Remarkable reduction or disappearance of retroodontoid pseudotumors after occipitocervical fusion. Report of three cases

Retroodontoid or periodontoid pseudotumor unassociated with rheumatoid arthritis or hemodialysis is clinically rare. The authors report three cases of retroodontoid pseudotumor that they treated surgically. All patients exhibited myelopathy of the upper cervical spinal cord. Plain radiography depicted atlantoaxial instability in two of the three patients. Spinal cord compression caused by a mass lesion in all patients was clearly demonstrated on magnetic resonance images. In two patients, the mass lesion was not limited to the retroodontoid region and expanded continuously to the cranial base. Posterior laminectomy of the atlas and occipitocervical fusion were performed. After surgery, the pseudotumor disappeared in two cases and was clearly reduced in one case, and neurological symptoms also improved. Retroodontoid pseudotumor is a lesion for which symptomatic improvement can be expected with posterior decompression and fusion, even without direct tumor excision.     

A case of fibrous pseudotumor originating from tunica vaginalis testis

A 32-year-old man presented with a complaint of painless palpable mass of the left scrotal content. Based on the preoperative diagnosis of scrotal or spermatic cordal benign tumor, local excision was performed. The histological diagnosis was scrotal fibrous pseudotumor. In Japan, only 35 cases of fibrous pseudotumor of the scrotum have been reported including our case. Orchiectomy was performed in 15 cases. Fibrous pseudotumor is a benign fibroproliferative lesion with dense hyalinization and sometimes focal calcification. It may be induced by previous intrascrotal inflammatory events such as epididymitis, an infected hydrocele, prior surgery or trauma. Although a relatively rare disease, a fibrous pseudotumor should be considered in the differential diagnosis of testicular and testicular tunica tumors. Our case was of a benign pseudotumor and orchiectomy could have been avoided.     

Inflammatory pseudotumor of the urinary bladder diagnosed using 3D-CT cystoscopy

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.     

Inflammatory pseudotumor of the bladder in neonates.

Inflammatory pseudotumors of the bladder are rare in children. We describe a 7-day-old male neonate with inflammatory pseudotumor of the bladder. He presented with a 3-day history of macroscopic hematuria. Ultrasonography, computed tomography and cystoscopy showed an intravesical mass arising from the right lateral wall. Pathologic findings obtained by open excision revealed that the tumor had spindle-shaped cells without significant atypia infiltrating into submucosal fibrous tissue. There has been no evidence of recurrent tumor 12 months post-operatively. To our knowledge our case is the first presentation in a neonate among the reported pediatric cases.     

Surgical excision of hemophilic pseudotumor of the ilium.

The iliac hemophilic pseudotumor is a rare complication of hemophilia occurring in 1-2% of patients with Factor VIII or Factor IX deficiency. It is frequently disabling and life threatening. This report presents a comparative study of postoperative results of two cases of hemophilic pseudotumor of ilium. One patient undergoing partial resection showed a favorable postoperative course, whereas the patient with complete resection of the pseudotumor died of postoperative bleeding and sepsis. Studies on the postoperative results of these two cases indicate that careful preoperative consideration of tumor size and degree of infiltration is of the utmost importance in operative management. Early excision of tumors eliminates the possibility of endogenous infection. Even partial resection of huge tumors, leaving the lateral wall intact for compression, can promote recovery of functions.     

Unresectable multifocal omental and peritoneal inflammatory myofibroblastic tumor in a child: revisiting the role of adjuvant therapy

Inflammatory myofibroblastic tumor is an uncommon lesion, also called pseudotumor, with a variable natural course from benign with spontaneous regression to mimicking malignant tumors. We report a case of diffuse peritoneal and omental pseudotumor in a 10-year-old boy characterized by aggressive behavior at the onset followed by stability after subtotal resection and chemotherapy. Total excision was not possible because of the tumor dissemination over the whole peritoneal surface. Adjuvant antiinflammatory drug (ketorolac tromethamine) and chemotherapy (methotrexate-vinblastine followed by ifosfamide-adriamycin and ifosfamide alone) were helpful to obtain rapidly complete resolution of clinical symptoms and anatomic stability of the residual lesions. Long-term evolution, in the absence of continued therapy, has been characterized by progressive involution and reduction of the residual masses.     

