Medical Radiology and Radiation Safety. 2017. Vol. 62. No. 2. P. 79-82

DOI: 10.12737/article_58f0b95756aed8.04575649

Case of Inflammatory Myofibroblastic Tumor of Mesentery with Significant Fatty Component

A.N. Bashkov¹, Z.V. Sheykh², S.V. Cholakyan¹, E.A. Ionova¹, V.I. Doga¹, М.А. Shabalin¹, O.O. Grigor’eva¹

1. A.I. Burnasyan Federal Medical Biophysical Center of FMBA, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; 2. S.P. Botkin City clinical hospital Moscow, Russia

Bаshkov A.N. - Head of Radiology Department; Sheykh Z.V. - Dr. Sci. Med., Professor, Head of Radiology Department; Cholakyan S.V. - Surgeon; Ionova E.A. - Dr. Sci. Med.; Doga V.I. - Head of Rentgenology Department; Shabalin M.A. - Surgeon; Grigor’eva O.O. - Radiologist

Abstract

Purpose: To describe own observation of inflammatory myofibroblastic tumor (IMT) of mesentery with a significant fatty component, retrospectively evaluate the diagnostic capabilities of computed tomography (CT).

Material and methods: CT with bolus intravenous administration of 100 ml of contrast agent Ultravist-370 was performed by multislice computed tomograph Aquilion 64 Toshiba.

Results: Patient M., 55 years old, was admitted to the clinic in July 2016 for surgical treatment due to the tumor in the abdominal cavity, which was detected by CT in May 2016. From the history it is known that since January 2016 the patient began to complain of weakness and weight loss. There were no abnormalities during physical examination and in the laboratory data. For staging pathological process control CT of the abdominal cavity with intravenous contrast was performed and then compared with previous СT scan. On the images of CT examination in the May 2016 in the mesogaster to the right of the median line oval shaped mass was defined, its seizes were 51x55x58 mm. On the present images seizes have reduced by about 10mm, more significantly decreased the volume of the mass - from 87 ml to 54 ml. The tumor is located directly under the anterior abdominal wall, surrounded by a loop of the small intestine. The outlines of mass were clear and smooth. The structure was not uniform due to inclusions of areas of fat (-75 HU) ranging in size from 4 mm to 29?16 mm, soft tissue component demonstrated the accumulation of contrast agent from 35 HU in the native phase to a maximum of 74 HU in delayed phase. There were not any other changes in the abdomen.

So after 2 months at the control CT scan before the planned surgery we observed positive changes in the form of reducing the size and more significantly volume of the lesion. In the differential range we considered fat-containing tumors - teratoma and liposarcoma. We did not think about inflammatory myofibroblastic tumor (IMT) as well as gastrointestinal stromal tumor, since the guidelines for X-ray diagnostics and different overviews of these tumors does not mention the possibility of the presence of fat in their structure. However, there were not any pathognomonic features of teratoma like calcification, cystic component, levels of fat / liquid. The outline of the mass was smooth and clear, so we could suggest an expansive rather than infiltrative growth, which has also made the conclusion about liposarcoma unlikely.

After preoperative preparation surgery was performed in the amount of resection of the small intestine segment with tumor and making enteroenteroanastomosis «end to end». After the morphological and immunohistochemistry analysis IMT of mesentery of small intestine was diagnosed.

Conclusion: 1. Fatty component in the structure of lesion of the mesentery of the small intestine does not rule out IMT. 2. Theoretically we can assume the possible presence of fat in the structure of the IMT any location. 3. Consideration should be given by IMT in the case of spontaneous reduction of the size of the observed tumor.

Key words: inflammatory myofibroblastic tumor, mesentery, fatty component, computed tomography

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For citation: Bashkov AN, Sheykh ZV, Cholakyan SV, Ionova EA, Doga VI, Shabalin МА, Grigoreva OO. Case of Inflammatory Myofibroblastic Tumor of Mesentery with Significant Fatty Component. Medical Radiology and Radiation Safety. 2017;62(2):79-82. Russian. DOI: 10.12737/article_58f0b9572d7131.31568909

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