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Gehle S, Quinsey C, McShane D, Thompson P, Quezada G. Infantile Myofibromatosis With Cutaneous, Visceral, and CNS Involvement: A Multimodal Approach to Therapy. J Pediatr Hematol Oncol 2023; 45:e921-e923. [PMID: 37526359 DOI: 10.1097/mph.0000000000002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/08/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Infantile myofibromatosis (IM) is a rare benign tumor of infancy. Cases with solitary and multicentric disease usually spontaneously regress, but multicentric disease with visceral involvement carries a poor prognosis. Few cases of multicentric disease with central nervous system (CNS) involvement have been reported, and none report survival. OBSERVATIONS We present a newborn with multicentric IM with cutaneous, visceral, and CNS involvement. She was treated with vinblastine, methotrexate, and the novel addition of intrathecal methotrexate with treatment response after 1 year of therapy. CONCLUSIONS Multicentric IM with CNS involvement can be successfully treated with a multimodal approach of chemotherapy with the addition of intrathecal methotrexate and surgery.
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Affiliation(s)
| | | | - Diana McShane
- Dermatology, School of Medicine, University of North Carolina, Chapel Hill, NC
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2
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Barry KK, Schienda J, Morrow JJ, Al-Ibraheemi A, Balkin DM, Church AJ, Eng W, Janeway KA, Kamihara J, Liang MG. Genomic analysis reveals germline and somatic PDGFRB variants with clinical implications in familial infantile myofibromatosis. Pediatr Blood Cancer 2023; 70:e30262. [PMID: 36861440 DOI: 10.1002/pbc.30262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Kelly K Barry
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jaclyn Schienda
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James J Morrow
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Alyaa Al-Ibraheemi
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel M Balkin
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alanna J Church
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Whitney Eng
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Katherine A Janeway
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Junne Kamihara
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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3
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Jabbari S, Salari B, He M, Dehner LP. Infantile Fibrosarcoma and Other Spindle Cell Neoplasms of Infancy. A Review of Morphologically Overlapping yet Molecularly Distinctive Entities. Fetal Pediatr Pathol 2022; 41:996-1014. [PMID: 35044292 DOI: 10.1080/15513815.2021.2024631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Regardless of age at presentation, many soft tissue neoplasms have overlapping histopathologic and immunophenotypic features to serve as a diagnostic challenge. CASE REPORT We reported a case of a spindle cell neoplasm in an infant, which was initially considered a vascular anomaly clinically and an eventual biopsy revealed marked inflammation with a spindle cell component that was resolved as an infantile fibrosarcoma with an ETV6 break-apart. CONCLUSION The context of this case lead to a further consideration of various other spindle cell neoplasms arising predominantly in the soft tissues during the infancy period as defined by the first two years of age. Though sharing similar morphologic features, these tumors can be categorized into several molecular genetic groups, which have provided both diagnostic and pathogenetic insights as well as treatment options in some cases.
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Affiliation(s)
- Shiva Jabbari
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA
| | - Behzad Salari
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA
| | - Mai He
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA.,St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO, USA
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, USA.,St. Louis Children's Hospitals, Washington University Medical Center, St. Louis, MO, USA
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Muacevic A, Adler JR, El Sayed F. A Recurrent Cheek Mass. Cureus 2022; 14:e31300. [PMID: 36514628 PMCID: PMC9733939 DOI: 10.7759/cureus.31300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Solitary infantile myofibroma is a benign fibrous tumor occurring in early childhood. Although rare, it is the most common benign fibrous tumor of infancy. The clinical course of the disease is almost uniformly good since most tumors regress spontaneously. When indicated, conservative surgical excision is the treatment of choice, with a low recurrence rate. We present a case of solitary infantile myofibroma that recurred after three attempts of surgical excision, questioning the reported recurrence rate and the standard of care in recurrent solitary infantile myofibroma.
