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Inflammatory Myofibroblastic Tumor: A Rare Case Report

Inflammatory myofibroblastic tumors (IMTs) are rare benign tumors that can occur anywhere in the body, most commonly in the pediatric and young adult populations. The gold standard treatment is surgical resection, possibly along with chemotherapy and/or radiotherapy. IMTs have a high recurrence rate...

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Autores principales: Luke, Nicholas D, Gottlieb, Samantha, Brothers, Julia, Winikoff, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122435/
https://www.ncbi.nlm.nih.gov/pubmed/37095797
http://dx.doi.org/10.7759/cureus.36579
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author Luke, Nicholas D
Gottlieb, Samantha
Brothers, Julia
Winikoff, Stephen
author_facet Luke, Nicholas D
Gottlieb, Samantha
Brothers, Julia
Winikoff, Stephen
author_sort Luke, Nicholas D
collection PubMed
description Inflammatory myofibroblastic tumors (IMTs) are rare benign tumors that can occur anywhere in the body, most commonly in the pediatric and young adult populations. The gold standard treatment is surgical resection, possibly along with chemotherapy and/or radiotherapy. IMTs have a high recurrence rate and may present with secondary symptoms, such as hemoptysis, fever, and stridor. We present a 13-year-old male patient with hemoptysis for one month who was subsequently diagnosed with an obstructing IMT of the trachea. The preoperative assessment showed the patient was not in acute distress and could protect his airway, even when lying flat. The treatment plan was discussed with the otolaryngologist, to keep the patient spontaneously breathing throughout the case. Anesthesia was induced with boluses of midazolam, remifentanil, propofol, and dexmedetomidine. Doses were adjusted as needed. Glycopyrrolate was also given to limit the patient's secretions before initiating the surgical procedure. The FiO(2) was kept under 30% as tolerated to reduce the risk of airway fire. During surgical resection, the patient was kept spontaneously breathing, and paralytics were avoided. Due to high tumor vascularity and inability to obtain hemostasis, the patient was kept intubated and on ventilation post-operatively until definitive treatment could be performed. On postoperative day 3, the patient returned to the operating room due to a worsening condition. He was found to have a partial obstruction of the right mainstem bronchus by the tumor. More of the tumor was debulked, and he remained intubated above the level of the debulked mass. The patient was then transferred to a higher acuity institution for advanced care. After the transfer, the patient underwent a carinal resection on cardiopulmonary bypass. This case provides insight into successfully sharing the airway during tracheal tumor resection, emphasizing minimizing the risk of airway fire and constant communication with the surgeon.
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spelling pubmed-101224352023-04-23 Inflammatory Myofibroblastic Tumor: A Rare Case Report Luke, Nicholas D Gottlieb, Samantha Brothers, Julia Winikoff, Stephen Cureus Anesthesiology Inflammatory myofibroblastic tumors (IMTs) are rare benign tumors that can occur anywhere in the body, most commonly in the pediatric and young adult populations. The gold standard treatment is surgical resection, possibly along with chemotherapy and/or radiotherapy. IMTs have a high recurrence rate and may present with secondary symptoms, such as hemoptysis, fever, and stridor. We present a 13-year-old male patient with hemoptysis for one month who was subsequently diagnosed with an obstructing IMT of the trachea. The preoperative assessment showed the patient was not in acute distress and could protect his airway, even when lying flat. The treatment plan was discussed with the otolaryngologist, to keep the patient spontaneously breathing throughout the case. Anesthesia was induced with boluses of midazolam, remifentanil, propofol, and dexmedetomidine. Doses were adjusted as needed. Glycopyrrolate was also given to limit the patient's secretions before initiating the surgical procedure. The FiO(2) was kept under 30% as tolerated to reduce the risk of airway fire. During surgical resection, the patient was kept spontaneously breathing, and paralytics were avoided. Due to high tumor vascularity and inability to obtain hemostasis, the patient was kept intubated and on ventilation post-operatively until definitive treatment could be performed. On postoperative day 3, the patient returned to the operating room due to a worsening condition. He was found to have a partial obstruction of the right mainstem bronchus by the tumor. More of the tumor was debulked, and he remained intubated above the level of the debulked mass. The patient was then transferred to a higher acuity institution for advanced care. After the transfer, the patient underwent a carinal resection on cardiopulmonary bypass. This case provides insight into successfully sharing the airway during tracheal tumor resection, emphasizing minimizing the risk of airway fire and constant communication with the surgeon. Cureus 2023-03-23 /pmc/articles/PMC10122435/ /pubmed/37095797 http://dx.doi.org/10.7759/cureus.36579 Text en Copyright © 2023, Luke et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Luke, Nicholas D
Gottlieb, Samantha
Brothers, Julia
Winikoff, Stephen
Inflammatory Myofibroblastic Tumor: A Rare Case Report
title Inflammatory Myofibroblastic Tumor: A Rare Case Report
title_full Inflammatory Myofibroblastic Tumor: A Rare Case Report
title_fullStr Inflammatory Myofibroblastic Tumor: A Rare Case Report
title_full_unstemmed Inflammatory Myofibroblastic Tumor: A Rare Case Report
title_short Inflammatory Myofibroblastic Tumor: A Rare Case Report
title_sort inflammatory myofibroblastic tumor: a rare case report
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122435/
https://www.ncbi.nlm.nih.gov/pubmed/37095797
http://dx.doi.org/10.7759/cureus.36579
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