Footing the diagnosis – Inflammatory myofibroblastic tumor of the ankle

Inflammatory myofibroblastic tumor (IMT) is a rare, borderline neoplasm characterized by the proliferation of myofibroblastic spindle cells within an inflammatory microenvironment. Initially considered a reactive lesion, IMT is now recognized as a true neoplasm due to its potential for local recurrence, rare metastasis, and association with specific genetic alterations. The authors report a case of a 37-year-old female who presented with swelling and pain in the right ankle region for the past 1 month. On ultrasound, it was well defined and heterogeneously hypoechoic with mild vascularity. It had an intermediate signal on T2, with heterogeneous enhancement. Histopathology of the biopsy specimen was suggestive of IMT. IMTs have a variable imaging appearance, typically well circumscribed with hypointensity on magnetic resonance imaging owing to the fibrotic components. Treatment typically involves complete surgical resection, which is often curative. However, for unresectable or recurrent cases, targeted therapies like anaplastic lymphoma kinase inhibitors have shown promise.