J Korean Soc Radiol.  2016 Aug;75(2):157-161. 10.3348/jksr.2016.75.2.157.

Aggressive and Multifocal Pulmonary Inflammatory Myofibroblastic Tumor in Young Woman

• Choi Y
• Chung MH
• Kim HJ
• Park KH
• Kim J
• Kwon SS
• Yoo WJ

• KMID: 2344808
• DOI: http://doi.org/10.3348/jksr.2016.75.2.157

Abstract

We report a case of pulmonary inflammatory myofibroblastic tumor (IMT) showing aggressive and unusually rapid progression. A 27-year-old woman was admitted to the emergency room due to dry cough, fever and blood-tinged sputum that lasted one week. Initial chest radiograph and computed tomography scan revealed multifocal pulmonary nodules, which subsequently progressed into large necrotic masses within two months. She underwent a fine needle biopsy of the largest mass in the right middle lung zone which revealed inflammatory myofibroblastic cells consistent with IMT. The masses showed complete regression after six months of corticosteroid therapy. This unusual clinical manifestation could help explain the reactive inflammatory nature associated with IMTs.

MeSH Terms

Adult
Biopsy, Fine-Needle
Cough
Emergency Service, Hospital
Female
Fever
Humans
Lung
Lung Neoplasms
Myofibroblasts*
Plasma Cell Granuloma, Pulmonary
Radiography, Thoracic
Sputum

Figure

• 

  Fig. 1 Aggressive and multifocal pulmonary inflammatory myofibroblastic tumor in a 27-year old woman. A. Chest radiograph on admission shows a round mass in the right middle lung field and some faint mass-like densities in the right infradiaphragmatic and left upper perihilar areas (arrows). B, C. Initial CT scans reveal multiple, sharply-circumscribed, round necrotic masses in the right superior (B) and posterior basal segments (C) of right lower lobe. CT = computed tomography D, E. Follow up CT scans after one month demonstrate progression of the masses into larger, ill-defined masses in the superior (D) and posterior basal segments (E) of right lower lobe with small amount of right pleural effusion. F, G. Histopathological examination of the automated core needle biopsy specimen in the right middle lobe mass shows a negative result in Ziehl-Neelsen stains for granuloma (Ziehl-Neelsen stain, × 200) (F) and inflammatory myofibroblastic cells consistent with IMT (hematoxylin and eosin stain, × 200) (G). CT = computed tomography, IMT = inflammatory myofibroblastic tumor H, I. Follow up CT scans obtained after 6 months of corticosteroid therapy show regression of previous masses in the superior (H) and posterior basal segments (I) of right lower lobe. CT = computed tomography

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