Myofibroblastic tumor (GIMT) in children: A case report

A 14-year-old girl, without any other clinical symptoms other than upper abdominal discomfort for 3 months, underwent upper gastrointestinal endoscopy. A large irregular mass with central ulceration (Figure 1A,B) was seen. Pathological examination and immunohistochemical examination demonstrated a gastric spindle cell tumor, and the final diagnosis was gastric inflammatory myofibroblastic tumor (GIMT, Figure 2A,B). GIMT is a rare and unique mesenchymal tumor, which often has low malignant manifestations or characteristics of borderline tumors. While it can occur at any age, there is a pediatric preponderance; it presents most commonly between 2 and 16 years old.1-3 It is rarely found in the esophagus or stomach. On endoscopic examination tumors typically appear as polypoid or elevated lesions that are mostly nodular or lobulated, with our without surface ulceration. Advanced tumors may demonstrate gastric wall invasion.4, 5 Histologically, GIMT are characterized by fibroblasts and spindle cell fibroblasts, and often accompanied with inflammatory infiltrates of a large number of plasma cells, lymphocytes, and eosinophil.3 The tumor cells are negative for CD117 expression and positive for SMA and ALK expression, whereas gastrointestinal stromal tumor tumors show the opposite profile.6 GIMTs have a relatively good prognosis but the literature reports a 1-year recurrence rate of about 25%, and a distant metastasis rate of <5%.7 Complete surgical resection is the preferred treatment and chemotherapy may be required. Ongoing clinical follow-up is needed, with regular imaging studies to check for recurrence.8 In this case, the patient's symptoms improved after laparoscopic subtotal gastrectomy and no recurrence was detected up to 1.5 years after surgery. The authors acknowledge that verbal consent has been obtained from the patient and family for the use of the images included in this manuscript. The authors declare no conflicts of interest.