IMT: Inflammatory Myofibroblastic Tumor...Explained by a Soft Tissue Pathologist

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Inflammatory myofibroblastic tumor (IMT) has emerged from the wastebasket category of "inflammatory pseudotumor" to become its own unique diagnostic entity. In my experience, brisk reactive proliferations can be easily confused with IMT. Watch this video to learn a few tricks to making the diagnosis of IMT. Special thanks to my dermatopathology fellow, Dr. Ed Fulton, for selecting these slides and helping with the production of this video.
Suggested reading:
www.ncbi.nlm.nih.gov/pubmed/1...
www.ncbi.nlm.nih.gov/pubmed/1...
www.ncbi.nlm.nih.gov/pubmed/2...
Please check out my Soft Tissue Pathology & Dermatopathology survival guide textbooks: bit.ly/2Te2haB ‬
This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@dr.chinmaypendharkar2227]

In the present era, where there is scarcity of good teachers, across the globe, these videos really help in generating interest in the field of Pathology and understanding the basics of the subject. Sir, you are really a great teacher and the present as well as the future generations of students of this subject, would remain indebted for the efforts, you've put in to spread the knowledge! Thankful to you, Sir!!

[@VirginiaWolf88]

I just had one of these cut out from between my eye and my eye brow. I'm 50. I'm hoping that it will be over now. I've been looking the subject up like crazy. Thank You for posting.

[@dctr666]

SI, last week I was diagnosed with one of these... it's located on my waist, and the only symptom I have is a huge mass, growing outside of my body... I first saw it a couple of years ago (5+) and the doctors I've went, all of them were certain it was a lypoma... I always had some mistrust about that diagnose (but, then again, I was obese - more than 115kg)...I wanted to start to regain my form, eventhough I was "healthy"...started jogging, and went back to my old passion, martial arts... At 44 years, I managed to get my yellow and my orange belt in karate, in less than 1,5 years, because of my hard training, and I've lost 25kg...(eventhough, there were a couple of weeks, while on vacations, that I had 2 or 3 that reappeared eheheh)...and that was when I saw how huge this thing is 8cm... I took the liberty on planning some exams, and only then, present myself to a different medic.. .and there it was "Inflammatory Myofibroblastic Tumor", of really slow growth and no symptom... So, I know the only treatment is surgery... but at sequels must I count with? Am I at any life threatening risk? Sorry to bother you...

[@drjfae9830564]

Muy interesante y muy bien explicado todo. Gracias

[@alinazar4928]

Was always confused about the two terms .. Thank you very much sir

[@matiwosaraya514]

Thanks for your efforts Dear.

[@omegaphillip6863]

Thank you Dr Jerad Gardner.

[@trishitabhattacharya3189]

Wonderful discussion Sir..you make this subject so interesting to decipher..Thank you Sir

[@marcomazzotta1921]

Excelent video !! Thanks

[@loudefeo2510]

Great,Thank You

[@miryachraf]

thank you so much. wonderful explanation as always !!!!

[@umarfarooqkhan8208]

Dear sir it is very nice and full of knowledge presentation

[@msteel2986]

You are an amazing pathology teacher. Thanks for your efforts in putting these videos together

[@JMGardnerMD]

Thank you so much for that feedback! It’s my honor to be able to repay my own mentors by teaching others.

[@rabiataseer8369]

great video.

[@SandhyaRamachandran]

AWSM...THANK U

[@znrsmsaa3655]

Thanks alot

[@Lansvacer]

Thanks for this and all your other briliant videos. Are there any distinctive ways to differentiate this from Myxoinflammatory fibroblastic sarcoma? (according to the last WHO), both have inflammatory infiltrate, myo/fibroblastic tumor cells with pretty much overlapping features (vesicular nuclei, nucleoli, atypia,...), and IMT also can have a myxoid pattern. SO, could they be indistinguishable on H&E alone? thanks again!

[@misterB2231]

are there inflammatory cells in Rhabdomyosarcoma ? can it be a differentiel of IMF tumors ?

[@LOLsaudi]

lovely, but what about post-operative spindle cell tumor?

[@haitrung94]

hi Dr, I'm staining some sections of oral squamous cell carciomoa, by alpha smooth muscle actin marker (a-SMA). I reveal that some possitive-a-sma cells have nucleus; but some cells have not. Whether these cells are myofibroblast or they are collagens?

[@wubaiyao1]

The case you shared in the video, the IMT of the skin, how to differentiate from dermal nodular fasciitis?

[@JMGardnerMD]

nodular fasciitis usually has more feathery “tissue culture” appearance with less fascicles formation. Also nodular fasciitis usually has minimal inflammation despite the “itis” in the name. kzbin.info/www/bejne/aJukm35ueJyMbMU

[@wubaiyao1]

@@JMGardnerMD your video is so helpful. Hope to see more cases of cutaneous soft tissue tumors. Thank you very much.

[@anjanamazumdar6812]

can there be presence of bone in inflammatory myofibroblastic tumor

[@zeinabvosough1791]

Thanks it was really helpfull.Can you name other soft tissue tumors with prominent inflammatory cells infiltration?

[@JMGardnerMD]

Inflammatory liposarcoma is the main one that comes to mind.

[@made3698]

Can a hemangiopericytic type vessels be seen

[@JMGardnerMD]

Yes. Many tumors can show staghorn/hemangiopericytic vascular pattern. More info here: kikoxp.com/posts/17762

[@myst3rymachin3]

I had this tumor it took doctors up to 4 months to diagnose me correctly

[@JMGardnerMD]

I’m sorry to hear about your diagnosis. Yes these can be difficult to diagnose sometimes. Best wishes for good health to you!

