Solitary Intestinal Fibromatosis with Perinatal Bowel Obstruction

A rare case of neonatal colonic obstruction caused by a solitary intestinal tumor

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.

A Solitary Intestinal Myofibroma: A Rare Cause of Neonatal Anemia

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.

Congenital fibrosarcoma of the bowel: sonographic description of a rare case of neonatal intestinal obstruction

A case of localization in the bowel of congenital fibrosarcoma (a rare soft-tissue tumor usually occurring in the extremities) causing intestinal obstruction in a newborn girl is described. A focal thickening of the ileal wall with features mimicking intussusception was identified at sonography; the final diagnosis was achieved by means of molecular analysis after surgical removal of the mass.

Solitary intestinal fibromatosis associated with congenital ileal atresia

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.

Gastrointestinal polyposis in childhood: clinicopathologic and genetic features

Gastrointestinal polyps and certain extraintestinal lesions in children may herald a hereditary polyposis syndrome, with an increased risk of neoplasia and other health problems for both children and their relatives. The availability of molecular/genetic screening tests has increased early diagnosis of younger members of known polyposis families. This article reviews the gross and microscopic features of polyposis syndromes of childhood and summarizes the molecular/genetic advances in this field. Clinical management is also briefly discussed.

Congenital gastrointestinal stromal tumour is morphologically indistinguishable from the adult form, but does not express CD117 and carries a favourable prognosis

AIMS

The histological and immunohistochemical features of a congenital stromal tumour of the jejunum are compared with those of adult gastrointestinal stromal tumours (GIST). The literature concerning the diagnosis and prognosis of congenital small intestinal stromal tumours is reviewed.

METHODS AND RESULTS

A term female infant presented with intestinal obstruction, from birth. Histology of a 15-mm jejunal nodule showed a predominantly spindle-cell tumour with epithelioid areas. There was a low mitotic count and mild nuclear pleomorphism, extensive necrosis and haemorrhage, and focal calcification. Immunohistochemically, tumour cells stained for muscle specific actin and vimentin. Staining for CD117 (c-kit), S100, desmin and CD34 was negative. The features were compared to those of seven adult cases: no morphological feature was specific to the congenital tumour, which was smaller than the adult cases. There were no ultrastructural features specific for a particular line of differentiation. Immunohistochemical staining patterns were similar, except for CD117, which was strongly positive in all adult tumours, but negative in the congenital tumour.

CONCLUSIONS

This congenital jejunal stromal tumour morphologically resembled adult GIST, but lack of c-kit expression suggests that it is nosologically distinct. Despite the presence of histological features which would cause the tumour to be categorized as malignant in an adult, it is apparent from previous reports of congenital small intestinal stromal tumours that the prognosis is favourable.

Solitary intestinal fibromatosis as a cause of bile vomiting in a neonate

The authors describe a 3-day-old newborn admitted with signs of intestinal obstruction caused by solitary intestinal fibromatosis (SIF). This is a very rare lesion, which has an excellent prognosis. The differential diagnosis of bilious vomiting in a neonate caused by other than tumorous processes in the neonatal intestine is extensive. Probably this kind of lesion is more frequent in the neonatal period than thought until now but underdiagnosed because of the difficulty of diagnosis. Therapy of choice is wide local excision, and prognosis is excellent.

Head and neck infantile myofibromatosis--a report of three cases

Infantile myofibromatosis (IM) is a proliferative disorder characterized by the development of single or multiple nodular lesions arising from cutaneous, subcutaneous, muscular, bone or visceral structures. This proliferation may occur at any anatomical site, but in 30% of the cases it involves the head and neck. We report here three cases of head and neck IM occurring in young children and presenting as solitary lesions. The clinical heterogeneity and the misleading histopathological appearances can make the diagnosis difficult. The treatment is surgical but the low rate of recurrence and the possibility of spontaneous tumoral regression may lead to conservative surgery or therapeutic abstention.

Solitary intestinal fibromatosis: a rare cause of intestinal perforation in neonates

Solitary intestinal fibromatosis (SIF) is very rare; only 9 cases have been described. A new case presenting unusually in a newborn is described and the previously reported cases are reviewed. SIF should be considered in the differential diagnosis of a newborn presenting with an intestinal perforation.

Solitary intestinal fibromatosis mimicking malabsorption syndromes

A 17-month-old baby had symptoms of malabsorption and partial intestinal obstruction. These were found to be caused by obliteration of the jejunum by solitary intestinal fibromatosis. Solitary intestinal fibromatosis, which may imitate malabsorptive diseases of the intestine, is a rare cause of intestinal obstruction in the neonatal period and infancy. Diagnostic aids and differential diagnosis of this rare disease are discussed, and previously reported cases are reviewed.

Solitary intestinal fibromatosis: a rare cause of intestinal obstruction in neonate and infant

A 5-month-old white boy infant exhibited remarkable growth retardation and subsequently developed ileal obstruction, which was found to be due to solitary intestinal fibromatosis. This rare lesion has an excellent prognosis if it is completely excised. This is in contrast to cases of congenital fibromatosis with multiple lesions, which carries a poor prognosis.

Case report 684. Infantile myofibromatosis

A 4-year-old boy presented with a mass in the left groin. Radiographic examination demonstrated that the soft-tissue mass contained calcification and was encroaching on the left femur. The pre-biopsy clinico-radiographic diagnosis was that of some sort of sarcoma. The pathological findings identified the mass as infantile myofibromatosis. This case serves to stress the need for greater caution in the clinico-radiographic diagnosis of soft-tissue tumors.

Solitary intestinal fibromatosis: a rare cause of neonatal obstruction

Solitary intestinal fibromatosis (SIF) is an unusual cause of neonatal intestinal obstruction. A fibromatosis located in the first part of the duodenum, close to the pylorus, was associated with a focus of heterotopic pancreas and mimicked congenital pyloric stenosis. It illustrates the difficulties encountered in the diagnosis and surgical management of this condition.

Infantile myofibromatosis: the most common fibrous tumor of infancy

We describe the clinical courses of four infants with infantile myofibromatosis (IM). This entity is a mesenchymal disorder of early infancy characterized by the formation of tumors in skin, muscle, viscera, bone, and subcutaneous tissues. Previously known as congenital generalized fibromatosis, IM was formerly thought to be a rare condition that was frequently fatal. The majority of the 170 affected patients we describe have been diagnosed since 1980. Furthermore, the mortality rate for these patients is less than 15%. Our review includes the clinical manifestations, as well as histopathologic features, and discusses the prognosis in affected infants. We found that infants with solitary lesions or multiple lesions without visceral involvement generally have a benign course. However, in patients with the multicentric form of the disorder and visceral involvement, 73% have died. Because the lesions may not be easily discernible and most spontaneously resolve, the condition is underdiagnosed and underreported. IM is the most common fibrous tumor of infancy and must be considered when evaluating children who present with either solitary or multiple tumors, particularly during the neonatal period.