A Case Report of Inflammatory Myofibroblastic Tumor Resection via Fiberoptic Bronchoscopy with Literature Review

A Case Report of Inflammatory Myofibroblastic Tumor Resection via Fiberoptic Bronchoscopy with Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Case Report of Inflammatory Myofibroblastic Tumor Resection via Fiberoptic Bronchoscopy with Literature Review Qian Ye, Lei Wu, Ming Liu, Xuejing Li, Lanfang Tang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7502952/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Mar, 2026 Read the published version in BMC Pediatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Among pediatric neoplasms, inflammatory myofibroblastic tumor (IMT) is a relatively rare disease that typically presents as a solitary tumor within the pulmonary parenchyma and potentially causes both intrapulmonary and extrapulmonary complications. Surgical resection remains the standard treatment. Reports on endoscopic resection via fiberoptic bronchoscopy are limited. We present the case of a 7-year-old boy who presented to our hospital with recurrent cough. Imaging revealed pulmonary atelectasis, and the tumor was successfully resected via snare electrocautery via fiberoptic bronchoscopy. Follow-up revealed no recurrence. Thus, bronchoscopic resection may be considered a viable alternative treatment option for this type of tumor. Figures Figure 1 Figure 2 Figure 3 Background Pulmonary inflammatory myofibroblastic tumor (IMT) is a mesenchymal soft tissue sarcoma with low malignant potential. Currently recognized as a distinct neoplastic entity, it presents unique clinical, pathological, and molecular characteristics. This tumor type has a relatively high prevalence in children, accounting for approximately 20% of primary lung tumors in the 9–10 year age group according to reported cases [ 1 , 2 ]. IMT is defined by the WHO as 'a mesenchymal neoplasm composed of differentiated myofibroblastic spindle cells. It can occur in pulmonary or extrapulmonary sites, mostly as local recurrence, with systemic symptoms being less common[ 3 ]. This tumor is predominantly benign and seldom metastasizes; however, it has a high recurrence rate [ 4 ]. The current literature reports that the formation of IMT (inflammatory myofibroblastic tumor) can be attributed to diverse causes, including trauma, surgery, autoimmune factors, inflammation, and infections (such as Epstein‒Barr virus or human herpesvirus), which contribute to tumor initiation and progression[ 5 ]. This article describes an adolescent who presented with a chief complaint of cough. Imaging of the lungs suggested atelectasis. Subsequent bronchoscopy revealed an endobronchial mass, which was subsequently resected via the bronchoscope via a snare. Case presentation A 7-year-old male child with no notable medical history was hospitalized at a local institution for persistent cough lasting 10 days. Thoracic computed tomography (CT) imaging revealed high-density opacity in the right intermediate bronchus, suggesting the presence of a foreign body. Bronchoscopy examination conducted at the local hospital identified an endobronchial lesion, with differential diagnoses including neoplasm or foreign body. The patient was subsequently referred to our medical center for specialized intervention. Upon admission, the patient was found to have human metapneumovirus (hMPV). Although human metapneumovirus (hMPV) can cause symptoms such as cough, fever, and mucus plugging in the lungs, we believe that pulmonary atelectasis in this child was not solely attributed to this virus. During hospitalization at our institution, contrast-enhanced chest CT was performed to determine the nature of the tracheal mass. The chest CT revealed multiple patchy ground‒glass opacities in the right upper lobe and a triangular hyperdense shadow (measuring approximately 4.4 mm×3.6 mm) within the right intermediate bronchus (Fig. 1 ). No significant enhancement was observed after contrast agent administration. The mediastinal window revealed no enlarged lymph nodes or soft tissue masses. Both the pulmonary arteries and veins showed no apparent filling defects. Under general anesthesia, we performed flexible bronchoscopy examinations on pediatric patients to determine the precise location of the mass and identify appropriate resection margins (Fig. 2 ). We subsequently performed bronchial mass snare resection via an electrocautery snare to remove the lesion, followed by repeated grasping of residual tissue with biopsy forceps. Postoperatively, multipoint cryoprobe hemostasis was conducted under bronchoscopic guidance. The pathological findings of the bronchial mass (Fig. 3 ) suggested a myofibroblastic tumor. The immunohistochemical staining results were as follows: Desmin (+), CD34 (+), CK (pan) (+), STAT6 (cytoplasmic +), Bcl-2 (focal +), Ki-67 (~ 10% +), and CD68 (+). On postoperative day 3, the patient had no significant fever; therefore, she was discharged. Given the high recurrence rate of IMT, follow-up bronchoscopy was performed for this child at 1 and 3 months after treatment, revealing no signs of tumor recurrence (Fig. 2 ). Discussion IMT is one of the more frequently encountered tumors in the pediatric population. Nevertheless, reports of IMTs arising in the airway