LETTERS TO THE EDITOR
|Year : 2023 | Volume
| Issue : 3 | Page : 268-269
Inflammatory Myofibroblastic Tumor in a Child Presented as Subacute Intestinal Obstruction Associated with Pancreatitis
Keerthana Bachala1, Ramjeewan Singh1, Amit Kumar Sinha1, Bindey Kumar1, Tarun Kumar2
1 Department of Paediatric Surgery, AIIMS, Patna, Bihar, India
2 Department of Pathology, AIIMS, Patna, Bihar, India
|Date of Submission||26-Sep-2022|
|Date of Decision||28-Feb-2023|
|Date of Acceptance||02-Mar-2023|
|Date of Web Publication||02-May-2023|
#609, Hostel 10, AIIMS, Patna - 801 507, Bihar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bachala K, Singh R, Sinha AK, Kumar B, Kumar T. Inflammatory Myofibroblastic Tumor in a Child Presented as Subacute Intestinal Obstruction Associated with Pancreatitis. J Indian Assoc Pediatr Surg 2023;28:268-9
|How to cite this URL:|
Bachala K, Singh R, Sinha AK, Kumar B, Kumar T. Inflammatory Myofibroblastic Tumor in a Child Presented as Subacute Intestinal Obstruction Associated with Pancreatitis. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Jun 2];28:268-9. Available from: https://www.jiaps.com/text.asp?2023/28/3/268/375519
Inflammatory myofibroblastic tumor (IMT) is a benign and unusual solid tumor that mostly affects children. The most common site is lungs and the incidence is less than 1 in 1 million. We, hereby, report a case of jejunal IMT presenting as subacute intestinal obstruction associated with pancreatitis.
A 1-year-old female child presented with bilious vomiting and constipation and abdominal distension for the past 3 months. On examination, the child had epigastric distension with mild tenderness. The child was managed conservatively. Contrast-enhanced computed tomography abdomen, however, revealed an enhancing circumferential mass around 2 cm at proximal jejunum and bulky pancreas. Serum amylase was 130 IU/L and serum lipase was 366 IU/L. On exploratory laparotomy, a 2 x 2 cm, firm, smooth mass was noted arising from the jejunum. The mass was 10 cm distal to duodeno-jejunal flexure and was encasing about 80% of the bowel lumen [Figure 1]a. Resection of the mass with end-to-end anastomosis was done. Postoperative period was uneventful. Ascitic amylase level was 266 IU/L and ascitic lipase was 4046 IU/L.
|Figure 1: (a) Intraoperative image of tumor marked with yellow arrow (b) (A) the section shows presence of a tumor in the serosal layer (H&E;x4), (B) the tumor is composed of oval to spindle cells, arranged in sheets with the presence of chronic inflammatory infiltrate (H&E;x10), (C) the tumor cells have elongated, prominent nuclei and moderate eosinophilic cytoplasm (H&E;x40), (D) immunopositive to vimentin (IHC;x10), (E) immunopositive for ALK1 (IHC;x10), (F) immunopositive for SMA (IHC;x10), (G) immunonegative for S-100 (IHC;x10), (H) Ki-67 proliferating index-1% (IHC;x10). SMA: Smooth muscle actin|
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Histopathological examination (HPE) revealed spindle cell neoplasm arising from serosal layer of the intestine [Figure 1]b. Immunohistochemistry confirmed IMT [Figure 1]b. The child was followed up for a period of 6 months and was asymptomatic.
In our case, pancreatitis could be associated with local inflammatory changes caused by the tumor and its proximity to pancreas. To our knowledge, this is the first reported case of jejunal IMT associated with pancreatitis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ciftci AO, Akçören Z, Tanyel FC, Senocak ME, Cağlar M, Hiçsönmez A. Inflammatory pseudotumor causing intestinal obstruction: Diagnostic and therapeutic aspects. J Pediatr Surg 1998;33:1843-5.
Dhouib A, Barrazzone C, Reverdin A, Anooshiravani M, Hanquinet S. Inflammatory myofibroblastic tumor of the lung: A rare cause of atelectasis in children. Pediatr Radiol 2013;43:381-4.