Congenital intestinal leiomyosarcoma in a neonate

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.

Pediatric intestinal leiomyosarcomas: case report and review of the literature

Primary intestinal leiomyosarcomas in children are rare tumors. Twenty-seven previous cases are documented in the literature with little information available on the treatment, survival, and prognostic factors surrounding these tumors. The authors report the 28th case of pediatric intestinal leiomyosarcoma and its follow-up, that of a newborn presenting with intestinal obstruction. Follow-up from all previously reported cases is not recorded and is needed. Our patient, like most children with this tumor, underwent complete excision with no evidence of recurrence at 5 years. Visceral metastases from these neoplasms are atypical, and recorded long-term prognosis may be favorable, unlike their counterpart in the adult population.

Infantile intestinal leiomyosarcoma: surgical resection (without adjuvant therapy) for cure

A 7-week-old boy presented with a 6-week history of failure to thrive, acute intestinal obstruction, and an apparently irreducible intussusception (noted on contrast enema). He underwent abdominal exploration, during which a cecal mass was identified and resected. The mass proved to be a leiomyosarcoma. Histologically, it was an intermediate-grade malignancy with a predicted 5-year survival rate of 16% to 23% based on data from the adult experience. Three years after resection and without having received adjuvant therapy, he is healthy and free of disease. A review of the literature showed that in infants these tumors are predominantly colonic, compared with the predilection for small intestinal lesions found in the older pediatric and adult populations. Infantile intestinal leiomyosarcomata are rare malignancies that do well if complete surgical excision of the disease can be accomplished. The histological prognostic indicators proposed for intestinal leiomyosarcomas in the adult population cannot be extrapolated to infants because when they occur in infants, they appear to be less aggressive, and these patients do well without adjuvant therapy.

[Primary leiomyosarcoma of the small intestine in a child]

BACKGROUND

Leiomyosarcomas of the digestive tract are very rare in children. They must be differentiated from benign tumors (leiomyoma, schwannoma...) and from other malignant tumors, sometimes with the aid of immuno-histochemical study.

CASE REPORT

A five-year old girl suffered from an abdominal mass associated with fever and alteration of the general condition. An ileal tumor, 8 cm in diameter, was resected. Histological and immunohistochemical studies (anti-vimentin antibodies, anti-actin antibodies and PS100) confirmed the diagnosis of leiomyosarcoma. Uncomplete adjuvant chemotherapy failed to prevent relapse of the tumor.

CONCLUSION

This case confirms the bad prognosis of such a tumor.

Intussusception and leiomyosarcoma of the gastrointestinal tract in a pediatric patient. Case report and review of the literature

Intestinal leiomyosarcoma is a rare tumor in infants and children; only 46 cases have been reported in the English literature. Presenting signs and symptoms include abdominal pain and gastrointestinal obstruction and bleeding. We describe a neonate with the unique presentation of ileocecal intussusception accompanying an ileal leiomyosarcoma. In contrast to adult patients, where intussusception is associated with smooth muscle tumors in 30% of cases, leiomyosarcoma and subsequent intussusception is rare in infancy and childhood. The overall prognosis for long-term survival is similar for both pediatric and adult patients with leiomyosarcoma of the intestinal tract, with a five-year survival in reported cases of 53% and 40%, respectively.

Principles in the management of pediatric intestinal leiomyosarcomas

Primary intestinal leiomyosarcomas in children are unusual tumors with little known about their natural history. Two patients (aged 9 and 10 years) with leiomyosarcoma of the jejunum treated at our institution are reported and added to the 20 other patients reported in the literature. The first patient had a grade 1 leiomyosarcoma completely resected, received no additional therapy, and remains alive with no evidence of disease 14 years later. The second patient presented with a perforated grade 2 leiomyosarcoma which was incompletely resected; he received combination chemotherapy with an initial good response, but eventually died from sarcomatosis 7 years after initial diagnosis. The 22 cases of pediatric intestinal leiomyosarcoma presented more commonly with obstruction or perforation, were able to be completely resected more often, and appear to have a better prognosis than in adults. Thus, intestinal leiomyosarcomas in children appear to have a natural history different from that of the same tumor arising in adults.

Intestinal leiomyosarcoma in childhood: report of two cases

Two girls, 5 and 8 years old, with a leiomyosarcoma of the rectosigmoid and ileum, respectively, were treated at Hospital Luis Calvo Mackenna. In each case, a segmental resection with primary anastomosis was done. After the initial surgery, neither girl has received further treatment for the tumor. To date the two patients remain clinically well and apparently tumor free.

Intestinal leiomyosarcoma in childhood

A 4-month-old boy with leiomyosarcoma of the ileum presented to us with complete intestinal obstruction. Small gut resection was done. The child was well 9 months after surgery with no evidence of a recurrence.