Brain Tumor Res Treat.  2015 Oct;3(2):138-140. 10.14791/btrt.2015.3.2.138.

Unusual Radiologic Finding of Intracranial Inflammatory Myofibroblastic Tumor Presenting a Cyst with Mural Nodule

• Park JH
• Yoon WS
• Chung DS

• KMID: 2114662
• DOI: http://doi.org/10.14791/btrt.2015.3.2.138

Abstract

An intracranial cyst tumor with a mural nodule can be representative of some types of brain tumors, but is a rare presentation of intracranial inflammatory myofibroblastic tumor (IMT). Herein, we report the case of an intracranial IMT in a 48-year-old woman presenting with the extremely unusual radiologic findings of a cyst with a mural nodule.

Keyword

Brain neoplasms; Central nervous system; Granuloma, plasma cell

MeSH Terms

Brain Neoplasms
Central Nervous System
Female
Granuloma, Plasma Cell
Humans
Middle Aged
Myofibroblasts*

Figure

• 

  Fig. 1 Intracranial inflammatory myofibroblastic tumor presenting as a cyst with a mural nodule in a 48-year-old woman. A: T2-weighted MRI shows a large cyst with septation in the right temporal lobe. An iso-signal-intense mass compared to gray matter is also seen in the anterior portion of the cyst. B: Contrast-enhanced T1-weighted MRI shows a strongly enhanced mural nodule. C: The tumor was not restricted on diffusion-weighted MRI. D: There was no evidence of recurrence on MRI 4 years later.

• 

  Fig. 2 The findings of immunohistochemical staining for mural nodule. A: At low magnification, the tumor is composed of a hyalinized fibrotic area (★) and a dense inflammatory area (arrowhead) (hematoxylin & eosin staining, ×40). B: The hyalinized area includes plasma cells (black arrow), lymphocytes (arrowhead), and atypical spindle cells (white arrow) in a collagenous background (×200). C: The stromal area is focally stained with smooth muscle actin (×400). D: Immunostaining for desmin is negative (×400).

Reference

1. Raz E, Zagzag D, Saba L, et al. Cyst with a mural nodule tumor of the brain. Cancer Imaging. 2012; 12:237–244.

2. Nawashiro H, Omura T, Kobayashi H. Cystic intracranial plasma cell granuloma. J Neurosurg. 2006; 105:799. author reply 799-800.

3. Coffin CM, Watterson J, Priest JR, Dehner LP. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol. 1995; 19:859–872.

4. Matsubara O, Tan-Liu NS, Kenney RM, Mark EJ. Inflammatory pseudotumors of the lung: progression from organizing pneumonia to fibrous histiocytoma or to plasma cell granuloma in 32 cases. Hum Pathol. 1988; 19:807–814.

5. Biselli R, Boldrini R, Ferlini C, Boglino C, Inserra A, Bosman C. Myofibroblastic tumours: neoplasias with divergent behaviour. Ultrastructural and flow cytometric analysis. Pathol Res Pract. 1999; 195:619–632.

6. Fletcher CDM, Unni K, Mertens F. Pathology and Genetics, Tumors of Soft Tissue and Bone. World Health Organization Classification of Tumors. Lyon: IARC press;2002. p. 91–93.

7. Häusler M, Schaade L, Ramaekers VT, Doenges M, Heimann G, Sellhaus B. Inflammatory pseudotumors of the central nervous system: report of 3 cases and a literature review. Hum Pathol. 2003; 34:253–262.

8. Park SB, Lee JH, Weon YC. Imaging findings of head and neck inflammatory pseudotumor. AJR Am J Roentgenol. 2009; 193:1180–1186.

9. Weber MA, Viehoever A, Stieltjes B, et al. Intracerebral manifestation of an atypical monoclonal plasma cell hyperplasia depicted by MR perfusion and diffusion tensor imaging and MR spectroscopy. AJR Am J Roentgenol. 2005; 185:784–787.

10. Kim DJ, Choi YS, Song YJ, Kim KU. Intracranial plasma cell granuloma. J Korean Neurosurg Soc. 2009; 46:161–164.