{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:06:48Z","timestamp":1790705208501,"version":"4.1.0"},"reference-count":42,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,10]]},"abstract":"We illustrate a case of an inflammatory myofibroblastic tumor (IMT) involving the bladder in a woman with dysuria and review the literature and differential diagnosis. Inflammatory myofibroblastic tumor, also referred to as pseudosarcomatous myofibroblastic proliferation, is a rare lesion that can arise in the genitourinary system and is characterized by a fascicular arrangement of myofibroblasts with admixed inflammatory cells and slitlike vessels. Urinary bladder IMT can be a diagnostic pitfall because its histologic features (brisk mitoses, invasion into muscularis propria, and prominent nucleoli) can mimic malignancy. The differential diagnosis of urinary bladder IMT includes sarcomatoid carcinoma and leiomyosarcoma. Diagnostic features such as bland nuclear chromatin, ganglion-like cells, pale eosinophilic cytoplasm with long processes, overexpression of anaplastic lymphoma kinase (immunohistochemistry or gene rearrangement studies), and the absence of atypical mitoses help distinguish IMT from its malignant mimics. Current controversies regarding postoperative spindle cell nodule and IMT are discussed.<\/jats:p>","DOI":"10.5858\/arpa.2014-0274-cc","type":"journal-article","created":{"date-parts":[[2014,9,30]],"date-time":"2014-09-30T18:30:55Z","timestamp":1412101855000},"page":"1272-1277","source":"Crossref","is-referenced-by-count":38,"title":["Inflammatory Myofibroblastic Tumor of the Bladder"],"prefix":"10.5858","volume":"138","author":[{"given":"Megan","family":"Alderman","sequence":"first","affiliation":[{"name":"From the Department of Pathology, University of Michigan Medical School, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi P.","family":"Kunju","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, University of Michigan Medical School, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"issue":"8","key":"i1543-2165-138-10-1272-b01","series-title":"Arch Pathol Lab Med","first-page":"1117","article-title":"Low-grade myofibroblastic proliferation of the urinary bladder","volume":"137","author":"Alquati\n S,","year":"2013","unstructured":"Alquati\n S, \n \n Gira\n FA, \n \n Bartoli\n V, \n et al\n . Low-grade myofibroblastic proliferation of the urinary bladder. Arch Pathol Lab Med. 2013;137(8):1117\u20131128."},{"issue":"5","key":"i1543-2165-138-10-1272-b02","series-title":"Mod Pathol","first-page":"592","article-title":"Utility of ALK-1 protein expression and ALK rearrangements in distinguishing inflammatory myofibroblastic tumor from malignant spindle cell lesions of the urinary bladder","volume":"20","author":"Sukov\n WR,","year":"2007","unstructured":"Sukov\n WR, \n \n Cheville\n JC, \n \n Carlson\n AW, \n et al\n . Utility of ALK-1 protein expression and ALK rearrangements in distinguishing inflammatory myofibroblastic tumor from malignant spindle cell lesions of the urinary bladder. Mod Pathol. 2007;20(5):592\u2013603."},{"issue":"4","key":"i1543-2165-138-10-1272-b03","series-title":"J Urol","first-page":"1235","article-title":"Inflammatory myofibroblastic tumors of the genitourinary tract: single entity or continuum?","volume":"180","author":"Cheng\n L,","year":"2008","unstructured":"Cheng\n L, \n \n Foster\n SR, \n \n MacLennan\n GT, \n et al\n . Inflammatory myofibroblastic tumors of the genitourinary tract: single entity or continuum?J Urol. 2008;180(4):1235\u20131240."