Inflammatory pseudotumour

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The term inflammatory pseudotumour (IPT) has been used to describe varying entities sharing histological features of a fibroblast or myofibroblast proliferation with an associated prominent chronic inflammatory cell infiltrate (see review [1]). The non-neoplastic members of this entity are generally reactive processes following infection or inflammation.

A subset of these cases would now be classified under the umbrella of IgG4-related disease. There is also a clear neoplastic group, now preferentially known as inflammatory myofibroblastic tumour (IMT), which shows distinct clinical and molecular characteristics including, in ~50% of cases, ALK tyrosine kinase translocations.

The term inflammatory pseudotumour is unhelpful in that even the non-neoplastic entities frequently present as tumours (in the Latin meaning of a swelling or mass). The neoplastic form, as discussed, is clearly 'tumour' and use of the term 'pseudotumour' can be misleading. Older literature that pre-dates the recognition of the neoplastic form (i.e. IMT) is confusing it does not distinguish the non-neoplastic entities from what would now be classified as inflammatory myofibroblastic tumour.

Treatment of both non-neoplastic and neoplastic form is mainly surgical. May recur locally in cases of inadequate excision. Steroids or other forms of immunosuppression are indicated in IgG4-related disease.

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