Muthiyal Sreekumar,  Kini Viswanatha,  Koshy Sheeja

Final Pr. ID: Poster #: CR-005

Inflammatory myofibroblastic tumour is a rare quasineoplastic lesion in the gatrointensitnal tract ; often present with variable and nonspecific imaging features, which may mimic other more common lesions, including malignancy. Occurrence in early infancy involving mesentery has been only sparsely reported in literature. We present such a paradigm in a 4 months old infant with clinical, radiological and histopathological features and corroborative overview of literature.
On Ultrasound abdomen, a mass lesion measuring about 6x4cm with irregular lobulated margin in the left lumbar–iliac fossa regions , involving the mesenteric planes and contigous descending colonic wall, having heterogeneous echotexture was seen . No calcification or cystic component was evident . Left kidney and spleen were seen separately . On Doppler it showed a few areas of vascularity.
On MRI ,It measured about 6.1x5.1x5.2 cm in CC, TR and AP dimensions with lobulated margins, involving the mesentery. It was heterogeously hypo intense on T1 W images and hyper intense on T2W images. On DW sequences, a few areas of restricted diffusion , predominantly along the periphery of the lesion, while the central areas showed minimal/non-restriction ; which also reflected in ADC map. On post contrast, the lesion showed moderate heterogeneous enhancement corresponding to the areas of restricted diffusion and dominant non enhancing components, suggesting areas of necrosis. Apart from contiguous colonic wall involvement , no other evidence of loco regional infiltration or metastasis was seen. Based on these, a diagnosis of Inflammatory myofibroblastic tumor was made.with differential diagnosis of non Hodgkin's lymphoma
The patient subsequently underwent laparotomy. On Histopathology, it showed myofibroblastic spindle cells and inflammatory infiltrates of lymphocytes with no evidence of nuclear pleomorphism or atypical mitosis ; suggesting the diagnosis of inflammatory myofibroblastic tumour ; which matched the MRI diagnosis. Read More

Authors:  Muthiyal Sreekumar , Kini Viswanatha , Koshy Sheeja

Keywords:  Inflammatory myofibroblastic tumour, mesentery, infant