Vocal cord inflammatory myofibroblastic tumor with mucoid deposits harboring TIMP3–ALK fusion: A potential diagnostic pitfall

Kenji Yorita, Yuki Togashi, Hideyuki Nakagawa, Katsushi Miyazaki, Seiji Sakata, Satoko Baba, Kengo Takeuchi, Yoshihiro Hayashi, Ichiro Murakami, Naoto Kuroda, Yoshinao Oda, Kenichi Kohashi, Yuichi Yamada, Daisuke Kiyozawa, Michael Michal, Michal Michal

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Abstract

A 35-year-old Japanese man who had experienced hoarseness for 10 years presented with a vocal cord lesion. A gross examination revealed a left vocal cord polyp occupying two-thirds of the vocal space. The endoscopically resected lesion contained scattered atypical fibroblastic, stellate, or ganglion-like cells with mucoid stroma. Vacuolated cells were also seen. Lymphoplasmacytic infiltrate was largely undetectable. A vocal cord polyp was first suspected, but well-differentiated liposarcoma and inflammatory myofibroblastic tumor (IMT) were included in the differential diagnoses. The tumor cells were positive for anaplastic lymphoma kinase (ALK), calponin, and vimentin, and negative for other smooth muscle markers by immunohistochemistry. Structures resembling myofibroblasts were not observed by electron microscopy, which confirmed abundant rough endoplasmic reticulum in the tumor cells and accumulated lipid droplets in some tumor cells. ALK gene rearrangement was detected by fluorescence in situ hybridization, and TIMP3–ALK fusion was confirmed by 5′ rapid amplification of cDNA ends. We diagnosed the lesion as an IMT, and an ALK-rearranged stellate cell tumor may be postulated. This is the first report of a fusion partner gene of ALK in a case of laryngeal IMT.

Original languageEnglish
Pages (from-to)366-371
Number of pages6
JournalPathology International
Volume69
Issue number6
DOIs
Publication statusPublished - 2019

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine

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    Yorita, K., Togashi, Y., Nakagawa, H., Miyazaki, K., Sakata, S., Baba, S., Takeuchi, K., Hayashi, Y., Murakami, I., Kuroda, N., Oda, Y., Kohashi, K., Yamada, Y., Kiyozawa, D., Michal, M., & Michal, M. (2019). Vocal cord inflammatory myofibroblastic tumor with mucoid deposits harboring TIMP3–ALK fusion: A potential diagnostic pitfall. Pathology International, 69(6), 366-371. https://doi.org/10.1111/pin.12796