnetic resonance imaging (MRI) and bronchoscopy and the change in tracheal distal third was confirmed. Right sided thoracotomy with mobilization of lung, tracheal resection and termino-terminal (T-T) anastomosis was undertaken. Subsequent histopathological analysis of surgically removed afflicted tracheal part including immunohistochemistry enabled us to definitively diagnose IMT. Four years after surgical resection, patient shows no recidivism of illness.

Conclusion: Definitive IMT diagnosis requires detailed diagnostic tests, most importantly, an adequate histopathological analysis including immunohistochemistry. Complete surgical resection is the treatment of choice in case of IMT. Further monitoring of patients is necessary due to risk of recurrence.

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