Maraviroc is an antiretroviral drug in the CCR5 receptor antagonist class

We report a case of IMT occurring as multiple nodules in the abdominal cavity of a 24-year-old man. The histological features together with the reactivity of spindle cells for Maraviroc actins, desmin, and ALK promptly excluded other possible neoplasms, such as solitary fibrous tumor, gastrointestinal stromal tumor, smooth muscle and neural tumors. ALK protein expression showed a cytoplasmic granular distribution, typically associated with the presence of the CLTC-ALK fusion gene, as confirmed by RT-PCR analysis.12 Cytoplasmic expression of ALK has been frequently found in IMT including cases involving the abdomen,but detailed evaluation of the expression pattern and of the underlying gene anomaly has been rarely performed; it should be noted that the abdomen is the favorite site of the highly aggressive epithelioid-cell variant of IMT, characterized by a perinuclear/nuclear membrane positivity of ALK and by the fusion RANBP2-ALK gene.In the present case, FISH analysis revealed peculiar findings, represented by a single red signal associated with 1 or, more rarely, 2 normal fused yellow signal, suggesting TGF-beta a combination of gene fusion and deletion. Despite the fusion probe excluded EML4 as a putative fusion partner, a similar FISH pattern was previously reported in non small cell lung cancer and was correlated to response to the ALK inhibitor crizotinib. Significant clinical response to crizotinib has been reported in two patients with epithelioid IMT involving the omentum. In the present case, since radical resection of the liver mass was not achieved, the patient was enrolled in a clinical trial with crizotinib, and after 4 months he showed stable disease. Postsurgical adjuvant treatments might be considered in abdominal IMT since it has the highest rate of local recurrence. Furthermore, in the present study we found that, in addition to the macroscopic nodules, tumor cells gsk256066 were dispersed as multiple microscopic foci even composed of single cells beneath the mesothelial layer of the omentum. The latter component might represent dissemination from the main mass along the mesothelium or, alternatively, might arise as independent neoplastic foci. Whatever the case is, these foci likely represent the potential cause of local recurrence and suggest that omentectomy should be considered in cases of abdominal IMT in order to obtain surgical radicality.

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