Inflammatory myofibroblastic tumor of the central nervous system and its relationship to inflammatory pseudotumor

Rebecca S. Swain, Tarik Tihan, Andrew E. Horvai, Dolores Di Vizio, Massimo Loda, Peter C. Burger, Bernd W. Scheithauer, Grace E. Kim

Research output: Contribution to journalArticle

Abstract

Inflammatory myofibroblastic tumor (IMT) is a distinctive spindle cell lesion and occurs primarily in soft tissue. Recent evidence suggests a neoplastic nature, although historically, both neoplastic and nonneoplastic processes were combined in this category. Originally described as a nonneoplastic process, the term inflammatory pseudotumor (IP) has been used synonymously with IMT. IMTs have been linked to ALK gene (2p23) rearrangements, and some have suggested an association with the human herpesvirus 8 (HHV-8). IMT in the central nervous system (CNS) is rare, its characteristics are poorly defined, and its relation to similar tumors at other sites is unclear. To better characterize IMT within the CNS, we studied clinicopathologic features of 6 IMTs and compared them with 18 nonneoplastic lesions originally classified as IP. The IMT group consisted of 2 male and 4 female patients with a median age of 29 years. Of the six IMTs, 5 occurred within the cerebral hemispheres, and one was in the posterior fossa. All tumors were composed of neoplastic spindle cells and a variable amount of inflammatory infiltrate. Eighteen IPs included in this study consisted of predominantly inflammatory masses occasionally seen in the setting of systemic diseases. Only 1 IMT and none of the IPs recurred during the follow-up period. Four IMTs had either ALK protein overexpression or 2p23 rearrangement, and 1 case demonstrated both. None of the IPs were positive for ALK. Neither IMT nor IP cases demonstrated HHV-8 expression. We suggest that IMT in the CNS is distinct from the nonneoplastic IP, and distinguishing IMT from nonneoplastic lesions should enable better decisions for patient management.

Original languageEnglish (US)
Pages (from-to)410-419
Number of pages10
JournalHuman pathology
Volume39
Issue number3
DOIs
StatePublished - Mar 1 2008

Keywords

  • Central nervous system
  • Inflammatory myofibroplastic tumor
  • Inflammatory pseudotumor
  • Plasma cell granuloma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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  • Cite this

    Swain, R. S., Tihan, T., Horvai, A. E., Di Vizio, D., Loda, M., Burger, P. C., Scheithauer, B. W., & Kim, G. E. (2008). Inflammatory myofibroblastic tumor of the central nervous system and its relationship to inflammatory pseudotumor. Human pathology, 39(3), 410-419. https://doi.org/10.1016/j.humpath.2007.07.012