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doi: https://doi.org/10.4132/jptm.2017.01.12    [Epub ahead of print]
Clinicopathological Study of 18 Cases of Inflammatory Myofibroblastic Tumors with Reference to ALK-1 Expression: 5-Year Experience in a Tertiary Care Center
Ramesh Babu Telugu1, Anne Jennifer Prabhu1, Nobin Babu Kalappurayil1, John Mathai2, Birla Roy Gnanamuthu3, Marie Therese Manipadam1
1Department of General Pathology, Christian Medical College and Hospital, Vellore, India
2Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, India
3Department of Thoracic Surgery, Christian Medical College and Hospital, Vellore, India
Corresponding Author: Ramesh Babu Telugu ,Tel: +91-9566434081, Fax: +91-416-2232054, Email: dr.rameshtelugu@gmail.com
Received: September 5, 2016;  Revised: January 2, 2017  Accepted: January 12, 2017.  Published online: April 17, 2017.
ABSTRACT
Background:
Inflammatory myofibroblastic tumor is a histopathologically distinctive neoplasm of children and young adults. According to World Health Organization (WHO) classification, inflammatory myofibroblastic tumor is an intermediate-grade tumor, with potential for recurrence and rare metastasis. There are no definite histopathologic, molecular or cytogenetic features to predict malignant transformation, recurrence or metastasis.
Methods:
A 5-year retrospective study of histopathologically diagnosed inflammatory myofibroblastic tumors of various anatomic sites was conducted to correlate anaplastic lymphoma kinase-1 (ALK-1) expression with histological atypia, multicentric origin of tumor, recurrence and metastasis. Clinical details of all the cases were noted from the clinical work station. Immunohistochemical stains for ALK-1 and other antibodies were performed. Statistical analysis was done using Fisher exact test.
Results:
A total of 18 cases of inflammatory myofibroblastic tumors were found during the study period, of which 14 were classical. The female-male ratio was 1:1 and the mean age was 23.8 years. Histologically atypical (four cases) and multifocal tumors (three cases, multicentric in origin) were noted. Recurrence was noted in 30% of ALK-1 positive and 37.5% of ALK-1 negative cases, whereas metastasis to the lung, liver and pelvic bone was noted in the ALK-1 positive group only.
Conclusions:
Overall, ALK-1 protein was expressed in 55.6% of inflammatory myofibroblastic tumors. There was no statistically significant correlation between ALK-1 expression, tumor type, recurrence and metastasis. However, ALK-1 immunohistochemistry is a useful diagnostic aid in the appropriate clinical and histomorphologic context.
Key Words: ALK protein; Atypia; Prognostic marker; Recurrence; Neoplasms
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