title: Agressive inflammatory myofibroblastic tumor of the liver with underlying schistosomiasis: a case report.
abstract: Inflammatory myofibroblastic tumor (IMT) occurs infrequently in the liver. It is controversial whether it represents a low grade mesenchymal neoplasm or a reactive inflammatory lesion. Local recurrence and metastasis are rare and some tumors are associated with infectious agents. We report on a case of a large and partially resected IMT with local recurrence and diaphragm and kidney infiltration detected on routine surveillance two years later. Histologically, the tumor showed spindle cells without atypia, mitosis or necrotic areas in a myxoid and collagenized background with inflammatory cells. In the liver portal tracts, granulomatous lesions with viable eggs of Schistosoma mansoni were identified. Immunohistochemistry demonstrated spindle cells which were smooth-muscle actin and vimentin positive. In conclusion, this case points out that these histological patterns do not predict the aggressive biological behavior of the lesion. A reason for the recurrence and the infiltration may be incomplete tumor resection. Further investigation is necessary in order to better clarify an infectious cause in some IMTs.
authors.affiliation: Department of Pathology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, 255 Rodolpho Paulo Rocco Av, 21941-590 Rio de Janeiro, Brazil. verapannain@hotmail.com
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Pannain
authors.forename: Juliana Vial
authors.initials: JV
authors.lastname: Passos
authors.forename: Ariovaldo
authors.initials: A
authors.lastname: Rocha Filho
authors.forename: Cristiane
authors.initials: C
authors.lastname: Villela-Nogueira
authors.forename: Adriana
authors.initials: A
authors.lastname: Caroli-Bottino
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D008099:Liver / Q000469:parasitology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009379:Neoplasms, Muscle Tissue / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012550:Schistosoma mansoni / Q000302:isolation & purification; D012552:Schistosomiasis / Q000150:complications* / Q000175:diagnosis*
references.citation: Mem Inst Oswaldo Cruz. 2004;99(5 Suppl 1):51-7
references.pmid: 15486635
references.citation: Am J Surg Pathol. 2001 Jun;25(6):761-8
references.pmid: 11395553
references.citation: Am J Surg Pathol. 2004 Dec;28(12):1609-14
references.pmid: 15577680
references.citation: Am J Surg Pathol. 1995 Aug;19(8):859-72
references.pmid: 7611533
references.citation: Am J Surg Pathol. 2007 Apr;31(4):509-20
references.pmid: 17414097
references.citation: World J Gastroenterol. 2000 Jun;6(3):458-460
references.pmid: 11819630
references.citation: Mod Pathol. 1999 Mar;12(3):279-86
references.pmid: 10102613
references.citation: Pediatr Dev Pathol. 2005 Mar-Apr;8(2):224-9
references.pmid: 15747099
references.citation: Am J Clin Pathol. 1978 Feb;69(2):176-81
references.pmid: 629225
references.citation: Med Trop (Mars). 1997;57(3):269-72
references.pmid: 9513156
references.citation: Am J Surg Pathol. 2001 May;25(5):624-9
references.pmid: 11342774
references.citation: J Pediatr Hematol Oncol. 2003 Feb;25(2):153-8
references.pmid: 12571469
references.citation: J Hematop. 2009 Jul;2(2):127-31
references.pmid: 19669195
references.citation: J Gastroenterol Hepatol. 2007 Dec;22(12):2143-7
references.pmid: 18031372
references.citation: Ann Surg. 1953 Aug;138(2):253-8
references.pmid: 13066016
references.citation: Am J Surg Pathol. 2001 Nov;25(11):1364-71
references.pmid: 11684952
references.citation: Histopathology. 2004 Oct;45(4):418-9
references.pmid: 15469485