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Gastric inflammatory myofibroblastic proliferation in children
J Estêvão-Costa1, J Correia-Pinto, F C Rodrigues
1Department of Pediatrics, Faculty of Medicine, University of Porto, Portugal.
Insights
Gastric inflammatory myofibroblastic proliferation (IMP) is a rare pediatric condition. This study details the ninth case, highlighting its presentation, pathology, and benign nature, crucial for avoiding misdiagnosis and aggressive treatment.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pathology
Background:
- Gastric inflammatory myofibroblastic proliferation (IMP) is exceptionally rare in children, primarily documented in case reports.
- This review encompasses the ninth pediatric case, detailing etiology, clinical/laboratory findings, pathology, treatment, and outcomes.
Observation:
- A predilection for preschool-aged females was noted.
- Key clinical features include abdominal pain, upper gastrointestinal hemorrhage, and abdominal mass.
- Constant finding of iron-deficiency anemia in affected children.
Findings:
- Lesions are elevated, full-thickness gastric wall involvements, often with luminal ulceration.
- Extragastric extension mimicking malignancy is frequent.
- Histological diagnosis post-surgical excision is definitive; Helicobacter pylori association suggests inflammatory origin.
Implications:
- Gastric IMP is a benign entity that can be mistaken for malignancy.
- Surgical excision is curative with low recurrence and no direct mortality.
- Awareness is vital to prevent unnecessary aggressive therapies in pediatric patients.
Abstract:
Gastric inflammatory myofibroblastic proliferation (IMP) is an extremely rare entity in children, which to our knowledge has only been mentioned in case reports. We describe the ninth pediatric case and review the literature concerning the etiology, clinical and laboratory features, pathology, treatment, and outcome. There has been a predominance in preschool females. Abdominal pain, upper gastrointestinal hemorrhage, and an abdominal mass, either isolated or associated, have been the main clinical features. Iron-deficiency anemia has been a constant finding. Lesions are elevated and involve the full thickness of the gastric wall, usually with ulceration of the luminal surface; extragastric extension suggesting malignancy is frequent. Diagnosis is made by histology after surgical excision. There was no mortality directly related to gastric IMP, and only one case recurred after surgical excision. The pathogenesis is controversial, but the finding of Helicobacter pylori in our case may indicate an inflammatory origin. Awareness of this benign lesion and its mimicry of malignancy is important so that inappropriately aggressive therapy can be avoided.