TÇCD 2012 30th Annual Congress of Turkish Pediatric Surgical Association

Introduction: Inflammatory myofibroblastic tumor (IMT) known as Inflammatory pseudotumor is a rare non-neoplastic disease in childhood. Usually, they are seen in the lung, liver and retroperitoneum. Herein, a patient who admitted with bloody vomiting and anemia is presented. Histopathologically, revealed inflammatory myofibroblastic tumor in the stomach.

Case: Ten-year-old female patient for upper respiratory tract infection two days after ingestion of acetylsalicylic acid was admitted with bloody vomiting and weakness. In laboratory studies, hemoglobin level was 3.4 gr/dl. As emergency, red blood cell transfusion was performed. Patients not previously known disease, physical examination was normal. Polypoid mass was found at the gastroduodenoscopy in the corpus of the stomach and biopsies were taken from here. Pathologic examination was found extensive vascular structures, increased inflammation and fibroblastic proliferation. In the abdominal computed tomography was seen  polypoid mass which extending in the lumen of the stomach in the large curvature of stomach  approximately in size 5.5 x 3.9 x3.7 cm. In addition, a few lymph nodes were found in the posterolateral of the greater curvature largest 9.5x6 mm. At laparotomy, greater curvature of stomach, in the intraluminal localization 4x5 cm. cm mass was palpated. Bleeding, polypoid mass structure was reached with gastrotomy and wedge resection was performed. Histopathologically, inflammatory myofibroblastic tumor (inflammatory pseudotumor) was reported. Postoperative course was uneventful and she discharged postoperative 10th day.

Discussion: The IMT’s are benign tumors. Local invasion, relapse, metastasis or malignant transformation is very rare. The etiology is unclear, but infection, trauma, radiation are emphasized. Mostly, they can diagnose histopathologically. Treatment is local excision. Early diagnosis and treatment are important in prognosis. There are reported cases of relapse and metastasis. IMT should be considered in the differential diagnosis of tumors of the stomach in children.

Giriş: Enflamatuar psödotümör olarak da bilinen enflamatuar myofibroblastik tümör (EMT) çocukluk çağında nadir görülen neoplastik olmayan bir hastalıktır. Etyolojisi tam bilinmemekle birlikte enfeksiyon, travma, radyasyon üzerinde durulmaktadır. Genellikle, akciğer, karaciğer ve retroperitonda lokalizedir. Midede enflamatuar myofibroblastik tümör nedeniyle opere edilen bir olguyu sunuyoruz.

Olgu sunumu:  On  yaşında kız hasta, solunum yolu enfeksiyonu nedeni ile asetilsalisilik asit alımından iki gün sonra kanlı kusma ve halsizlik ile başvurdu.  Hemoglobin 3.4 g/dl olarak saptanarak eritrosit transfüzyonu yapıldı. Gastroduodenoskopide,  mide korpusunda  polipoid  kitle saptanarak biyopsi alındı. Kitlenin incelemesinde yoğun vasküler yapılar, artmış enflamasyon ve fibroblastik proliferasyon bulundu. Karın BT’sinde; mide büyük kurvaturda 5.5 cm x 3.9 cm x3.7 cm boyutlarında mide lümenine polipoid uzanım gösteren kitle görüldü. Ayrıca büyük kurvatur posterolateralinde  en büyüğü 9.5x6 mm boyutlarında birkaç lenf nodu saptandı. Laparatomide, mide büyük kurvaturunda intraluminal yerleşimli  4x5 cm. boyutlarında kitle palpe edildi. Gastrotomiyle  kanamalı, polipoid  yapıdaki kitleye ulaşılarak wedge rezeksiyon yapıldı. Histopatolojik olarak, enflamatuar myofibroblastik tümör (enflamatuar psödotümör) rapor edildi. Postoperatif herhangi bir sorunu olmayan hasta 10.günde taburcu edildi. İzleminde herhangi bir sorunu olmadı.

Sonuç:   Çocuklarda saptanan mide tümörleri içinde EMT ayırıcı tanıda akılda tutulmalıdır. Total eksizyon çok güz güldürücü sonuçlar verir.