are rare, comprising only approximately 0.04%-0.07% of respiratory tract neoplasms[ 1 ]. IMT represents a distinct pathological entity featuring a proliferation of tumor-like myofibroblastic spindle cells along with a prominent inflammatory infiltrate, predominantly composed of plasma cells, lymphocytes, and eosinophils[ 6 ]. Depending on the predominant cell type found in the lesion, different designations are used in medical texts, such as plasma cell granulomas (or tumors), xanthogranulomas, plasmacell-histiocytoma complexes, or postinflammatory pseudotumors [ 6 ]. Imaging studies and biopsy play crucial roles in the diagnosis of IMT; however, histological evaluation remains the gold standard [ 7 ]. Histologically, IMT is a well-circumscribed mesenchymal tumor composed of fascicularly arranged spindle cells [ 8 ]. Immunohistochemically, IMT typically shows positivity for CD34 and desmin[ 9 ]. Approximately 50% of IMTs (inflammatory myofibroblastic tumors) contain a chromosomal abnormality that leads to the activation of the anaplastic lymphoma kinase (ALK) gene, which is located at position 2p23 on chromosome 2[ 10 ]. These rearrangements result in constitutive overexpression of the ALK tyrosine kinase. Importantly, IMT diagnosis remains possible even in the absence of detectable ALK protein expression by staining (ALK negative) [ 11 , 12 ]. However, mutations in the ALK gene have not yet been confirmed to be associated with the prognosis of IMT[ 12 – 14 ]. ALK-negative inflammatory myofibroblastic tumors may have greater metastatic potential, whereas pediatric IMTs generally exhibit a relatively favorable prognosis following surgical resection[ 6 ]. The pathogenesis of IMT remains under investigation, but chronic or recurrent respiratory infections or airway irritation leading to inflammatory responses are considered etiological factors. Currently, many studies suggest that the formation of IMTs results from the interaction of multiple factors, including inflammatory responses and chromosomal aberrations[ 15 , 16 ]. IMT predominantly occurs in young people, including children, adolescents, and young adults. While it typically originates in the lungs, it can develop in any part of the body[ 6 ]. The clinical manifestations of IMT are also diverse, depending on the size, location, growth rate, and individual tolerance of the tumor [ 7 ]. IMT demonstrates local invasiveness, with a reported distant metastasis rate of approximately 1%-5% [ 3 , 15 , 17 , 18 ]. According to the current literature, surgical resection continues to be the mainstay of treatment[ 19 ] and is associated with a low recurrence rate and a 10-year survival rate of approximately 80%[ 3 , 20 ]. For tumors that are not amenable to direct resection, limited reports suggest that adjuvant therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, immunotherapy, chemotherapy, and radiotherapy can reduce tumor size, thereby reducing the extent of surgery required [ 21 , 22 ]. Approximately one-third of patients present with systemic inflammation, including fever and other clinical manifestations[ 23 ]. Some patients may present with extrapulmonary manifestations, including clinical features such as fever, weight loss, anemia, thrombocytosis, hyperproteinaemia, and an elevated erythrocyte sedimentation rate (ESR)[ 21 , 24 ]. Radiographically, it appears as a well-defined, solitary, lobulated mass on plain X-ray images and demonstrates heterogeneous attenuation or enhancement on CT images[ 25 ]. Surgical approaches can be classified as thoracotomy, transbronchial approach, or video-assisted thoracoscopic surgery (VATS). Among these, lobectomy is the most common procedure. In pediatric patients, tumor resection via the bronchoscopic snare technique is more effective and has a favorable prognosis than conventional surgery, given the substantial degree of tissue injury inherent to open procedures. Bronchoscopic intervention can achieve a definitive cure or long-term control of the IMT[ 26 ]. Reddy [ 27 ] reported a case of an 18-year-old female who presented to a local hospital with a 4-month history of dyspnea. She underwent cervical and thoracic CT scans and bronchoscopy, which revealed a soft tissue mass at the carina resulting in occlusion of the right main bronchus. Under general anesthesia with a tracheostomy approach, pediatric patients undergo bronchoscopic resection of the IMT [ 27 ]. If the tracheal tumor is excessively large, bronchial artery embolization may be considered to reduce the overall tumor volume, followed by removal of the tumor via bronchoscopy via a snare and biopsy forceps[ 19 ]. The literature reports that among 3 cases of bronchoscopically resected IMT, follow-up revealed that 2 patients were completely cured with no recurrence after 4 years. The remaining case involved a tumor deemed unresectable due to its large size and underwent interventional therapy first [ 26 ]. Luke[ 28 ] reported a 13-year-old boy who presented with hemoptysis and wheezing as the main symptoms. A chest CT revealed an endotracheal mass. The child subsequently underwent bronchoscopic tumor resection under general anesthesia, and pathological biopsy confirmed an inflammatory myofibroblastic tumor (IMT). Bronchoscopic tumor resection was performed