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Metastatic inflammatory myofibroblastic tumor identified by EUS-FNA in mediastinal lymph nodes with ancillary FISH studies for ALK rearrangement

Authors

  • Samuel Borak M.D.,

    1. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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  • Gene P. Siegal M.D., Ph.D.,

    1. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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  • Vishnu Reddy M.D.,

    1. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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  • Nirag Jhala M.D.,

    1. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
    Current affiliation:
    1. Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Darshana Jhala M.D.

    Corresponding author
    1. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
    Current affiliation:
    1. Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
    • Associate Professor, Department of Pathology, University of Pennsylvania, Director of Anatomic Pathology, Philadelphia VAMC, Path and Lab Medicine, 3900, Woodland Avenue, Philadelphia, PA 19104
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Abstract

Inflammatory myofibroblastic tumor (IMT) is an exquisitely rare neoplasm with a low incidence of metastasis. Previously, cytologic diagnosis of this entity, by fine needle aspiration (FNA) or endoscopic ultrasound guided fine needle aspiration (EUS-FNA), was challenging, if not impossible. However, advancements in the field of molecular pathology, the applications of which have lagged in cytopathology relative to other disciplines, now makes diagnosis possible. Here we report a case of pulmonary inflammatory myofibroblastic tumor with mediastinal nodal metastasis in a 74-year-old man, definitively diagnosed by EUS-FNA utilizing morphologic, immunohistochemical, and molecular findings, including fluorescent in situ hybridization studies for ALK gene rearrangement. This case report demonstrates the value of ancillary molecular studies to assist in the diagnosis of rare neoplasms, including those at sites of metastasis. Diagn. Cytopathol. 2012. © 2012 Wiley Periodicals, Inc.

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