Advances in uterine inflammatory myofibroblastic tumours: Diagnostic challenges and risk stratification

The current understanding of inflammatory myofibroblastic tumours (IMTs) of the gynaecological tract has recently been enhanced by their increased recognition. This increase is largely due to greater accessibility to RNA-based molecular assays used to identify their defining ALK rearrangements. This review summarises the clinical characteristics, morphological spectrum, immunohistochemical profile and molecular underpinnings of uterine IMT. Additionally, this review discusses practical diagnostic considerations including overlap between uterine IMT and smooth muscle tumours as well as pregnancy-associated uterine IMT. Finally, we highlight recent literature demonstrating the potential for aggressive behaviour in uterine IMT, including a novel risk stratification model for identifying high-risk IMT. Uterine inflammatory myofibroblastic tumours (IMT) are increasingly recognised and show considerable overlap with uterine smooth muscle tumours. This review summarises the morphological spectrum, immunohistochemical profile and molecular underpinnings of uterine IMT and highlights recent literature demonstrating the potential for aggressive behaviour, including a novel risk stratification model for predicting behaviour in uterine IMT. image