title: Possible role of TGF β1 in inflammatory pseudotumor associated with multiple neuroendocrine tumors of the small intestine.
abstract: BACKGROUND
  Inflammatory myofibroblastic tumors (IMTs), a rare condition of unknown etiology, have often been reported to be associated with specific infections or malignant tumors. The question of whether IMT themselves are an inflammatory or a neoplastic process is still going on.
  
  
  METHODS
  A 57-year-old female patient was transferred to our hospital with ileus caused by a mesenterial tumor. Intraoperatively, the mesenteric mass and the dependent small intestine segment, as well as a suspect hepatic lesion, were resected. The histopathological investigation revealed 8 malignant neuroendocrine tumors (NET) of the small intestine with lymphatic and hepatic metastasis and a mesenteric IMT. The postoperative course was uneventful, and the patient was discharged on the 18th postoperative day. The last follow-up after 30 months showed no recurrence of the IMT but clinical and radiological evidence of a persistent hepatic metastasis of the NETs. While plasma Chromogranin A remained suppressed by Sandostatin, the TGF β1 level was markedly elevated.
  
  
  CONCLUSIONS
  Based on the current literature and our previous experiences, we can state that IPT are an aberrant secondary immunological process possibly induced by excessive TGF β1 and not a neoplasia. Nevertheless, the tumorous behavior points to a continuity between inflammation and neoplasia. Differential diagnoses and the potential molecular pathogenesis are further discussed.
authors: Magdeburg University Hospital, Department of General, Visceral and Vascular Surgery, Leipziger Strasse 44, 39104 Magdeburg, Germany. Electronic address: andrej.udelnow@med.ovgu.de.
authors: Andrej
authors: A
authors: Udelnow
authors: Magdeburg University Hospital, Institute of Pathology, Leipziger Strasse 44, 39104 Magdeburg, Germany.
authors: Doerthe
authors: D
authors: Jechorek
authors: Magdeburg University Hospital, Department of General, Visceral and Vascular Surgery, Leipziger Strasse 44, 39104 Magdeburg, Germany.
authors: Cora
authors: C
authors: Wex
authors: Magdeburg University Hospital, Department of Nephrology, Hypertensiology, Diabetology and Endocrinology, Leipziger Strasse 44, 39104 Magdeburg, Germany.
authors: Silke
authors: S
authors: Klose
authors: Magdeburg University Hospital, Department of Radiology, Leipziger Strasse 44, 39104 Magdeburg, Germany.
authors: Maciej
authors: M
authors: Pech
authors: Magdeburg University, Institute of Molecular and Clinical Immunology, Leipziger Strasse 44, 39104 Magdeburg, Germany.
authors: Annegret
authors: A
authors: Reinhold
authors: Magdeburg University Hospital, Department of General, Visceral and Vascular Surgery, Leipziger Strasse 44, 39104 Magdeburg, Germany.
authors: Frank
authors: F
authors: Meyer
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006104:Granuloma, Plasma Cell / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D007421:Intestine, Small / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism*; D018358:Neuroendocrine Tumors / Q000378:metabolism*; D053773:Transforming Growth Factor beta1 / Q000378:metabolism*
chemical_list: D053773:Transforming Growth Factor beta1
keywords: Inflammatory pseudotumor; Neuroendocrine tumor