Calcifying pseudotumor of the neural axis--case report

A 22-year-old female presented with a calcifying pseudotumor of the neural axis manifesting as generalized convulsive seizure twice within 1 year. Computed tomography revealed a small, calcified mass lesion located in the right parietal lobe adjacent to the skull. The tumor was composed of an extensively calcified mass with accompanying peripheral epithelioid cells and focal mature bone structure, consistent with the diagnosis of a calcifying pseudotumor of the neural axis. Following complete excision of the tumor, the patient has been free from seizures for 8 years.     

A case of fibrous pseudotumor of the spermatic cord

A case of fibrous pseudotumor of the left spermatic cord is reported. The patient was a 4-year-old boy with the complaint of swelling and pain of the left scrotal contents. An intrascrotal tumor was suspected and surgical exploration was carried out. A small tumor was resected and histological examination revealed fibrous pseudotumor. This tumor was not a true neoplasm, but was due to an inflammatory disease. The clinical and histological findings of the tumor are discussed.     

Inflammatory pseudotumor of the breast in a patient with a high serum IgG4 level: histologic similarity to sclerosing pancreatitis

The association between IgG4 and inflammatory pseudotumor was first reported with regard to pancreatic pseudotumor, which is well known as sclerosing pancreatitis or autoimmune pancreatitis. In addition, there is increasing evidence that IgG4 is also involved in inflammatory pseudotumor of the extrapancreatic tissue. In this report, we present a case of IgG4-related inflammatory pseudotumor of the breast. A 46-year-old woman presented with an induration in the left breast. Radiologic examination revealed an ill-circumscribed mass measuring 1.6 cm in diameter in the left breast. Breast cancer could not be ruled out radiologically, and excision biopsy was performed for a definite diagnosis. Histologically, this nodule was composed of an irregular proliferation of stromal cells associated with severe lymphoplasmacytic infiltration, obliterative phlebitis, and eosinophils. No atypical feature regarding the stromal cells or lymphocytes was observed. Furthermore, many plasma cells within the lesion were immunohistochemically positive for IgG4, and the serum IgG4 concentration of this patient was elevated on postoperative examination. This case suggests that inflammatory pseudotumor of the breast has a pathogenetic process similar to that of sclerosing pancreatitis. IgG4 might become a useful marker for inflammatory pseudotumor of the breast, and it might benefit from steroid therapy, as does sclerosing pancreatitis.     

Multifocal fibrous pseudotumor of testicular tunics. Possible clinical dilemma.

A morphologic characterization of a tunical multifocal fibrous pseudotumor is presented because of the clinical dilemma this rare entity causes urologists and pathologists. This report demonstrates the necessity for familiarity with testicular pseudotumors in order to avoid an unnecessary orchiectomy. If histopathologic examination of biopsies from every pseudotumor nodule fails to demonstrate malignancy, excision of the entire tunics including the pseudotumors is appropriate therapy.     

Inflammatory pseudotumors of the lung.