},{"issue":"6","key":"i1543-2165-138-10-1272-b04","series-title":"Hum Pathol","first-page":"807","article-title":"Soft tissue tumors of the urinary bladder, part I: myofibroblastic proliferations, benign neoplasms, and tumors of uncertain malignant potential","volume":"38","author":"Lott\n S,","year":"2007","unstructured":"Lott\n S, \n \n Lopez-Beltran\n A, \n \n Maclennan\n GT, \n et al\n . 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Am J Surg Pathol. 1984;8(2):101\u2013108."},{"issue":"7","key":"i1543-2165-138-10-1272-b06","series-title":"Am J Surg Pathol","first-page":"787","article-title":"Pseudosarcomatous myofibroblastic proliferations of the bladder: a clinicopathologic study of 42 cases","volume":"30","author":"Harik\n LR,","year":"2006","unstructured":"Harik\n LR, \n \n Merino\n C, \n \n Coindre\n JM, \n et al\n . Pseudosarcomatous myofibroblastic proliferations of the bladder: a clinicopathologic study of 42 cases. Am J Surg Pathol. 2006;30(7):787\u2013794."},{"key":"i1543-2165-138-10-1272-b07","series-title":"Diagnostic Pathology: Genitourinary","year":"2010","unstructured":"Amin\n M, \n \n McKenney\n J, \n \n Tickoo\n S, \n et al\n , eds. Diagnostic Pathology: Genitourinary. 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Am J Surg Pathol. 1995;19(8):859\u2013872."},{"issue":"12","key":"i1543-2165-138-10-1272-b09","series-title":"Am J Surg Pathol","first-page":"1502","article-title":"Inflammatory myofibroblastic tumors of the urinary tract: a clinicopathologic study of 46 cases, including a malignant example inflammatory fibrosarcoma and a subset associated with high-grade urothelial carcinoma","volume":"30","author":"Montgomery\n EA,","year":"2006","unstructured":"Montgomery\n EA, \n \n Shuster\n DD, \n \n Burkart\n AL, \n et al\n . Inflammatory myofibroblastic tumors of the urinary tract: a clinicopathologic study of 46 cases, including a malignant example inflammatory fibrosarcoma and a subset associated with high-grade urothelial carcinoma. Am J Surg Pathol. 2006;30(12):1502\u20131512."},{"issue":"5","key":"i1543-2165-138-10-1272-b10","series-title":"Histopathology","first-page":"491","article-title":"Spindle cell lesions of the bladder and urinary tract","volume":"55","author":"Shanks\n JH,","year":"2009","unstructured":"Shanks\n JH, \n \n Iczkowski\n KA. \n \n Spindle cell lesions of the bladder and urinary tract. Histopathology. 2009;55(5):491\u2013504."},{"issue":"9","key":"i1543-2165-138-10-1272-b11","series-title":"Mod Pathol","first-page":"931","article-title":"Expression of ALK1 and p80 in inflammatory myofibroblastic tumor and its mesenchymal mimics: a study of 135 cases","volume":"15","author":"Cessna\n MH,","year":"2002","unstructured":"Cessna\n MH, \n \n Zhou\n H, \n \n Sanger\n WG, \n et al\n . Expression of ALK1 and p80 in inflammatory myofibroblastic tumor and its mesenchymal mimics: a study of 135 cases. 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Anaplastic lymphoma kinase (ALK 1) staining and molecular analysis in inflammatory myofibroblastic tumours of the bladder: a preliminary clinicopathological study of nine cases and review of the literature. Mod Pathol. 2004;17(7):765\u2013771."},{"issue":"1","key":"i1543-2165-138-10-1272-b14","series-title":"Am J Surg Pathol","first-page":"99","article-title":"Utility of a comprehensive immunohistochemical panel in the differential diagnosis of spindle cell lesions of the urinary bladder","volume":"33","author":"Westfall\n DE,","year":"2009","unstructured":"Westfall\n DE, \n \n Folpe\n AL, \n \n Paner\n GP, \n et al\n . Utility of a comprehensive immunohistochemical panel in the differential diagnosis of spindle cell lesions of the urinary bladder. 