on three patients with bronchitis-associated inflammatory myofibroblastic tumors. Postoperative follow-up, including clinical, radiological, and bronchoscopic assessments, was conducted for 26 months, 21 months, and 10 months, respectively, and no recurrence was observed [ 29 ]. Conclusion There are limited clinical reports on bronchoscopic resection of inflammatory myofibroblastic tumors. This technique offers advantages such as minimal tissue trauma, reduced blood loss, and lower surgical risk. However, it is inherently subject to limitations related to tumor location and size. Nevertheless, this technique can lead to improved long-term survival rates and quality of life for patients and can be appropriately implemented in clinical practice. Bronchoscopic interventional therapy can serve as a method for the definitive cure or long-term control of IMT. However, owing to the limited number of clinical cases currently available, long-term follow-up is still necessary to determine the patient prognosis and recurrence rate. Abbreviations IMT Inflammatory myofibroblastic tumor CT Computed Tomography ESR erythrocyte sedimentation rate VATS video-assisted thoracoscopic surgery ALK: anaplastic lymphoma kinase Declarations Ethics approval This study was approved by the Clinical Research Ethics Committee of the Children's Hospital of Zhejiang University School of Medicine (2025-IRB-0380), and consent was obtained from the patient and his guardians. Consent to Participate declaration not applicable. Consent to Publish declaration Not applicable. Acknowledgements Not applicable. Author contributions Xuejing Li participated in the diagnostic pathways and treatment. Qian Ye wrote the paper. Ming Liu revised the manuscript. All the authors have read and approved the final manuscript. Funding No specific funding was used for the current manuscript. Data availability Not applicable. Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent for publication was obtained from the legal guardian of the under-16 patient for all medical images and clinical photographs included in this case report. Consent for publication Written informed consent for publication was obtained from the legal guardian of the under16 patient for all medical images and clinical photographs included in this case report. Competing interests The authors declare that they have no competing interests. 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Srp Arh Celok Lek 2015, 143 (7-8):458-463. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Mar, 2026 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 06 Nov, 2025 Reviews received at journal 04 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviewers agreed at journal 17 Oct, 2025 Reviewers invited by journal 15 Oct, 2025 Editor invited by journal 15 Oct, 2025 Editor assigned by journal 17 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 16 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7502952","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":535543965,"identity":"6447c38c-6b3e-4ff5-b309-f81b6dec806b","order_by":0,"name":"Qian Ye","email":"","orcid":"","institution":"Children's Hospital Zhejiang University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Ye","suffix":""},{"id":535543966,"identity":"29354dd7-aea1-4f5a-b3a1-3bafb25fb533","order_by":1,"name":"Lei Wu","email":"","orcid":"","institution":"Children's Hospital Zhejiang University School of 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1","display":"","copyAsset":false,"role":"figure","size":169554,"visible":true,"origin":"","legend":"\u003cp\u003eA triangular high-density shadow is noted within the lumen of the right middle lobe bronchus.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7502952/v1/e0f86871a818025d6f3762a5.png"},{"id":94638812,"identity":"28d0a04a-feeb-4bb5-88fe-69f7b247528f","added_by":"auto","created_at":"2025-10-29 07:31:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":273781,"visible":true,"origin":"","legend":"\u003cp\u003eA: Bronchoscopic view of the tracheal mass; B: Fiberoptic bronchoscopy was repeated within one month; C: Fiberoptic bronchoscopy was repeated within three months\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7502952/v1/3bb1a7b8d3eafc948a733b9f.png"},{"id":94640876,"identity":"af01c762-4ab7-4c8b-b994-b01d41c17e8a","added_by":"auto","created_at":"2025-10-29 07:50:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":313300,"visible":true,"origin":"","legend":"\u003cp\u003ePathology image of a pediatric patient\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7502952/v1/128b20fdb39aea130576ca9d.png"},{"id":104739567,"identity":"cb413ce2-b24a-4b13-8555-6f0deb7dab3e","added_by":"auto","created_at":"2026-03-16 16:09:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2522288,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7502952/v1/24e1b86b-5594-474e-9509-8e89fbc9a19d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Case Report of Inflammatory Myofibroblastic Tumor Resection via Fiberoptic Bronchoscopy with Literature Review","fulltext":[{"header":"Background","content":"\u003cp\u003ePulmonary inflammatory myofibroblastic tumor (IMT) is a mesenchymal soft tissue sarcoma with low malignant potential. Currently recognized as a distinct neoplastic