BACKGROUND: Inflammatory pseudotumors of the lung are rare and often present a dilemma for the surgeon at time of operation. We reviewed our experience with patients who have this unusual pathology. METHODS: Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at the Mayo Clinic. Twenty-three patients (0.04%) had resection of an inflammatory pseudotumor of the lung. There were 12 women and 11 men. Median age was 47 years (range, 5 to 77 years). Six patients (26%) were less than 18 years old. All pathologic specimens were re-reviewed, and the diagnosis of inflammatory pseudotumor was confirmed. Eighteen patients (78%) were symptomatic which included cough in 12, weight loss in 4, fever in 4, and fatigue in 4. Four patients had prior incomplete resections performed elsewhere and underwent re-resection because of growth of residual pseudotumor. Wedge excision was performed in 7 patients, lobectomy in 6, pneumonectomy in 6, chest wall resection in 2, segmentectomy in 1, and bilobectomy in 1. Complete resection was accomplished in 18 patients (78%). Median tumor size was 4.0 cm (range, 1 to 15 cm). There were no operative deaths. Follow-up was complete in all patients and ranged from 3 to 27 years (median, 9 years). RESULTS: Overall 5-year survival was 91%. Nineteen patients are currently alive. Cause of death in the remaining 4 patients was unrelated to pseudotumor. The pseudotumor recurred in 3 of the 5 patients who had incomplete resection; 2 have had subsequent complete excision with no evidence of recurrence 8 and 9 years later. CONCLUSIONS: We conclude that inflammatory pseudotumors of the lung are rare. They often occur in children, can grow to a large size, and are often locally invasive, requiring significant pulmonary resection. Complete resection, when possible, is safe and leads to excellent survival. Pseudotumors, which recur, should be re-resected.     

Nuchal fibrocartilaginous pseudomotor. Case report and review of the literature

The case of a 30-year-old woman who, many years after a trauma to the neck, developed a hard tissue mass in the posterior midline at C5-C6 level is reported. The patient underwent surgical excision of the mass. Nucal fibrocartilaginous pseudotumor (NFP) was diagnosed. This is a very rare non-neoplastic lesion, probably arising throug a post-traumatic metaplasia of the nuchal ligament, and only 14 cases have been reported to date in the literature. The clinicopathologic and neuroradiologic features of NFP are described.     

Hemophilic pseudotumor of the first lumbar vertebra

Hemophilic pseudotumor involving the spine is extremely uncommon and presents a challenging problem. Preoperative planning, angiography, intra and perioperative monitoring with factor VIII cover and postoperative care for hemophilic pseudotumor is vital. Recognition of the artery of Adamkiewicz in the thoracolumbar junction helps to avoid intraoperative neurological injury. We report the case of a 26-year-old male patient with hemophilia A, who presented with a massive pseudotumor involving the first lumbar vertebra and the left iliopsoas. Preoperative angiography revealed the artery of Adamkiewicz arising from the left first lumbar segmental artery. Excision of pseudotumor was successfully carried out with additional spinal stabilization. At 2 years followup, there was no recurrence and the patient was well stabilized with a satisfactory functional status. Surgical excision gives satisfactory outcome in such cases.     

Inflammatory pseudotumor of the urinary bladder and sigmoid colon.

We report an unusual case of an inflammatory pseudotumor of the bladder. A biopsy specimen prior to surgical treatment suggested leiomyosarcoma, and computerized tomography and magnetic resonance imaging strongly suggested bladder tumor with sigmoid colon invasion. Accordingly, radical surgical treatment consisting of total cystectomy, anterior resection of the sigmoid colon, and ileal conduit was performed. After operation, however, histological examination revealed an inflammatory pseudotumor of bladder and sigmoid colon. These findings were confirmed by immunohistochemical staining for smooth muscle specific actin, desmin, S-100, and vimentin. Histological examination revealed a diverticulum of the sigmoid colon in the middle of the pseudotumor, and this diverticulum may have ruptured to cause the inflammatory pseudotumor of bladder and sigmoid colon.     

Is calcifying fibrous pseudotumor a late sclerosing stage of inflammatory myofibroblastic tumor?