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Elsbernd A, Boulouadnine B, Ahmed A, Farooqi M, Sandritter T, Shakhnovich V, Blanding D, Demoulin JB, Thompson J. Novel Oncogenic PDGFRB Variant in Severe Infantile Myofibromatosis With Response to Imatinib Using Therapeutic Drug Monitoring. JCO Precis Oncol 2022; 6:e2200250. [DOI: 10.1200/po.22.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Abbey Elsbernd
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Atif Ahmed
- Department of Laboratory Medicine and Pathology, Seattle Children's Hospital, Seattle, WA
| | - Midhat Farooqi
- Department of Pathology & Laboratory Medicine, Children's Mercy Hospitals and Clinics, Kansas City, MO
- Department of Pathology, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Tracy Sandritter
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Valentina Shakhnovich
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, MO
- Division of Gastroenterology, Hepatology & Nutrition, Children's Mercy Hospitals and Clinics, Kansas City, MO
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Darius Blanding
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Joel Thompson
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
- Division of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospitals and Clinics, Kansas City, MO
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Carruthers V, Barnett S, Rees R, Arif T, Slater O, Ramanujachar R, Johnson K, Brown S, Graham C, Burke GAA, Veal GJ. Clinical utility of vinblastine therapeutic drug monitoring for the treatment of infantile myofibroma patients: A case series. Pediatr Blood Cancer 2022; 69:e29722. [PMID: 35441483 DOI: 10.1002/pbc.29722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/17/2022]
Abstract
Infantile myofibroma is a rare, benign tumour of infancy typically managed surgically. In a minority of cases, more aggressive disease is seen and chemotherapy with vinblastine and methotrexate may be used, although evidence for this is limited. Chemotherapy dosing in infants is challenging, and vinblastine disposition in infants is unknown. We describe the use of vinblastine therapeutic drug monitoring in four cases of infantile myofibroma. Marked inter- and intrapatient variability was observed, highlighting the poorly understood pharmacokinetics of vinblastine in children, the challenges inherent in treating neonates, and the role of adaptive dosing in optimising drug exposure in challenging situations.
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Affiliation(s)
- Vickyanne Carruthers
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Shelby Barnett
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Rees
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Tasnim Arif
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | | | | | | | - Sarah Brown
- Southampton General Hospital, Southampton, UK
| | | | - G A Amos Burke
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Gareth J Veal
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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New Therapeutic Approach in an Infant With Systemic Myofibromatosis and Intestinal Hemorrhage. J Pediatr Hematol Oncol 2022; 44:109-112. [PMID: 34486566 DOI: 10.1097/mph.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
We report the case of an infant with multicentric myofibromatosis affecting the gastric and intestinal mucosa, leading to continuous intestinal hemorrhage and iron deficiency. Conventional vinblastine and methotrexate combination treatment was administered for 4 months, but persistent intestinal blood loss required repeated blood transfusions. Because of insufficient tumor response to treatment, we opted for the experimental combination of rapamycin and dasatinib. Six weeks after the start of this therapy, hemoglobin levels stabilized without transfusions, and no fecal blood loss was detected. In addition, a follow-up magnetic resonance imaging excluded tumor progression. We here show the effectiveness of an experimental therapy with rapamycin and dasatinib in a child with multicentric myofibromatosis after the failure of conventional therapy with vinblastine and methotrexate.
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Pattisapu P, Wenger TL, Dahl JP, Bly RA, Bonilla‐Velez J, Wu N, Hall A, Rudzinski ER, Perkins JA. Avoidance of surgery for head and neck infantile myofibromatosis using imatinib monotherapy. Clin Case Rep 2022; 10:e05382. [PMID: 35154723 PMCID: PMC8826127 DOI: 10.1002/ccr3.5382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 01/06/2023] Open
Abstract
Describe a novel use for a kinase inhibitor, imatinib, in young children with a known activated somatic mutation in PDGFR-beta. Two patients with infantile myofibromatosis treated with imatinib. Case description of evaluation, diagnosis and treatment decisions for infantile myfibromatosis of the head and neck. Description of medical therapy for infantile myofibromatosis in these patients. For function threatening myofibromas of a known genotype, in infants, targeted medical therapy is a treatment option.
