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Inflammatory Pseudotumor (Myoblastic Tumor) of the Genitourinary Tract

¹ Department of Radiology, Ulsan University Hospital, University of Ulsan, 290-3 Jeonha-dong, Ulsan, 682-714, Korea.
² Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —67-year-old man with inflammatory pseudotumor of kidney. Unenhanced (A), corticomedullary phase (B), and early excretory phase (C) images of dynamic CT of kidney show solid mass in lower pole of left kidney. Subtle increased density on unenhanced scan may indicate calcification. On corticomedullary and early excretory phases, mass enhanced and washed out (arrows, B and C). Primary radiologic diagnosis was renal cell carcinoma. Left radical nephrectomy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —67-year-old man with inflammatory pseudotumor of kidney. Unenhanced (A), corticomedullary phase (B), and early excretory phase (C) images of dynamic CT of kidney show solid mass in lower pole of left kidney. Subtle increased density on unenhanced scan may indicate calcification. On corticomedullary and early excretory phases, mass enhanced and washed out (arrows, B and C). Primary radiologic diagnosis was renal cell carcinoma. Left radical nephrectomy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —67-year-old man with inflammatory pseudotumor of kidney. Unenhanced (A), corticomedullary phase (B), and early excretory phase (C) images of dynamic CT of kidney show solid mass in lower pole of left kidney. Subtle increased density on unenhanced scan may indicate calcification. On corticomedullary and early excretory phases, mass enhanced and washed out (arrows, B and C). Primary radiologic diagnosis was renal cell carcinoma. Left radical nephrectomy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —46-year-old man with inflammatory pseudotumor of pancreas and kidney. Inflammatory pseudotumor manifests as multifocal disease such as lymphoma. Contrast-enhanced CT scans show bulbous enlargement of the pancreas (arrow, A) and multifocal low-attenuation lesions (arrowheads, A) in both kidneys. Multiple enlarged nodes in porta hepatis and portocaval space were also present (not shown). Primary radiologic diagnosis was lymphoma. Sonography-guided kidney biopsy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —46-year-old man with inflammatory pseudotumor of pancreas and kidney. Inflammatory pseudotumor manifests as multifocal disease such as lymphoma. Contrast-enhanced CT scans show bulbous enlargement of the pancreas (arrow, A) and multifocal low-attenuation lesions (arrowheads, A) in both kidneys. Multiple enlarged nodes in porta hepatis and portocaval space were also present (not shown). Primary radiologic diagnosis was lymphoma. Sonography-guided kidney biopsy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —38-year-old man with inflammatory pseudotumor of adrenal gland. Inflammatory pseudotumor manifests as local tumor recurrence and metastasis on follow-up images. Contrast-enhanced CT scan shows heterogeneously enhancing mass (arrow) in right adrenal gland. Perihepatic fluid collection is also evident.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —38-year-old man with inflammatory pseudotumor of adrenal gland. Inflammatory pseudotumor manifests as local tumor recurrence and metastasis on follow-up images. Axial T2-weighted MR image (B) shows heterogeneous signal intensity mass in right adrenal gland. Contrast-enhanced axial T1-weighted MR image (C) shows heterogeneous and peripheral enhancement. Primary radiologic diagnosis was primary adrenal tumor. Right adrenalectomy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —38-year-old man with inflammatory pseudotumor of adrenal gland. Inflammatory pseudotumor manifests as local tumor recurrence and metastasis on follow-up images. Axial T2-weighted MR image (B) shows heterogeneous signal intensity mass in right adrenal gland. Contrast-enhanced axial T1-weighted MR image (C) shows heterogeneous and peripheral enhancement. Primary radiologic diagnosis was primary adrenal tumor. Right adrenalectomy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —38-year-old man with inflammatory pseudotumor of adrenal gland. Inflammatory pseudotumor manifests as local tumor recurrence and metastasis on follow-up images. At 2-year follow-up, contrast-enhanced CT scan shows heterogeneously enhancing large mass in right adrenalectomy site, presumed to be local tumor recurrence. Chest CT scan also showed multiple metastatic pulmonary nodules (not shown).