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Genes Chromosomes Cancer. 2003;38(2):187\u2013190."},{"issue":"5","key":"i1543-2165-138-10-1272-b17","series-title":"Histopathology","first-page":"569","article-title":"ALK expression in pseudosarcomatous myofibroblastic proliferations of the genitourinary tract","volume":"48","author":"Hirsch\n MS,","year":"2006","unstructured":"Hirsch\n MS, \n \n Dal Cin\n P, \n \n Fletcher\n CD. \n \n ALK expression in pseudosarcomatous myofibroblastic proliferations of the genitourinary tract. Histopathology. 2006;48(5):569\u2013578."},{"issue":"5","key":"i1543-2165-138-10-1272-b18","series-title":"Am J Surg Pathol","first-page":"e34","article-title":"Sarcomatoid carcinoma of the urinary bladder: the final common pathway of urothelial carcinoma dedifferentiation","volume":"35","author":"Cheng\n L,","year":"2011","unstructured":"Cheng\n L, \n \n Zhang\n S, \n \n Alexander\n R, \n et al\n . 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Lyon, France: IARC Press;2004."},{"issue":"10","key":"i1543-2165-138-10-1272-b20","series-title":"Mod Pathol","first-page":"1043","article-title":"Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms","volume":"14","author":"Iczkowski\n KA,","year":"2001","unstructured":"Iczkowski\n KA, \n \n Shanks\n JH, \n \n Gadaleanu\n V, \n et al\n . Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. Mod Pathol. 2001;14(10):1043\u20131051."},{"issue":"6","key":"i1543-2165-138-10-1272-b21","series-title":"Hum Pathol","first-page":"711","article-title":"Expression of anaplastic lymphoma kinase in soft tissue tumors: an immunohistochemical and molecular study of 249 cases","volume":"35","author":"Li\n XQ,","year":"2004","unstructured":"Li\n XQ, \n \n Hisaoka\n M, \n \n Shi\n DR, \n et al\n . Expression of anaplastic lymphoma kinase in soft tissue tumors: an immunohistochemical and molecular study of 249 cases. Hum Pathol. 2004;35(6):711\u2013721."},{"issue":"8","key":"i1543-2165-138-10-1272-b01","series-title":"Arch Pathol Lab Med","first-page":"1117","article-title":"Low-grade myofibroblastic proliferation of the urinary bladder","volume":"137","author":"Alquati\n S,","year":"2013","unstructured":"Alquati\n S, \n \n Gira\n FA, \n \n Bartoli\n V, \n et al\n . Low-grade myofibroblastic proliferation of the urinary bladder. Arch Pathol Lab Med. 2013;137(8):1117\u20131128."},{"issue":"5","key":"i1543-2165-138-10-1272-b02","series-title":"Mod Pathol","first-page":"592","article-title":"Utility of ALK-1 protein expression and ALK rearrangements in distinguishing inflammatory myofibroblastic tumor from malignant spindle cell lesions of the urinary bladder","volume":"20","author":"Sukov\n WR,","year":"2007","unstructured":"Sukov\n WR, \n \n Cheville\n JC, \n \n Carlson\n AW, \n et al\n . Utility of ALK-1 protein expression and ALK rearrangements in distinguishing inflammatory myofibroblastic tumor from malignant spindle cell lesions of the urinary bladder. Mod Pathol. 2007;20(5):592\u2013603."},{"issue":"4","key":"i1543-2165-138-10-1272-b03","series-title":"J Urol","first-page":"1235","article-title":"Inflammatory myofibroblastic tumors of the genitourinary tract: single entity or continuum?","volume":"180","author":"Cheng\n L,","year":"2008","unstructured":"Cheng\n L, \n \n Foster\n SR, \n \n MacLennan\n GT, \n et al\n . Inflammatory myofibroblastic tumors of the genitourinary tract: single entity or continuum?J Urol. 2008;180(4):1235\u20131240."