Inflammatory myofibroblastic tumor in a pediatric patient. A case report from Bolivia.

Abstract

Inflammatory myofibroblastic tumor (IMT) is a distinctive neoplasm with limited metastatic potential. It is a rare disease in pediatrics, generally benign, although with possible progression to malignancy. We present the case of a 6-year-old female patient referred from a second-level hospital due to a clinical picture of large abdominal distension and a palpable abdominal mass. On admission, the patient presented slightly pale, hydrated mucous membranes, complained of abdominal discomfort, a distended abdomen, tender to superficial and deep palpation, with no peritoneal irritation. A giant abdominal mass was palpated occupying all quadrants of the abdomen, of hard consistency, tender to deep palpation, and hypoactive air sounds (AAR). An abdominal ultrasound was performed, which reported a retroperitoneal tumor lesion. Based on this finding, an abdominal and pelvic computed tomography (CT) scan with contrast was indicated, with the finding of a heterogeneous retroperitoneal tumor lesion likely related to neuroblastoma. Based on all the findings, the patient was admitted to the operating room for exploratory laparotomy and open biopsy. Transoperatively, a giant abdominal mass was revealed. Histopathological findings were consistent with inflammatory myofibroblastic tumor. The diagnosis was confirmed with immunohistochemistry. A comprehensive multidisciplinary evaluation was performed, and surgical intervention was initiated, with favorable outcomes. From a therapeutic perspective, complete surgical resection remains the mainstay of treatment, as it was in our clinical case, especially in localized and resectable lesions, as it is associated with a lower risk of recurrence. This clinical case highlights the inherent complexity of addressing IMT in pediatric patients, reinforcing the need for close collaboration between pediatricians, surgeons, imaging specialists, pathologists, and oncologists. Furthermore, due to the rarity of the disease in the pediatric population, further research and collective experience are needed to improve our understanding of IMT and refine treatment strategies for these cases.