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Gastric leiomyoblastoma (epithelioid leiomyoma) occurring in a child: a case report
B B Rogers1, J E Grishaber, D H Mahoney
1Department of Pathology, Texas Children's Hospital, Houston.
Insights
A rare gastric leiomyoblastoma in a child caused refractory iron deficiency anemia due to tumor erosion and bleeding. This case highlights key diagnostic features differentiating it from other smooth muscle tumors.
Area of Science:
- Gastroenterology
- Pediatric Oncology
- Surgical Pathology
Background:
- Leiomyoblastomas are uncommon smooth muscle neoplasms, typically found in adult gastrointestinal tracts.
- Gastric leiomyoblastomas in pediatric patients are exceptionally rare.
Observation:
- A child presented with persistent iron deficiency anemia attributed to a gastric leiomyoblastoma.
- Microscopic examination revealed epithelioid and spindled cells in a perithelial pattern, characteristic of leiomyoblastoma.
- The tumor exhibited superficial erosion, identified as the source of chronic gastrointestinal bleeding.
Findings:
- Immunohistochemical analysis confirmed muscle actin, vimentin, desmin, and alpha-1-antichymotrypsin expression.
- Electron microscopy identified focal densities alternating with thin filaments, supporting a smooth muscle origin.
- Diagnostic features effectively distinguished the leiomyoblastoma from inflammatory pseudotumors.
Implications:
- This case underscores the importance of considering leiomyoblastomas in pediatric patients with unexplained anemia.
- Accurate histopathological and immunohistochemical evaluation is crucial for correct diagnosis and differentiating from pseudotumors.
- Prognosis appears linked to tumor size, mitotic activity, and cellular morphology, guiding clinical management.
Abstract:
Leiomyoblastomas are rare smooth muscle tumors occurring most commonly in the gastrointestinal tract of adults. We report the unusual occurrence of a gastric leiomyoblastoma in a child who presented with refractory iron deficiency anemia. The tumor had a superficial erosion which was apparently the source of intermittent hemorrhage resulting in anemia. Epithelioid cells, spindled cells, and cells arranged in a perithelial pattern were seen by microscopy, characteristic of a leiomyoblastoma. Immunohistochemical staining demonstrated muscle actin, vimentin, desmin, and alpha-1-antichymotrypsin, and electron microscopy showed focal densities alternating with thin filaments. All of these features help to differentiate the tumor from an inflammatory pseudotumor. Leiomyoblastomas are associated with paragangliomas and pulmonary chondromas in children, but these were not present in this child. The prognosis of leiomyoblastomas may be related to tumor size, mitotic rate, and cellular characteristics.