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Inflammatory myofibroblastic tumor of the small intestine mimicking acute appendicitis: a case report and review of the literature.

Oeconomopoulou A, de Verney Y, Kanavaki K, Stefanaki K, Pavlakis K, Salakos C - J Med Case Rep (2016)

Bottom Line: Inflammatory myofibroblastic tumor of the small intestine is a rare, benign neoplasm in children that should be considered as a possible cause of acute abdomen.A precise diagnosis can be made on the basis of histologic findings.Surgical excision is the treatment of choice.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Department, "IASO" Maternity and Children's Hospital, 37-39 Kifisias Street, 15123, Marousi, Athens, Greece. alexoeconomopoulou@gmail.com.

ABSTRACT

Background: Inflammatory myofibroblastic tumor is a rare tumor of a borderline malignancy. Although it is commonly seen in children, the number of childhood cases in the current literature is limited. The lung is the most commonly affected location. However, cases that have been documented in the mesentery-omentum have mostly been located in the mesentery of the small bowel and not in the antimesenteric edge as in our patient.

Case presentation: A 6-year-old Greek boy was referred to our hospital with acute abdominal pain mimicking appendicitis. Ultrasound and computed tomography revealed a solid mass in the abdomen. The patient underwent laparoscopic resection of the tumor, and histopathology and immunohistochemical analysis favored an omental-mesenteric myxoid hamartoma, which is a variant of an inflammatory myofibroblastic tumor. The patient's postoperative course was uneventful, and he has been asymptomatic during follow-up.

Conclusions: Inflammatory myofibroblastic tumor of the small intestine is a rare, benign neoplasm in children that should be considered as a possible cause of acute abdomen. A precise diagnosis can be made on the basis of histologic findings. Surgical excision is the treatment of choice.

No MeSH data available.


Related in: MedlinePlus

Torsion of the pediculated mass covered by inflammatory omentum in contact with the antimesenteric edge of the small bowel, exteriorized by the umbilical incision
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Fig4: Torsion of the pediculated mass covered by inflammatory omentum in contact with the antimesenteric edge of the small bowel, exteriorized by the umbilical incision

Mentions: As the boy’s history and physical examination referred to acute appendicitis, ultrasound was performed. Ultrasonography showed a well-defined, hypoechogenic solid mass measuring 6 × 2 cm in the right iliac fossa (Figs. 1 and 2). Other abdominal structures, including the appendix, liver, and kidneys, were normal. Because of the complex nature of the lesion, computed tomography was also performed. A computed tomographic scan showed a solid mass measuring 6 × 2.4 cm in the right abdomen. The mass was in contact at one end with the ascending colon and at the other end with the small bowel (Fig. 3). Imaging findings excluded the presence of acute appendicitis or Meckel’s diverticulum. Emergency laparoscopic exploration was performed using a 10-mm trocar placed in the umbilicus with two accessory trocars in the left and right lower quadrants (5 mm). A pediculated solid mass attached to the antimesenteric edge of the ileum and 8 cm proximal to the ileocecal valve was found. It was covered by inflammatory omentum. It appeared ischemic due to torsion at the level of the pediculated attachment to the ileum. The inflammatory part of the omentum covering the mass was laparoscopically resected free, and the mass with the adjacent ileal loop was exteriorized through a circumbilical incision at the site of the umbilical opening and easily separated from the ileal edge [8]. The ileal wall was normal (Fig. 4).Fig. 1


Inflammatory myofibroblastic tumor of the small intestine mimicking acute appendicitis: a case report and review of the literature.

Oeconomopoulou A, de Verney Y, Kanavaki K, Stefanaki K, Pavlakis K, Salakos C - J Med Case Rep (2016)

Torsion of the pediculated mass covered by inflammatory omentum in contact with the antimesenteric edge of the small bowel, exteriorized by the umbilical incision
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837596&req=5

Fig4: Torsion of the pediculated mass covered by inflammatory omentum in contact with the antimesenteric edge of the small bowel, exteriorized by the umbilical incision
Mentions: As the boy’s history and physical examination referred to acute appendicitis, ultrasound was performed. Ultrasonography showed a well-defined, hypoechogenic solid mass measuring 6 × 2 cm in the right iliac fossa (Figs. 1 and 2). Other abdominal structures, including the appendix, liver, and kidneys, were normal. Because of the complex nature of the lesion, computed tomography was also performed. A computed tomographic scan showed a solid mass measuring 6 × 2.4 cm in the right abdomen. The mass was in contact at one end with the ascending colon and at the other end with the small bowel (Fig. 3). Imaging findings excluded the presence of acute appendicitis or Meckel’s diverticulum. Emergency laparoscopic exploration was performed using a 10-mm trocar placed in the umbilicus with two accessory trocars in the left and right lower quadrants (5 mm). A pediculated solid mass attached to the antimesenteric edge of the ileum and 8 cm proximal to the ileocecal valve was found. It was covered by inflammatory omentum. It appeared ischemic due to torsion at the level of the pediculated attachment to the ileum. The inflammatory part of the omentum covering the mass was laparoscopically resected free, and the mass with the adjacent ileal loop was exteriorized through a circumbilical incision at the site of the umbilical opening and easily separated from the ileal edge [8]. The ileal wall was normal (Fig. 4).Fig. 1

Bottom Line: Inflammatory myofibroblastic tumor of the small intestine is a rare, benign neoplasm in children that should be considered as a possible cause of acute abdomen.A precise diagnosis can be made on the basis of histologic findings.Surgical excision is the treatment of choice.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Department, "IASO" Maternity and Children's Hospital, 37-39 Kifisias Street, 15123, Marousi, Athens, Greece. alexoeconomopoulou@gmail.com.

ABSTRACT

Background: Inflammatory myofibroblastic tumor is a rare tumor of a borderline malignancy. Although it is commonly seen in children, the number of childhood cases in the current literature is limited. The lung is the most commonly affected location. However, cases that have been documented in the mesentery-omentum have mostly been located in the mesentery of the small bowel and not in the antimesenteric edge as in our patient.

Case presentation: A 6-year-old Greek boy was referred to our hospital with acute abdominal pain mimicking appendicitis. Ultrasound and computed tomography revealed a solid mass in the abdomen. The patient underwent laparoscopic resection of the tumor, and histopathology and immunohistochemical analysis favored an omental-mesenteric myxoid hamartoma, which is a variant of an inflammatory myofibroblastic tumor. The patient's postoperative course was uneventful, and he has been asymptomatic during follow-up.

Conclusions: Inflammatory myofibroblastic tumor of the small intestine is a rare, benign neoplasm in children that should be considered as a possible cause of acute abdomen. A precise diagnosis can be made on the basis of histologic findings. Surgical excision is the treatment of choice.

No MeSH data available.


Related in: MedlinePlus