},{"issue":"6","key":"i1543-2165-138-10-1272-b04","series-title":"Hum Pathol","first-page":"807","article-title":"Soft tissue tumors of the urinary bladder, part I: myofibroblastic proliferations, benign neoplasms, and tumors of uncertain malignant potential","volume":"38","author":"Lott\n S,","year":"2007","unstructured":"Lott\n S, \n \n Lopez-Beltran\n A, \n \n Maclennan\n GT, \n et al\n . Soft tissue tumors of the urinary bladder, part I: myofibroblastic proliferations, benign neoplasms, and tumors of uncertain malignant potential. Hum Pathol. 2007;38(6):807\u2013823."},{"issue":"2","key":"i1543-2165-138-10-1272-b05","series-title":"Am J Surg Pathol","first-page":"101","article-title":"Postoperative spindle cell nodules of genitourinary tract resembling sarcomas: a report of eight cases","volume":"8","author":"Proppe\n KH,","year":"1984","unstructured":"Proppe\n KH, \n \n Scully\n RE, \n \n Rosai\n J. \n \n Postoperative spindle cell nodules of genitourinary tract resembling sarcomas: a report of eight cases. 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Altona, Manitoba, Canada: Amirsys; 2010."},{"issue":"8","key":"i1543-2165-138-10-1272-b08","series-title":"Am J Surg Pathol","first-page":"859","article-title":"Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor): a clinicopathologic and immunohistochemical study of 84 cases","volume":"19","author":"Coffin\n CM,","year":"1995","unstructured":"Coffin\n CM, \n \n Watterson\n J, \n \n Priest\n JR, \n et al\n . Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor): a clinicopathologic and immunohistochemical study of 84 cases. 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Am J Surg Pathol. 2006;30(12):1502\u20131512."},{"issue":"5","key":"i1543-2165-138-10-1272-b10","series-title":"Histopathology","first-page":"491","article-title":"Spindle cell lesions of the bladder and urinary tract","volume":"55","author":"Shanks\n JH,","year":"2009","unstructured":"Shanks\n JH, \n \n Iczkowski\n KA. \n \n Spindle cell lesions of the bladder and urinary tract. Histopathology. 2009;55(5):491\u2013504."},{"issue":"9","key":"i1543-2165-138-10-1272-b11","series-title":"Mod Pathol","first-page":"931","article-title":"Expression of ALK1 and p80 in inflammatory myofibroblastic tumor and its mesenchymal mimics: a study of 135 cases","volume":"15","author":"Cessna\n MH,","year":"2002","unstructured":"Cessna\n MH, \n \n Zhou\n H, \n \n Sanger\n WG, \n et al\n . Expression of ALK1 and p80 in inflammatory myofibroblastic tumor and its mesenchymal mimics: a study of 135 cases. Mod Pathol. 2002;15(9):931\u2013938."},{"issue":"12","key":"i1543-2165-138-10-1272-b12","series-title":"Am J Surg Pathol","first-page":"1609","article-title":"ALK-1 expression in inflammatory myofibroblastic tumor of the urinary bladder","volume":"28","author":"Tsuzuki\n T,","year":"2004","unstructured":"Tsuzuki\n T, \n \n Magi-Galluzzi\n C, \n \n Epstein\n JI. \n \n ALK-1 expression in inflammatory myofibroblastic tumor of the urinary bladder. Am J Surg Pathol. 2004;28(12):1609\u20131614."},{"issue":"7","key":"i1543-2165-138-10-1272-b13","series-title":"Mod Pathol","first-page":"765","article-title":"Anaplastic lymphoma kinase (ALK 1) staining and molecular analysis in inflammatory myofibroblastic tumours of the bladder: a preliminary clinicopathological study of nine cases and review of the literature","volume":"17","author":"Freeman\n A1,","year":"2004","unstructured":"Freeman\n A1, \n \n Geddes\n N, \n \n Munson\n P, \n et al\n . Anaplastic lymphoma kinase (ALK 1) staining and molecular analysis in inflammatory myofibroblastic tumours of the bladder: a preliminary clinicopathological study of nine cases and review of the literature. Mod Pathol. 