APPENDICEAL INFLAMMATORY MYOFIBROBLASTIC TUMOUR: A RARE POSTOPERATIVE FINDING
Authors: Raj Rahul , M Shaikh Junaid , P Jadhav Sarojini 
Published: June 2023

Introduction- Inammatory myobroblastic tumour (IMT), which usually affects children and young adults, is a rare neoplastic lesion of unknown aetiology.[1–5]Once thought to be reactive, now these lesions are considered to be neoplastic.[2] Denitive diagnosis of IMT is conrmed by histopathological analysis and immunohistochemical tests of surgically removed specimen.[1–5] According to the World Health Organization, IMT is a distinctive lesion composed of myobroblastic spindle cells accompanied by an inammatory inltrate of plasma cells, lymphocytes, and eosinophils.[1–6] Inammatory myobroblastic tumour is a relatively new histopathological term. In the literature, this entity was formerly known as inammatory pseudotumor, plasma cell granuloma, plasma cell pseudo-tumour, pseudo-sarcomatous myobroblastic proliferation, reactive pseudo-sarcomatous response, omental-mesenteric myxoid hamartoma, and inammatory brosarcoma. This unication of descriptive terms was achieved on the basis of considerable morphological and clinical overlap, combined with both clinical and genetic evidenc of its neoplastic nature.[2,3,5,7] IMT was rst described in 1937 as a primary lung tumour [1,2,3,5,7] but it was subsequently recognized that virtually any anatomical site can be involved.[1,4,6,7] Most of the extrapulmonary IMTs are localized in the mesentery of the small intestine, omentum, and retroperitoneum.[1,4] To this date, IMTs of the gastrointestinal tract are rare.[1,3,8] Most of these reported cases are adolescent or adult males.[2,3] A 13 years old male patient presented to surgery casualty wi Case Report- th complaints of pain in abdomen vomiting for 4 days on clinical examination patient have tachycardia and tenderness in right iliac fossa. Initial USG A+P was suggestive of perforated appendix with early lump formation. Patient was managed conservatively and discharged after 3 days. But after 2 weeks patient again presented with similar complaints and progressively increasing lump in right lower abdomen. Lump was 15x8cm in right iliac fossa extending to hypogastric and right lumbar region rm to hard in consistency with mild tenderness on deep palpation. Ultrasound of abdomen suggestive of organised haematoma. CECT abdomen and pelvis suggestive of inamed appendix with suspicious perforation and well-dened heterogenous collection of max volume 340cc could represent organised haematoma. Patient was posted for elective exploratory laparotomy with intra op ndings of 1) mass of size 15x10x8cm located in right lower quadrant 2) whole specimen weighed 350gms 3) appendix showed diffuse inammation and adherent to mass. Appendicectomy along with excision of mass was done and sent for histopathology. HPE Report-Benign spindle cell lesion highly suggestive of inammatory myobroblastic tumour. IMT is a rare lesion that can represent a Conclusion- n unexpected intra-operative nding at emergency surgery. Generally, IMTs have a good outcome but they have a tendency for local recurrence and small risk of distant metastasis. IMT can be observed in appendices even though it is rare. Complete surgical resection should be the method for curative treatment. Denitive diagnosis of IMT is conrmed by histopathological analysis and immunohistochemical tests of surgically removed specimen.