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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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Sugai Y, Hirayama Y, Iinuma Y, Nakaya K, Aikou T, Taki S, Hashidate H, Kinoshita Y. A rare case of neonatal colonic obstruction caused by a solitary intestinal tumor. Surg Case Rep 2021; 7:26. [PMID: 33464419 PMCID: PMC7815852 DOI: 10.1186/s40792-021-01107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Intestinal obstruction caused by a tumor is very rare in newborns, and the preoperative diagnosis is difficult. We herein report a rare case of neonatal colonic obstruction due to solitary intestinal myofibroma with characteristic findings on gastrografin enema and the surgical strategy. Case presentation A 4-day-old female infant presented to our neonatal intensive-care unit with abdominal distention and bilious vomiting after feeding. A gastrografin enema showed that the transverse colon near the hepatic flexure was not delineated at the oral side. When pressure was applied, a small amount of contrast material moved into the mouth in the form of threads. Microcolon was not observed, and stenosis of the transverse colon was found 9 cm from the Bauhin valve. Partial resection and end-to-end anastomosis were performed. A pathological examination of the resected specimen suggested gastrointestinal stromal tumor (GIST). After obtaining a second opinion, the histology and immunohistological markers were deemed characteristic of infantile myofibroma. Conclusion If string sign and a napkin ring appearance are found in a case of neonatal intestinal obstruction, surgery should be performed with a tumor in mind. In cases of neonatal intestinal obstruction caused by a tumor, the lesion should be resected with a sufficient surgical margin before the pathological examination.
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Affiliation(s)
- Yu Sugai
- Department of Pediatric Surgery, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan.
| | - Yutaka Hirayama
- Department of Pediatric Surgery, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan
| | - Yasushi Iinuma
- Department of Pediatric Surgery, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan
| | - Kengo Nakaya
- Department of Pediatric Surgery, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan
| | - Takato Aikou
- Department of Pediatric Surgery, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan.,Department of Pediatric Surgery, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka City, Niigata, 940-2085, Japan
| | - Shotaro Taki
- Department of Pediatric Surgery, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan
| | - Hideki Hashidate
- Department of Pathology, Niigata-City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata, 950-1197, Japan
| | - Yoshiaki Kinoshita
- Division of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Ottenhoff JSE, Nikkels PGJ, Terwisscha van Scheltinga CEJ, Naeije L. A Solitary Intestinal Myofibroma: A Rare Cause of Neonatal Anemia. Case Rep Oncol 2017; 10:890-896. [PMID: 29279689 PMCID: PMC5731177 DOI: 10.1159/000481305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022] Open
Abstract
Solitary infantile myofibroma with visceral involvement is very rare. We present an unusual case of a solitary myofibroma with abdominal localization in a 1-day-old female neonate who presented with severe anemia and rectal bleeding. A bleeding myofibroma was found, located in the wall of the jejunum, and totally resected. In case of a solitary lesion, treatment is relatively easy and effective, with excellent prognosis after total resection. The multiple form (myofibromatosis) has a poor prognosis with low survival rates. We therefore recommend total body MRI for all patients diagnosed with myofibroma to rule out other lesions.