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Affiliation(s)
- Prasanth Pattisapu
- Department of Otolaryngology–Head & Neck SurgeryNationwide Children's Hospital and The Ohio State UniversityColumbusOhioUSA
- Center for Surgical Outcomes ResearchAbigail Wexner Research InstituteNationwide Children's HospitalColumbusOhioUSA
| | - Tara L. Wenger
- Department of Genetic MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - John P. Dahl
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
- Division of Pediatric Otolaryngology–Head & Neck SurgerySeattle Children's HospitalSeattleWashingtonUSA
| | - Randall A. Bly
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
- Division of Pediatric Otolaryngology–Head & Neck SurgerySeattle Children's HospitalSeattleWashingtonUSA
| | - Juliana Bonilla‐Velez
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
- Division of Pediatric Otolaryngology–Head & Neck SurgerySeattle Children's HospitalSeattleWashingtonUSA
| | - Natalie Wu
- Department of PediatricsDivision of Hematology/OncologyUniversity of Washington School of MedicineSeattleWashingtonUSA
- Cancer and Blood Disorders CenterSeattle Children's HospitalSeattleWashingtonUSA
| | - Anurekha Hall
- Department of PediatricsDivision of Hematology/OncologyUniversity of Washington School of MedicineSeattleWashingtonUSA
- Cancer and Blood Disorders CenterSeattle Children's HospitalSeattleWashingtonUSA
| | - Erin R. Rudzinski
- Division of PathologySeattle Children's HospitalSeattleWashingtonUSA
- Department of PathologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jonathan A. Perkins
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Washington School of MedicineSeattleWashingtonUSA
- Division of Pediatric Otolaryngology–Head & Neck SurgerySeattle Children's HospitalSeattleWashingtonUSA
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Manisterski M, Benish M, Levin D, Shiran SI, Sher O, Gortzak Y, Elhasid R. Diverse presentation and tailored treatment of infantile myofibromatosis: A single-center experience. Pediatr Blood Cancer 2021; 68:e28769. [PMID: 33063933 DOI: 10.1002/pbc.28769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Infantile myofibromatosis (IM) is a rare benign fibrous tumor with diverse clinical presentations and treatments, such as watchful waiting, surgical excision, and low-dose chemotherapy. PROCEDURE Clinical presentation and tailored treatment of five infants with solitary and generalized IM are described, together with a review of the literature. RESULTS Three patients underwent total-body magnetic resonance imaging (MRI) at diagnosis and during follow up, which revealed disease extension that aided in designing treatment. Visceral involvement included central nervous system, cardiac, gastrointestinal, muscle, bone, and subcutaneous tissue lesions. The patient with the solitary form of IM was followed up without treatment and had spontaneous improvement. Patients with the multicentric form received intravenous low-dose methotrexate and vinblastine chemotherapy. One patient who received oral methotrexate due to cardiac involvement and unfeasible central line access had excellent results. Recurrence was successfully treated by the same methotrexate and vinblastine regimen as that administered at diagnosis. CONCLUSIONS We suggest screening all patients with one or more IM lesions by means of total body MRI due to its inherent superior soft tissue resolution. Total-body MRI may also be used for routine follow up. Oral methotrexate can be administered successfully in patients that lack central line access, and recurrent lesions can be treated with the same chemotherapeutic combination as that given at diagnosis. Long-term follow up is needed, since recurrence could appear years after initial presentation of the disease.
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Affiliation(s)
- Michal Manisterski
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Marganit Benish
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dror Levin
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shelly I Shiran
- Pediatric Radiology Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Osnat Sher
- Institute of Pathology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yair Gortzak
- Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ronit Elhasid
- Department of Pediatric Hemato-Oncology, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Proust S, Benchimol G, Fraitag S, Starck J, Giacobbi V, Pierron G, Bodemer C, Orbach D. Major response to imatinib and chemotherapy in a newborn patient prenatally diagnosed with generalized infantile myofibromatosis. Pediatr Blood Cancer 2021; 68:e28576. [PMID: 32896962 DOI: 10.1002/pbc.28576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/26/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Stéphanie Proust
- Pediatric Oncology Department, University Hospital, Angers, France
| | - Gabriel Benchimol
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sylvie Fraitag
- Pathology Department, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Julie Starck
- Intensive Care Unit, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | | | - Gaelle Pierron
- Department of Somatic Genetic, Institut Curie, Paris, France
| | - Christine Bodemer
- Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
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Turpin B, Todd KE, Pressey JG. Reply to comment on: Solitary myofibroma preceding the development of multicentric myofibromatosis: A report of two cases with surveillance recommendations. Pediatr Blood Cancer 2020; 67:e28669. [PMID: 32798246 DOI: 10.1002/pbc.28669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Brian Turpin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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