Epithelioid inflammatory myofibroblastic sarcoma of stomach: diagnostic pitfalls and clinical characteristics

Inflammatory myofibroblastic tumor (IMT) is a neoplasm composed of spindled neoplastic myofibroblasts admixed with reactive lymphoplasmacytic cells, plasma cells, and/or eosinophils, which has an intermediate biological behavior. An IMT variant with plump round epithelioid or histiocytoid tumor cells, recognized as epithelioid inflammatory myofibroblastic sarcoma (EIMS), has a more clinically aggressive progression. To the best of our knowledge, only about 40 cases of EIMS have previously been reported in limited literature. Here, we report here a case of unusual EIMS with a relative indolent clinical behavior. We reviewed the literature for 18 similar cases. The patients present with a highly aggressive inflammatory myofibroblastic tumor characterized by round or epithelioid morphology, prominent neutrophilic infiltrate, and positive staining of ALK with RANBP2-ALK gene fusion or RANBP1-ALK gene fusion, or EML4-ALK gene fusion. Our case is the first case of primary stomach EIMS. Moreover, the mechanisms of the rare entity have not been widely recognized and require further study. Early accurate diagnosis and complete resection of this tumor is necessary. Some researchers suggest expression of PD-L1 may provide new strategies for ALK-targeted therapy.