PMC4835684_01
A middle-aged female with a 5-month history of febrile condition, weight loss, left lumbar pain, and edema of the left leg; A and B, Axial images of the initial abdominopelvic CT, right kidney hydronephrosis; C, Sagittal reformatted image during the late parenchymal phase. Inflammatory myofibroblastic tumor (IMT) occupies the entire pelvis. It is presented as a soft tissue mass, hypodense to skeletal muscles and uterus. Fat planes between pelvic organs and sacrum are erased due to infiltrative tumor growth.
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Soft tissue planes between the uterus and bowels, ureters and both ovaries were erased (Figure 1).
Histologic specimens. A, Myofibroblastic proliferation with dense hyalinization and inflammatory infiltrate (Hematoxylin-eosin staining with 100 times magnification (H&E, x 100)); B, Myofibroblastic proliferation with dense lymphoplasmocytic infiltration (H&E, x 100). Mitoses and atypia of the cells were not observed.
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Routine hematoxylin-eosin (HE) stain showed hyalinized stroma with myofibroblasts and numerous inflammatory cell infiltrates (Figure 2).
CT scan eight months after the initial work up. A and B, Axial images; C, Sagittal reformatted image during the late parenchymal phase. Both kidneys restored normal morphology. Proximal part of the left ureter is still slightly dilated. Reduction in IMT tumor volume is apparent. Uterine cavity can be recognized. Soft tissue bands, slightly hypodense to the uterus, traverse perirectal, perivesical, and pre-sacral space are seen.
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Eight months after the initial work-up, further tumor regression was noted with iso- and hypodense strands of tumor tissue arranged in the radial fashion connecting uterus and pelvic walls (Figure 3).
CT scan 24 months after the initial work up. A, Axial image at the level of the midabdomen; B, Axial image at the level of the uterine body during the excretory phase. Complete regression of the pelvic inflammatory myofibroblastic tumor is apparent with recuperation of the right kidney hydronephrosis (left kidney not shown). The outer margins of the uterus are indistinct from the bowel loops suggesting adhesions.
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The only apparent abnormality was an invisible fat tissue plane between the uterus and the adjacent bowel loops, thus suggesting adhesions (Figure 4).
MRI of the pelvis four years after the initial work up. A, Sagittal T1 weighted fat suppressed sequence (T1W FS); B, Axial T1W FS sequences; C, Sagittal T2W FS; D, Axial T2W FS sequences. Uterus and vagina morphology is completely normal according to the patient's age. Uterus is slightly distracted to the left pelvic wall. Anatomical zone of the uterus is preserved and the endometrium has a normal width. Parametria is normal too.
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T1 weighted fat suppression sequence, T2 weighted fat suppression sequence, fast spin echo sequence, pelvic organs with normal topography and morphology without residual periuterine fibrosis were depicted. The uterus corpus, cervix zone anatomy, and the width of the endometrium were within normal limits (Figure 5).
Diffusion weighted images of the pelvis on the 5-year follow-up MRI. There is no evidence of qualitative changes of water diffusion in the region of interest.
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Diffusion weighted images were obtained during these MRI exams and no apparent changes were observed (Figure 6).