Qap (Anatomical Pathology) 

QAP Peer Review

AP190
Case History: F/10, 4 cm mass in urinary bladder. Partial cystectomy performed
Intended diagnosis: Inflammatory myofibroblastic tumor. Contributed by:KFT
Code Diagnosis Comment Score
anonymous Inflammatory myofibroblastic tumour (100%) May be positive for actin, desmin, ALK-1. Also perform immunostains for myogenin and myo-D1 to exclude embryonal rhabdomyosarcoma.  100
anonymous Inflammatory myofibroblastic tumor (100%) Immuno ALK-1 staining usually positive in IMT of bladder. A panel of immunostains should also include: S-100 protein, cytokeratin, desmin, smooth muscle actin, CD34.  100
anonymous Spindle cell tumor, favor inflammatory myofibroblastic tumor (99%). Ddx: Post-operative spindle cell tumor (1%). Correlate with any history of operation, and perform ALK-1 immunostaining (positive in inflammatory myofibroblastic tumor).  100
anonymous INFLAMMATORY MYOFIBROBLASTIC TUMOR(INFLAMMATORY PSEUDOTUMOR) 100% Differential includes low grade leiomyosarcoma, especially myxoid subtype. More sampling of the tumor border, if invasive, favor low grade leiomyosarcoma. Immunostains, although overlap, may sometimes help for distinction betwen the two. INFLAMMATORY PSEUDOTUMOR usually CK+/-, actin+/-, desmin +/-. Leiomyosarcoma usually CK-, actin+, desmin +/-.  100
anonymous Inflammatory myofibroblastic tumor. (100%) Do ALK-1 stain to confirm.  100
anonymous Bladder - Inflammatory myofibroblastic tumour 100% nil  100
anonymous Spindle cell lesion, with differential diagnosis of 1. Inflammatory myofibroblastic tumour (80%) 2. Leiomyosarcoma (10%) 3. Rhabdomyosarcoma (10%) A panel of immunostaining including ALK-1, desmin, myogenin, MyoD1, muscle-specific actin should be performed. ALK-1 will be positive in inflammatory myofibroblastic tumour.  100
anonymous Inflammatory pseudotumour 100% nil  90
anonymous Inflammatory myofibroblastic tumor (Inflammatory pseudotumor) nil  100
anonymous INFLAMMATORY MYOFIBROBLASTIC TUMOUR nil  100
anonymous Inflammatory myofibroblastic tumour 90% Other spindle cell neoplasm 10% Perform: Alk-1 desmin, MyoD1 (rhabdomyosarcoma, leiomyosarcoma)  100
anonymous Inflammatory myofibroblastic tumor/inflammatory pseudotumor To perform ALK1 immunostaining, and correlate with clinical history for previous bladder instrumentation or operation  100
anonymous Inflammatory pseudotumor nil  90
anonymous Sarcoma, favour spindle cell rhabdomyosarcoma DDx: leiomyosarcoma, fibroblastic/myofibroblastic tumour. Probability: 100% nil  30
anonymous Inflammatory myofibroblastic tumour 100% nil  100
anonymous Inflammatory pseudosarcomatous myofibroblastic proliferation. nil  100