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Affiliation(s)
- Janna S E Ottenhoff
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - L Naeije
- Department of Pediatric Oncology, Hematology and BMT, BC Children's Hospital, Vancouver, British Columbia, Canada
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Nicolas G, Kfoury T, Shimlati R, Tohmeh M, Wakim R. Incidental Finding and Management of Mesenteric Fibromatosis. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:389-94. [PMID: 27279600 PMCID: PMC4917074 DOI: 10.12659/ajcr.898122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Male, 45 Final Diagnosis: Mesenteric fibromatosis Symptoms: — Medication: — Clinical Procedure: Surgical removal of the mesenteric fibromatosis Specialty: Surgery
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Affiliation(s)
| | - Tony Kfoury
- Department of Surgery, Mount Lebanon Hospital, Beirut, Lebanon
| | | | - Maroon Tohmeh
- Department of Surgery, Mount Lebanon Hospital, Beirut, Lebanon
| | - Raja Wakim
- Department of Surgery, Mount Lebanon Hospital, Beirut, Lebanon
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Coulon A, McHeik J, Milin S, Levard G, Levillain P, Fromont G. Solitary intestinal fibromatosis associated with congenital ileal atresia. J Pediatr Surg 2007; 42:1942-5. [PMID: 18022453 DOI: 10.1016/j.jpedsurg.2007.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report for the first time an association between congenital solitary intestinal fibromatosis and intestinal atresia. The spindle cell proliferation showed a high apoptotic index contrasting with a low proliferation rate, suggesting that the tumor may have undergone focal and spontaneous regression, leading to intestinal atresia.
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Affiliation(s)
- Alix Coulon
- Department of Pathology, CHU-Universite de Poitiers, Poitiers, France
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Holubar S, Dwivedi AJ, O'Connor J. Giant Mesenteric Fibromatosis Presenting as Small Bowel Obstruction. Am Surg 2006. [DOI: 10.1177/000313480607200512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mesenteric fibromatosis is a proliferative fibroblastic neoplasia of the small intestine mesentery that may occur as a unique or multiple formation. Mesenteric fibromatosis is a rare, locally aggressive neoplasm and may present with abdominal discomfort, abdominal pain, weight loss, or symptoms of ureteral obstruction, mesenteric ischemia, or intestinal obstruction. It is of the utmost importance to distinguish mesenteric fibromatosis from gastrointestinal stromal tumors. Histopathology accurately differentiates between these two distinct entities. The preferred treatment is local surgical excision with a margin of uninvolved tissue. The involvement of important structures like the superior mesenteric artery and the superior mesenteric vein may pose a challenge during resection, but these tumors can be excised and the vessels repaired primarily.
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Affiliation(s)
- Stefan Holubar
- From the Department of Surgery, North Shore University/Long Island Jewish Medical Center, Manhasset, New York
| | - Amit J. Dwivedi
- From the Department of Surgery, North Shore University/Long Island Jewish Medical Center, Manhasset, New York
| | - James O'Connor
- From the Department of Surgery, North Shore University/Long Island Jewish Medical Center, Manhasset, New York
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Abstract
Mesenteric fibromatosis (MF) is a rare, benign tumor commonly associated with Gardner's syndrome. The signs and symptoms in patients with MF are insidious. Patients may present with abdominal pain or discomfort when the tumors reach large sizes, which is typical at the time of diagnosis. Differentiating MF from other neoplasms such as gastrointestinal stromal tumors may present a diagnostic dilemma, especially in patients without any history of familial adenomatous polyposis. In the present report, we discuss a young girl who presented with MF. A pertinent review of the literature is also presented. This case is peculiar in that MF presented at a young age in a patient without history of familial adenomatous polyposis and occurred in the omentum with local invasion to the stomach.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of California, Irvine, Orange, CA 92868, USA.
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Abstract
Mesenteric fibromatosis is a rare, benign fibrous lesion found in the bowel mesentery or the retroperitoneum. Its biological behavior is intermediate between benign fibrous tissue proliferation and fibrosarcoma. Fibromatosis characteristically is locally invasive and tends to recur but does not metastasize. Most reported cases have been in older individuals, and there is a frequent association with familial polyposis coli, previous trauma, and hormonal imbalance. The authors report a case of mesenteric fibromatosis in a 32-month-old girl with a 1-month history of abdominal pain who was discovered to have an abdominal mass. After appropriate investigations, the mass was excised. The pathology report confirmed the diagnosis of fibromatosis. Mesenteric fibromatosis in children, as in adults, presents a management challenge for the surgeon.
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Affiliation(s)
- S A Al Jadaan
- Department of Surgery, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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