Calcifying fibrous pseudotumor is a recently described distinctive lesion, characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcifications and a lymphoplasmacytic infiltrate. The cause and pathogenesis are unclear, but a possible relationship with other pseudotumors, like nodular fasciitis or inflammatory myofibroblastic tumor, has been proposed by some authors. However, cases with overlapping histologic features have not been reported. A 17-year-old girl with multiple peritoneal calcifying fibrous pseudotumors and inflammatory myofibroblastic tumors (inflammatory pseudotumors) is described. Some multinodular lesions showed calcifying fibrous pseudotumors next to inflammatory myofibroblastic tumors. Transitional stages between calcifying fibrous pseudotumor and inflammatory myofibroblastic tumor were also present. This case clearly illustrates a histogenetic relationship between calcifying fibrous pseudotumor and inflammatory myofibroblastic tumor, and it suggests that calcifying fibrous pseudotumor is a late sclerosing stage of inflammatory myofibroblastic tumor, at least in some cases.     

Asymptomatic calcifying fibrous pseudotumor compressing heart cavities

Calcifying fibrous pseudotumor is a rare benign lesion composed mostly of dense hyalinized colagen with multiple dystrophic or psammomatous calcifications and variable lymphoplasmacytic infiltrate. Children and young adults are most commonly affected by this tumor of uncertain pathogenesis. This is a case of an asymptomatic young woman with calcifying fibrous pseudotumor of the pericardium compressing heart cavities. Partial resection and marsupialization of the mass was performed.     

A rare lesion of the central nervous system: inflammatory pseudotumor

Inflammatory pseudotumor is an uncommon tumor, initially described in the lung, but which can involve various organs. It is a controversial entity. We report the case of a 19-year-old-man with an inflammatory pseudotumor localized in the central nervous system, revealed by epilepsy. Characteristically, the inflammatory pseudotumor is an inflammatory mass leading to manifestations related to its localization. Relatively ubiquitous, this tumor is seldom described in the central nervous system. This uncommon lesion is part of a heterogeneous group of entities which are difficult to diagnose for both surgical pathologists and clinicians.     

42例肺部炎性假瘤的诊断与外科治疗

目的：探讨肺部炎性假瘤的临床特点、诊断及外科治疗。方法：对４２例肺部炎性假瘤的临床资料进行回顾性分析。结果：全组均行手术治疗,无术后并发症和死亡,术前仅１８例（４２．９％）诊断正确;余２４例中２０例疑为肺癌,４例误诊为结核瘤或良性肿瘤。结论：该病病程长,症状较轻。从临床症状和影像学上很难与肺癌鉴别。强调术前纤维支气管镜和经皮肺穿刺检查十分重要。肺部炎性假瘤虽属良性,亦应尽早手术治疗。术式以局部切除和肺叶切除为主,尽量多保留正常肺组织。     

儿童输尿管炎性假瘤1例报告并文献复习

目的：探讨输尿管炎性假瘤(1nflammatory pseudotumor，IPT)的临床特点，提高其诊治水平。方法：报告1例9岁男性输尿管IPT患者，并复习文献就相关问题予以讨论。结果：术后患者恢复良好，痊愈出院。病理检查证实为输尿管IPT。结论：IPT指组织炎性增生形成的肿瘤样团块，根据症状、体征及影像学检查结果难与恶性肿瘤相鉴别，其确诊有赖于病理学检查。输尿管IPT治疗大多仍需行外科手术，并在治疗后进行随访。     

Fibrous pseudotumor of the tunica vaginalis testis

The incidence of fibrous pseudotumor of the tunica vaginalis testis is rare. It is a benign, fibroproliferative process with hyalinization and sometimes with focal calcification. In most cases malignancy is suspected although by careful physical examination it may be possible to establish the diagnosis pre-operatively. The best form of therapy is frozen section biopsy of the pseudotumor followed by excision; including if necessary the tunica vaginalis. If the pseudotumor is locally extensive an epididymectomy is sometimes necessary. A study of the literature reveals that because of the rarity of this lesion orchidectomy appears to have been performed in most cases. A case report of a patient with fibrous pseudotumor of the tunica vaginalis testis is presented.