Inflammatory myofibroblastic tumor of the ileum in a 17-year-old adolescent: A case report

Abstract

Although the lung is the most common site of inflammatory myofibroblastic tumors (IMT), they sometimes arise in other locations such as the small intestine. A 17-year-old male presented with four days of nausea and vomiting, preceded by one week of crampy abdominal pain, followed by inability to pass feces and flatus. He also reported progressive abdominal swelling over two years, accompanied by significant unquantified weight loss, loss of appetite, and night sweats. On examination, he appeared in severe pain. The abdomen was distended with a 20 × 15 cm hard, nontender mass with irregular borders in the suprapubic region. Multiple inguinal lymph nodes were palpable. Laboratory and imaging investigations were performed including complete blood count (CBC), renal function tests, liver enzymes, serum electrolytes were done. Contrast-enhanced abdominal CT revealed a well-defined, loculated, heterogeneous mass in the lower abdomen, with rhabdomyosarcoma and neuroblastoma considered as differential diagnoses. Ultrasonography-guided fine-needle aspiration cytology was nondiagnostic. After discussion with the patient and his family, surgical intervention was undertaken for both diagnostic and therapeutic purposes. Midline laparotomy revealed a large globular mass arising from the antimesenteric border of the ileum. En bloc resection with ileoileal anastomosis was performed, and the specimen was sent for histopathology, which confirmed an inflammatory myofibroblastic tumor. Postoperatively, a multidisciplinary team—including surgeons, pathologists, radiologists, and pediatric hemato-oncologists—recommended chemotherapy. The patient received four cycles of methotrexate and vinblastine. Imaging at the end of chemotherapy and one-year post-treatment showed no evidence of recurrence. Inflammatory myofibroblastic tumors should be considered in the differential diagnosis of pediatric patients presenting with abdominal masses or nonspecific abdominal symptoms. • Inflammatory myofibroblastic tumors are rare neoplasms with myofibroblast proliferation. • They may arise in lungs, soft tissues, abdomen, and rarely in the small intestine. • IMTs show variable behavior, from benign growth to locally invasive lesions. • Etiology is unclear, with infections, autoimmune conditions, trauma, or surgery suggested. • Diagnosis requires histopathology, and complete surgical excision is the main treatment.