entity, it presents unique clinical, pathological, and molecular characteristics. This tumor type has a relatively high prevalence in children, accounting for approximately 20% of primary lung tumors in the 9\u0026ndash;10 year age group according to reported cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIMT is defined by the WHO as 'a mesenchymal neoplasm composed of differentiated myofibroblastic spindle cells. It can occur in pulmonary or extrapulmonary sites, mostly as local recurrence, with systemic symptoms being less common[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This tumor is predominantly benign and seldom metastasizes; however, it has a high recurrence rate [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The current literature reports that the formation of IMT (inflammatory myofibroblastic tumor) can be attributed to diverse causes, including trauma, surgery, autoimmune factors, inflammation, and infections (such as Epstein‒Barr virus or human herpesvirus), which contribute to tumor initiation and progression[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis article describes an adolescent who presented with a chief complaint of cough. Imaging of the lungs suggested atelectasis. Subsequent bronchoscopy revealed an endobronchial mass, which was subsequently resected via the bronchoscope via a snare.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 7-year-old male child with no notable medical history was hospitalized at a local institution for persistent cough lasting 10 days. Thoracic computed tomography (CT) imaging revealed high-density opacity in the right intermediate bronchus, suggesting the presence of a foreign body. Bronchoscopy examination conducted at the local hospital identified an endobronchial lesion, with differential diagnoses including neoplasm or foreign body. The patient was subsequently referred to our medical center for specialized intervention. Upon admission, the patient was found to have human metapneumovirus (hMPV). Although human metapneumovirus (hMPV) can cause symptoms such as cough, fever, and mucus plugging in the lungs, we believe that pulmonary atelectasis in this child was not solely attributed to this virus.\u003c/p\u003e\u003cp\u003eDuring hospitalization at our institution, contrast-enhanced chest CT was performed to determine the nature of the tracheal mass. The chest CT revealed multiple patchy ground‒glass opacities in the right upper lobe and a triangular hyperdense shadow (measuring approximately 4.4 mm\u0026times;3.6 mm) within the right intermediate bronchus (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No significant enhancement was observed after contrast agent administration. The mediastinal window revealed no enlarged lymph nodes or soft tissue masses. Both the pulmonary arteries and veins showed no apparent filling defects.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUnder general anesthesia, we performed flexible bronchoscopy examinations on pediatric patients to determine the precise location of the mass and identify appropriate resection margins (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We subsequently performed bronchial mass snare resection via an electrocautery snare to remove the lesion, followed by repeated grasping of residual tissue with biopsy forceps. Postoperatively, multipoint cryoprobe hemostasis was conducted under bronchoscopic guidance. The pathological findings of the bronchial mass (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) suggested a myofibroblastic tumor. The immunohistochemical staining results were as follows: Desmin (+), CD34 (+), CK (pan) (+), STAT6 (cytoplasmic +), Bcl-2 (focal +), Ki-67 (~\u0026thinsp;10% +), and CD68 (+).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOn postoperative day 3, the patient had no significant fever; therefore, she was discharged.\u003c/p\u003e\u003cp\u003eGiven the high recurrence rate of IMT, follow-up bronchoscopy was performed for this child at 1 and 3 months after treatment, revealing no signs of tumor recurrence (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIMT is one of the more frequently encountered tumors in the pediatric population. Nevertheless, reports of IMTs arising in the airway are rare, comprising only approximately 0.04%-0.07% of respiratory tract neoplasms[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIMT represents a distinct pathological entity featuring a proliferation of tumor-like myofibroblastic spindle cells along with a prominent inflammatory infiltrate, predominantly composed of plasma cells, lymphocytes, and eosinophils[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Depending on the predominant cell type found in the lesion, different designations are used in medical texts, such as plasma cell granulomas (or tumors), xanthogranulomas, plasmacell-histiocytoma complexes, or postinflammatory pseudotumors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Imaging studies and biopsy play crucial roles in the diagnosis of IMT; however, histological evaluation remains the gold standard [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Histologically, IMT is a well-circumscribed mesenchymal tumor composed of fascicularly arranged spindle cells [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Immunohistochemically, IMT typically shows positivity for CD34 and desmin[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Approximately 50% of IMTs (inflammatory myofibroblastic tumors) contain a chromosomal abnormality that leads to the activation of the anaplastic lymphoma kinase (ALK) gene, which is located at position 2p23 on chromosome 2[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These rearrangements result in constitutive overexpression of the ALK tyrosine kinase. Importantly, IMT diagnosis remains possible even in the absence of detectable ALK protein expression by staining (ALK negative) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, mutations in the ALK gene have not yet been confirmed to be associated with the prognosis of IMT[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. ALK-negative inflammatory myofibroblastic tumors may have greater metastatic potential, whereas pediatric IMTs generally exhibit a relatively favorable prognosis following surgical resection[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe pathogenesis of IMT remains under investigation, but chronic or recurrent respiratory infections or airway irritation leading to inflammatory responses are considered etiological factors. Currently, many studies suggest that the formation of IMTs results from the interaction of multiple factors, including inflammatory responses and chromosomal aberrations[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. IMT predominantly occurs in young people, including children, adolescents, and young adults. While it typically originates in the lungs, it can develop in any part of the body[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The clinical manifestations of IMT are also diverse, depending on the size, location, growth rate, and individual tolerance of the tumor [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. IMT demonstrates local invasiveness, with a reported distant metastasis rate of approximately 1%-5% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the current literature, surgical resection continues to be the mainstay of treatment[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and is associated with a low recurrence rate and a 10-year survival rate of approximately 80%[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For tumors that are not amenable to direct resection, limited reports suggest that adjuvant therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, immunotherapy, chemotherapy, and radiotherapy can reduce tumor size, thereby reducing the extent of surgery required [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Approximately one-third of patients present with systemic inflammation, including fever and other clinical manifestations[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Some patients may present with extrapulmonary manifestations, including clinical features such as fever, weight loss, anemia, thrombocytosis, hyperproteinaemia, and an elevated erythrocyte sedimentation rate (ESR)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Radiographically, it appears as a well-defined, solitary, lobulated mass on plain X-ray images and demonstrates heterogeneous attenuation or enhancement on CT images[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSurgical approaches can be classified as thoracotomy, transbronchial approach, or video-assisted thoracoscopic surgery (VATS). Among these, lobectomy is the most common procedure. In pediatric patients, tumor resection via the bronchoscopic snare technique is more effective and has a favorable prognosis than conventional surgery, given the substantial degree of tissue injury inherent to open procedures. Bronchoscopic intervention can achieve a definitive cure or long-term control of the IMT[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Reddy [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] reported a case of an 18-year-old female who presented to a local hospital with a 4-month history of dyspnea. She underwent cervical and thoracic CT scans and bronchoscopy, which revealed a soft tissue mass at the carina resulting in occlusion of the right main bronchus. Under general anesthesia with a tracheostomy approach, pediatric patients undergo bronchoscopic resection of the IMT [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. If the tracheal tumor is excessively large, bronchial artery embolization may be considered to reduce the overall tumor volume, followed by removal of the tumor via bronchoscopy via a snare and biopsy forceps[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The literature reports that among 3 cases of bronchoscopically resected IMT, follow-up revealed that 2 patients were completely cured with no recurrence after 4 years. The remaining case involved a tumor deemed unresectable due to its large size and underwent interventional therapy first [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Luke[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] reported a 13-year-old boy who presented with hemoptysis and wheezing as the main symptoms. A chest CT revealed an endotracheal mass. The child subsequently underwent bronchoscopic tumor resection under general anesthesia, and