International journal of surgery case reports · 2026
Inflammatory myofibroblastic tumor of the psoas muscle presenting as a retroperitoneal mass: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Alqatta Wail, Alfaqeeh Shaima
Аннотация
INTRODUCTION: Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of intermediate biological potential characterized by myofibroblastic spindle-cell proliferation and a variable inflammatory infiltrate. Although IMT may arise in a wide range of anatomical locations, primary involvement of the psoas muscle is exceptionally uncommon and may present significant diagnostic challenges due to its nonspecific clinical and radiological features.
CASE PRESENTATION: A 29-year-old man presented with progressive left flank and left iliac fossa pain radiating to the back and left lower limb. Contrast-enhanced computed tomography (CT) revealed a 5.8 × 4.7 × 6.6 cm hypervascular intramuscular mass within the left psoas muscle, highly suspicious for a malignant retroperitoneal soft-tissue neoplasm. CT-guided core needle biopsy was inconclusive. Due to persistent symptoms and diagnostic uncertainty, the patient underwent complete surgical excision of the lesion. Histopathological examination demonstrated a spindle-cell proliferation with a prominent inflammatory infiltrate, while immunohistochemistry showed positivity for vimentin and smooth muscle actin with focal weak ALK-1 expression and a low Ki-67 proliferation index, confirming the diagnosis of IMT. Surgical margins were negative. The postoperative course was uneventful, and the patient remained free of recurrence at 5-month follow-up.
DISCUSSION: Primary IMT of the psoas muscle is extremely rare and may closely mimic malignant retroperitoneal tumors on clinical and radiological evaluation. Preoperative diagnosis is often difficult, and image-guided biopsy may be non-diagnostic. Definitive diagnosis relies on histopathological and immunohistochemical assessment, while complete surgical excision remains the treatment of choice for localized disease.
CONCLUSION: IMT should be considered in the differential diagnosis of retroperitoneal and intramuscular soft-tissue masses, particularly in young adults. Complete surgical resection provides both definitive diagnosis and effective treatment, with favorable short-term outcomes when negative margins are achieved.
CASE PRESENTATION: A 29-year-old man presented with progressive left flank and left iliac fossa pain radiating to the back and left lower limb. Contrast-enhanced computed tomography (CT) revealed a 5.8 × 4.7 × 6.6 cm hypervascular intramuscular mass within the left psoas muscle, highly suspicious for a malignant retroperitoneal soft-tissue neoplasm. CT-guided core needle biopsy was inconclusive. Due to persistent symptoms and diagnostic uncertainty, the patient underwent complete surgical excision of the lesion. Histopathological examination demonstrated a spindle-cell proliferation with a prominent inflammatory infiltrate, while immunohistochemistry showed positivity for vimentin and smooth muscle actin with focal weak ALK-1 expression and a low Ki-67 proliferation index, confirming the diagnosis of IMT. Surgical margins were negative. The postoperative course was uneventful, and the patient remained free of recurrence at 5-month follow-up.
DISCUSSION: Primary IMT of the psoas muscle is extremely rare and may closely mimic malignant retroperitoneal tumors on clinical and radiological evaluation. Preoperative diagnosis is often difficult, and image-guided biopsy may be non-diagnostic. Definitive diagnosis relies on histopathological and immunohistochemical assessment, while complete surgical excision remains the treatment of choice for localized disease.
CONCLUSION: IMT should be considered in the differential diagnosis of retroperitoneal and intramuscular soft-tissue masses, particularly in young adults. Complete surgical resection provides both definitive diagnosis and effective treatment, with favorable short-term outcomes when negative margins are achieved.