.
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.