pathological biopsy confirmed an inflammatory myofibroblastic tumor (IMT). Bronchoscopic tumor resection was performed on three patients with bronchitis-associated inflammatory myofibroblastic tumors. Postoperative follow-up, including clinical, radiological, and bronchoscopic assessments, was conducted for 26 months, 21 months, and 10 months, respectively, and no recurrence was observed [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere are limited clinical reports on bronchoscopic resection of inflammatory myofibroblastic tumors. This technique offers advantages such as minimal tissue trauma, reduced blood loss, and lower surgical risk. However, it is inherently subject to limitations related to tumor location and size. Nevertheless, this technique can lead to improved long-term survival rates and quality of life for patients and can be appropriately implemented in clinical practice. Bronchoscopic interventional therapy can serve as a method for the definitive cure or long-term control of IMT. However, owing to the limited number of clinical cases currently available, long-term follow-up is still necessary to determine the patient prognosis and recurrence rate.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIMT Inflammatory myofibroblastic tumor\u003c/p\u003e\n\u003cp\u003eCT Computed Tomography\u003c/p\u003e\n\u003cp\u003eESR erythrocyte sedimentation rate\u003c/p\u003e\n\u003cp\u003eVATS video-assisted thoracoscopic surgery\u003c/p\u003e\n\u003cp\u003eALK: anaplastic lymphoma kinase\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Clinical Research Ethics Committee of the Children\u0026apos;s Hospital of Zhejiang University School of Medicine (2025-IRB-0380), and consent was obtained from the patient and his guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXuejing Li\u0026nbsp;participated in the diagnostic pathways and treatment.\u0026nbsp;Qian Ye wrote the paper. Ming Liu revised the manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u0026nbsp;specific\u0026nbsp;funding was used for the current manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from the legal guardian of the under-16 patient for all medical images and clinical photographs included in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from the legal guardian of the under16 patient for all medical images and clinical photographs included in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDe Palma A, Loizzi D, Sollitto F, Loizzi M: \u003cstrong\u003eSurgical treatment of a rare case of tracheal inflammatory pseudotumor in pediatric age\u003c/strong\u003e. \u003cem\u003eInteract Cardiovasc Thorac Surg \u003c/em\u003e2009, \u003cstrong\u003e9\u003c/strong\u003e(6):1035-1037.\u003c/li\u003e\n\u003cli\u003eGleason BC, Hornick JL: \u003cstrong\u003eInflammatory myofibroblastic tumours: where are we now?\u003c/strong\u003e\u003cem\u003eJ Clin Pathol \u003c/em\u003e2008, \u003cstrong\u003e61\u003c/strong\u003e(4):428-437.\u003c/li\u003e\n\u003cli\u003eFletcher CD: \u003cstrong\u003eThe evolving classification of soft 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Surgical resection remains the standard treatment. Reports on endoscopic resection via fiberoptic bronchoscopy are limited. We present the case of a 7-year-old boy who presented to our hospital with recurrent cough. Imaging revealed pulmonary atelectasis, and the tumor was successfully resected via snare electrocautery via fiberoptic bronchoscopy. Follow-up revealed no recurrence. Thus, bronchoscopic resection may be considered a viable alternative treatment option for this type of tumor.\u003c/p\u003e","manuscriptTitle":"A Case Report of Inflammatory Myofibroblastic Tumor Resection via Fiberoptic Bronchoscopy with Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 07:31:01","doi":"10.21203/rs.3.rs-7502952/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-06T08:07:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-04T11:56:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194046931683269606962030804339845255299","date":"2025-11-04T10:55:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-02T01:12:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117902929222215853719070622447182807828","date":"2025-10-17T09:12:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-15T08:05:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-15T06:17:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T08:49:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T03:17:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-09-17T03:14:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d276c177-41a7-46a0-8da3-edd9085db17d","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:04:58+00:00","versionOfRecord":{"articleIdentity":"rs-7502952","link":"https://doi.org/10.1186/s12887-026-06631-x","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2026-03-13 15:58:54","publishedOnDateReadable":"March 13th, 2026"},"versionCreatedAt":"2025-10-29 07:31:01","video":"","vorDoi":"10.1186/s12887-026-06631-x","vorDoiUrl":"https://doi.org/10.1186/s12887-026-06631-x","workflowStages":[]},"version":"v1","identity":"rs-7502952","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7502952","identity":"rs-7502952","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}