Rare case of small bowel inflammatory myofibroblastic tumor

Rare small bowel inflammatory myofibroblastic tumor

Abstract

The inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm with variable biological behavior, which predominantly affects the lungs but can also appear in extrapulmonary sites, including the gastrointestinal tract. When situated in the small intestine, IMT presents substantial diagnostic and therapeutic difficulties. This case emphasizes the complications in diagnosing and surgically managing IMT in an unusual location. A patient, aged 67 with a past record of secondary iron-deficiency anemia, underwent a diagnostic examination due to gastrointestinal symptoms. The esophagogastroduodenoscopy showed a minor hiatal hernia, while a 5 mm hyperemic polyp, confirmed as a tubular adenoma, was identified by colonoscopy. Further MR enterography imaging detected a polypoid tumor approximately 28 mm in the right iliac region, which led to surgical intervention. A lower midline laparotomy revealed an intraluminal tumor in the proximal ileum, 60 cm from the ileocecal valve. A 20 cm segment of the impacted bowel was resected and an end-to-end ileo-ileal anastomosis was successfully achieved. The diagnosis of IMT with an R0 resection was confirmed through histopathological and immunohistochemical analysis. This case underlines the significance of considering IMTs in the differential diagnosis of unexplained gastrointestinal symptoms and highlights the role of imaging and surgical resection in reaching definitive management. Boosting awareness of IMTs in medical practice can lead to earlier recognition and improved patient outcomes.