2004;17(7):765\u2013771."},{"issue":"1","key":"i1543-2165-138-10-1272-b14","series-title":"Am J Surg Pathol","first-page":"99","article-title":"Utility of a comprehensive immunohistochemical panel in the differential diagnosis of spindle cell lesions of the urinary bladder","volume":"33","author":"Westfall\n DE,","year":"2009","unstructured":"Westfall\n DE, \n \n Folpe\n AL, \n \n Paner\n GP, \n et al\n . Utility of a comprehensive immunohistochemical panel in the differential diagnosis of spindle cell lesions of the urinary bladder. Am J Surg Pathol. 2009;33(1):99\u2013105."},{"issue":"4","key":"i1543-2165-138-10-1272-b15","series-title":"J Clin Pathol","first-page":"428","article-title":"Inflammatory myofibroblastic tumours: where are we now?","volume":"61","author":"Gleason\n BC,","year":"2008","unstructured":"Gleason\n BC, \n \n Hornick\n JL. \n \n Inflammatory myofibroblastic tumours: where are we now?\n J Clin Pathol. 2008;61(4):428\u2013437."},{"issue":"2","key":"i1543-2165-138-10-1272-b16","series-title":"Genes Chromosomes Cancer","first-page":"187","article-title":"ALK-ATIC fusion in urinary bladder inflammatory myofibroblastic tumor","volume":"38","author":"Debiec-Rychter\n M,","year":"2003","unstructured":"Debiec-Rychter\n M, \n \n Marynen\n P, \n \n Hagemeijer\n A, \n \n Pauwels\n P. \n \n ALK-ATIC fusion in urinary bladder inflammatory myofibroblastic tumor. Genes Chromosomes Cancer. 2003;38(2):187\u2013190."},{"issue":"5","key":"i1543-2165-138-10-1272-b17","series-title":"Histopathology","first-page":"569","article-title":"ALK expression in pseudosarcomatous myofibroblastic proliferations of the genitourinary tract","volume":"48","author":"Hirsch\n MS,","year":"2006","unstructured":"Hirsch\n MS, \n \n Dal Cin\n P, \n \n Fletcher\n CD. \n \n ALK expression in pseudosarcomatous myofibroblastic proliferations of the genitourinary tract. Histopathology. 2006;48(5):569\u2013578."},{"issue":"5","key":"i1543-2165-138-10-1272-b18","series-title":"Am J Surg Pathol","first-page":"e34","article-title":"Sarcomatoid carcinoma of the urinary bladder: the final common pathway of urothelial carcinoma dedifferentiation","volume":"35","author":"Cheng\n L,","year":"2011","unstructured":"Cheng\n L, \n \n Zhang\n S, \n \n Alexander\n R, \n et al\n . Sarcomatoid carcinoma of the urinary bladder: the final common pathway of urothelial carcinoma dedifferentiation. Am J Surg Pathol. 2011;35(5):e34\u2013e46."},{"key":"i1543-2165-138-10-1272-b19","series-title":"World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs","author":"Eble\n JN,","year":"2004","unstructured":"Eble\n JN, \n \n Sauter\n G, \n \n Epstein\n JI, \n \n Sesterhenn\n IA, \n \n eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon, France: IARC Press;2004."},{"issue":"10","key":"i1543-2165-138-10-1272-b20","series-title":"Mod Pathol","first-page":"1043","article-title":"Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms","volume":"14","author":"Iczkowski\n KA,","year":"2001","unstructured":"Iczkowski\n KA, \n \n Shanks\n JH, \n \n Gadaleanu\n V, \n et al\n . Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. Mod Pathol. 2001;14(10):1043\u20131051."},{"issue":"6","key":"i1543-2165-138-10-1272-b21","series-title":"Hum Pathol","first-page":"711","article-title":"Expression of anaplastic lymphoma kinase in soft tissue tumors: an immunohistochemical and molecular study of 249 cases","volume":"35","author":"Li\n XQ,","year":"2004","unstructured":"Li\n XQ, \n \n Hisaoka\n M, \n \n Shi\n DR, \n et al\n . 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