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —47-year-old woman with inflammatory pseudotumor of retroperitoneum. Contrast-enhanced CT scans show homogeneously enhancing mass (arrow, A) in aortic bifurcation area. Nonvisualization of left iliac vein, probably due to thrombus, is evident.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —47-year-old woman with inflammatory pseudotumor of retroperitoneum. Contrast-enhanced CT scans show homogeneously enhancing mass (arrow, A) in aortic bifurcation area. Nonvisualization of left iliac vein, probably due to thrombus, is evident.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —47-year-old woman with inflammatory pseudotumor of retroperitoneum. Axial T2-weighted MR image (C) shows slightly high-signal-intensity mass in retroperitoneum. Contrast-enhanced axial T1-weighted MR image (D) shows peripheral rim enhancement. Primary radiologic diagnosis was retroperitoneal sarcoma with associated thrombosis. Results of surgical resection indicated inflammatory pseudotumor.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —47-year-old woman with inflammatory pseudotumor of retroperitoneum. Axial T2-weighted MR image (C) shows slightly high-signal-intensity mass in retroperitoneum. Contrast-enhanced axial T1-weighted MR image (D) shows peripheral rim enhancement. Primary radiologic diagnosis was retroperitoneal sarcoma with associated thrombosis. Results of surgical resection indicated inflammatory pseudotumor.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —14-year-old boy with inflammatory pseudotumor of pelvis. Inflammatory pseudotumor manifests as a large pelvic mass such as rhabdomyosarcoma. Contrast-enhanced CT scan shows hydronephrosis (arrow) of left kidney and subcapsular hematoma formation (arrowhead).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —14-year-old boy with inflammatory pseudotumor of pelvis. Inflammatory pseudotumor manifests as a large pelvic mass such as rhabdomyosarcoma. Contrast-enhanced CT scan of lower abdomen and pelvis shows a large heterogeneous enhancing mass (arrow). Primary radiologic diagnosis was malignant neoplasm such as rhabdomyosarcoma.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —13-year-old boy with inflammatory pseudotumor of bladder who complained of painless hematuria. Gray-scale sonography (A) and power Doppler sonography (B) images show protruded intraluminal mass in bladder. Increased vascularity (arrow, B) on power Doppler sonography is evident.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —13-year-old boy with inflammatory pseudotumor of bladder who complained of painless hematuria. Gray-scale sonography (A) and power Doppler sonography (B) images show protruded intraluminal mass in bladder. Increased vascularity (arrow, B) on power Doppler sonography is evident.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —13-year-old boy with inflammatory pseudotumor of bladder who complained of painless hematuria. Contrast-enhanced CT scan shows strongly enhancing mass (arrow) in bladder. Cystoscopic biopsy was performed. Pathologic results indicated inflammatory pseudotumor.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —21-year-old woman with inflammatory pseudotumor of bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Contrast-enhanced CT scans show heterogeneous enhancing mass in pelvis. Normal-appearing left ovary (arrow, C) and no visible right ovary are evident. So, right ovarian tumor was considered.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —21-year-old woman with inflammatory pseudotumor of bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Contrast-enhanced CT scans show heterogeneous enhancing mass in pelvis. Normal-appearing left ovary (arrow, C) and no visible right ovary are evident. So, right ovarian tumor was considered.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —21-year-old woman with inflammatory pseudotumor of bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Contrast-enhanced CT scans show heterogeneous enhancing mass in pelvis. Normal-appearing left ovary (arrow, C) and no visible right ovary are evident. So, right ovarian tumor was considered.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —21-year-old woman with inflammatory pseudotumor of bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Axial (D) and coronal (E) T2-weighted MR images show multiloculated large mass in pelvis with compression to bladder. Normal-appearing left ovary (arrow, E) and no visible right ovary are evident.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7E —21-year-old woman with inflammatory pseudotumor of bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Axial (D) and coronal (E) T2-weighted MR images show multiloculated large mass in pelvis with compression to bladder. Normal-appearing left ovary (arrow, E) and no visible right ovary are evident.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7F —21-year-old woman with inflammatory pseudotumor of bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Sagittal contrast-enhanced T1-weighted MR image shows enhancement of septa and compression to bladder. Partial cystectomy was performed. Pathologic results indicated inflammatory pseudotumor arising from urinary bladder.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7G —21-year-old woman with inflammatory pseudotumor of the bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Gross specimen (G) and corresponding photomicrograph (H) show white, gelatinous mass with cystic change and hemorrhage. Multifocal infiltrations of various inflammatory cells (box, H) are evident.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7H —21-year-old woman with inflammatory pseudotumor of the bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Gross specimen (G) and corresponding photomicrograph (H) show white, gelatinous mass with cystic change and hemorrhage. Multifocal infiltrations of various inflammatory cells (box, H) are evident.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7I —21-year-old woman with inflammatory pseudotumor of the bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Photomicrographs show spindle cells within collagenous or myxoid matrix, with a mixed inflammatory cell infiltration. On smooth muscle actin, tumor cells are diffusely positive (not shown). (I, H and E x10; J, H and E x40)

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7J —21-year-old woman with inflammatory pseudotumor of the bladder. Inflammatory pseudotumor manifests as a large multiloculated pelvic mass such as ovarian tumor. Photomicrographs show spindle cells within collagenous or myxoid matrix, with a mixed inflammatory cell infiltration. On smooth muscle actin, tumor cells are diffusely positive (not shown). (I, H and E x10; J, H and E x40)

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