[@lisadaughtry4503]

Yeah. I had two biopsies before getting one taken out of my right lung. Didn't find out until it was taken out and sent off to be tested.

[@lopamudrakakoti]

Sir, will you make a video on different fibroblastic tumours and myofibroblastic tumour and how to differentiate between them

[@JMGardnerMD]

Which entities in particular are you wanting to learn more about? I already have videos about desmoid fibromatosis, nodular fasciitis, low grade fibromyxoid sarcoma, myxofibrosarcoma, infantile digital fibromatosis/inclusion body fibroma. I’ll probably cover more over time but if you have a “wish list”, let me know.

[@lopamudrakakoti]

@@JMGardnerMD Thank you sir. it will be really helpful if you can show the difference between fibroblast and myofibroblast..and I will be great full if you show case of low grade myofibroblastic sarcoma

[@JMGardnerMD]

I honestly don’t know how to reliably tell fibroblasts and myofibroblasts apart. They seem to have a lot of overlap and I personally suspect they exist on a spectrum with each other. I usually teach fibroblastic/myofibroblastic as one overlapping big category. Low grade myofibroblastic sarcoma is such a difficult diagnosis to make and to teach. Best handled by experts. I still find them very challenging. But I’ll see if I can find enough good examples to make a video.

[@lopamudrakakoti]

@@JMGardnerMD It will be helpful sir if you could. I have a question about IMT. Sir, how do you be so sure if it's Alk negative.. should we term it IMT or IPT

[@SandhyaRamachandran]

Curious to know the treatment...

[@JMGardnerMD]

Surgical excision is usual treatment

[@SandhyaRamachandran]

@@JMGardnerMD thank u

[@rachelgibson4749]

My 18 year old son’s doctor called me and said this is what the lump on his back came back as. She said he needs surgery to remove more tissue so it don’t grow back. She also said she and the pathologist have never seen this before. So how would I go about finding someone to confirm if this is even really what he has?

[@JMGardnerMD]

Christopher Fletcher at Brigham and Women’s hospital in Boston is a soft tissue pathology expert. Or any of the soft tissue pathologists at Mayo Clinic or Cleveland Clinic. Your son’s doctor could contact the pathologist and request they send it out to one of these places for a second opinion. Most inflammatory myofibroblastic tumors behave in a benign way. Best wishes to you and your son.

[@rachelgibson4749]

Jerad Gardner, MD Thanks so much!

[@sandeepgote9319]

Hi sir I know more about this deases

[@marizvibar7347]

Hi Sir what is reactive myofibroblastic tumor? How will you that it is benign or cancer?

[@marizvibar7347]

Know*

[@JMGardnerMD]

Reactive means benign.

[@marizvibar7347]

@@JMGardnerMD wow thank u so much for your reply. ❤

[@marizvibar7347]

@@JMGardnerMD Sir is there any chance of recurrence? My doctor said that they need further study if there is any treatment for this since this is benign.

[@marizvibar7347]

@@JMGardnerMD thank you again Sir for ur reply. I will share your youtube account here in Philippines 🇵🇭

[@lordjim24]

Hi Jerad, just curious, since you're an associate professor, why you haven't chosen to pursue a PhD? -Andrew

[@JMGardnerMD]

In the USA, most MDs do not pursue PhD. It can be done (my Dermpath partner is actually an MD/PHD and is director of the Md/PhD program at our University). But only a small minority of our students do it. It is done during the course of medical school. Some people get PhDs and then later become MDs. But it seems extremely rare in my experience for an MD to go back and get a PhD after completing medical training. I didn’t have any clue about research until after I finished med school. So never really considered doing an Md/PhD. Plus, I think it takes a certain type of mind with a real passion and insatiable curiosity for deep research to be a great PhD. And I don’t have that type of mind. True, I have done a lot of research and writing (my 100th paper will be published this month), and I think I’ve made some decent contributions of new medical knowledge, but research isn’t my true passion. I love patient care and teaching the most...that’s where my heart is.

[@lordjim24]

@@JMGardnerMD Thanks, that's helpful. I am considering doing an MD/PhD in Pathology myself, which is why I asked. Also, I'm wondering how you got interested in Pathology in the first place? What led you to choose that specialty over all the others? What draws me to pathology is the opportunities it allows for closely analyzing a medical problem at the gross anatomical and cellular level. You're getting straight at the problem. There is no taking blood pressures or asking the patients qualitative questions about pain or discomfort. You are coming face to face with the disease, and you are making the final diagnosis. Surgery also brings you physically close to the anatomical problem of the patient, but from my understanding, it does not allow you to "linger" over it and appreciate it in all its complexities. You can't take your time in making your decision about what to do in surgery, whereas pathology allows you time to mull things over. Perhaps you have a similar view of pathology? Thanks. -Andrew

[@JMGardnerMD]

Yes I love the analytical side of pathology and the time to mull things over is very nice both intellectually and practically (easier to take time off to take my kids to the doctor etc...I can usually easily shift my schedule around whereas that is more difficult in a clinic). Pathology is objective in many ways although there is also a surprising amount of subjectivity too. Here’s my story of how I got interested in pathology: thepathologist.com/issues/0217/social-superstar/

[@JMGardnerMD]

Yes I love the analytical side of pathology and the time to mull things over is very nice both intellectually and practically (easier to take time off to take my kids to the doctor etc...I can usually easily shift my schedule around whereas that is more difficult in a clinic). Pathology is objective in many ways although there is also a surprising amount of subjectivity too. Here’s my story of how I got interested in pathology: thepathologist.com/issues/0217/social-superstar/

[@amaliyadipita6906]

👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾❤️❤️❤️❤️❤️

[@lukedebenham208]

sweeet!

[@nageshkote4747]

Kannadadalli heli sir