title: Inoperable inflammatory myofibroblastic tumour of the para-nasal sinuses and orbit with recurrence responding to methotrexate and prednisolone: a case report.
abstract: BACKGROUND
  Inflammatory myofibroblastic tumour is a rare neoplasm with a potential to behave in a malignant manner. It can occur anywhere in the body, however involvement of the head, especially the para-nasal sinuses is rare.
  
  
  METHODS
  A 33-year-old South Asian male presented with coryzal symptoms including a persistent cough with an asymmetrical swelling of the left side of the face. Imaging revealed a mass lesion involving the para-nasal sinuses eroding into the orbit. Histology and the clinical picture were compatible with inflammatory myofibroblastic tumour. As curative excision of the tumour was not feasible, medical management was offered. Despite early features of remission to glucocorticoids, tapering resulted in recurrence. Hence combination therapy with glucocorticoids and methotrexate was commenced with dramatic reduction of tumour burden and the patient has been in remission to date.
  
  
  CONCLUSIONS
  Inflammatory myofibroblastic tumour has the potential to behave in a malignant manner. Medical management with chemotherapy, glucocorticoids and non-steroidal anti-inflammatory drugs though effective, do not have a uniform response pattern. Surgically unresectable inflammatory myofibroblastic tumour above neck should be treated aggressively with combination regimens. Combination of prednisolone with methotrexate has been shown to have good outcome.
authors: National Hospital of Sri Lanka, Colombo, Sri Lanka. rayno.navinan@gmail.com.
authors: Mitrakrishnan Rayno
authors: MR
authors: Navinan
authors: National Hospital of Sri Lanka, Colombo, Sri Lanka. isurujith@gmail.com.
authors: Isurujith
authors: I
authors: Liyanage
authors: National Hospital of Sri Lanka, Colombo, Sri Lanka. sandaherath@yahoo.com.
authors: Sandamalee
authors: S
authors: Herath
authors: National Hospital of Sri Lanka, Colombo, Sri Lanka. yudhishdran@yahoo.com.
authors: Jevon
authors: J
authors: Yudhishdran
authors: National Hospital of Sri Lanka, Colombo, Sri Lanka. mcs627@gmail.com.
authors: Chrishan
authors: C
authors: Shivanthan
authors: Department of Pathology, Faculty of Medicine, University of Sri Jayawardenepura, Colombo, Sri Lanka. dulani.ben@gmail.com.
authors: Dulani
authors: D
authors: Beneragama
authors: National Hospital of Sri Lanka, Colombo, Sri Lanka. kulatunga.aruna@yahoo.com.
authors: Aruna
authors: A
authors: Kulatunga
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009379:Neoplasms, Muscle Tissue / Q000188:drug therapy* / Q000473:pathology; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010256:Paranasal Sinuses / Q000187:drug effects / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005938:Glucocorticoids; D011239:Prednisolone; D008727:Methotrexate
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