.
Fig 4: Intraoperative image with tumor insitu
The post-operative course was unremarkable, and after 24 hours of
observation in Intensive care Unit (ICU) the patient was transferred to
the surgery ward. He recovered well and discharged after fifth
Post-operative day.
Histopathological examination of the resected specimen showed an
Inflammatory Myofibroblastic tumor. The tumor showed nodular hyperplasia
with diffuse eosinophilic infiltrate, subserosal bland spindle to
stellate cells proliferation along with lymphoid aggregates,
lymphocytes, plasma cells, and eosinophils.
Discussion : Inflammatory Myofibroblastic tumors being rare
neoplasms with diverse clinical presentations can affect various organs
like lungs, liver, endolarynx, maxillary sinus, oral cavity etc.[5]
However, their involvement in the gastrointestinal tract is particularly
rare and their expression as intussusception is even rarer. [4].
Their exact etiology remains uncertain but they can even mimic various
inflammatory conditions and their behavior ranges from benign to locally
aggressive or rarely malignant, making the diagnosis challenging.
Some common causes of adult ileocolic intussusception are adhesions,
polyp, inflammatory bowel disease, gastro intestinal tumor (GIST) etc.
[6]. Inflammatory Myofibroblastic Tumor Presenting as Ileocolic
Intussusception is a rare diagnosis, so it is even difficult for a
resources equipped centers to diagnose. Diagnosing this rare condition
in Hetauda Hospital, a district hospital located in sub-urban region
with inadequate resources is quite challenging. The diagnosis of this
condition at our center either reflects the inadequacies in studies or
not frequently reported.
In our case, the patient’s presentation with abdominal pain, vomiting,
and imaging findings of intussusception prompted further investigation,
leading to the diagnosis of an IMT. Surgical resection followed by
histopathological examination of the resected specimen performed.
Immuno histochemical staining (IHC) which helps to identify specific
marker expressed by tumor cells like Smooth muscle actin (SMA),
anaplastic lymphoma kinase (ALK Protein), vimentin, and CD34. These IHC
features can help in distinguishing benign or malignant nature of the
tumor. Together in conjunction with histopathological features, they can
help to establish confirmatory diagnosis. However, in sub-urban area
like ours, patient presents with their complaints and after getting
relief from their issues, they do not come up to hospital for follow up.
Therefore, in our case we are unable to give Immunohistochemistry (IHC)
reports as he was lost to follow up.
Further studies, research and case reports are necessary to understand
the etiology, behavior, and optimal management strategies for IMTs,
particularly those involving gastrointestinal tract. Additionally,
increased awareness among clinicians is also essential to ensure early
recognition, prompt diagnosis, and appropriate surgical intervention, as
demonstrated in this case, are crucial for optimal management and
favorable patient outcomes of these rare tumors.
Conclusion :
This case report shares a very rare condition of inflammatory
myofibroblastic tumor (IMT), presenting with ileocolic intussusception
in a middle-aged man, which is extremely uncommon and can be confused
with other inflammatory conditions however, through diagnostic
evaluation and multidisciplinary approach can result in early diagnosis,
optimal management and favorable patient outcomes of these rare tumors.