Gastric inflammatory myofibroblastic tumor in an infant with melena: A case report

Inflammatory myofibroblastic tumor (IMT) of the gastrointestinal tract is exceedingly rare in the pediatric population and typically clinically silent. A previously healthy 12-month-old girl presented with melena and pallor, along with severe anemia (hemoglobin 2.7 g/dL). She was stabilized with transfusions. An initial abdominal ultrasound suggested a Meckel's diverticulum, but the exploratory laparotomy ruled this diagnosis out. Intraoperative gastroscopy revealed a gastric mass in the lesser curvature and biopsies were taken. Microscopy showed granulation tissue and nonspecific inflammation. A postoperative full-body CT-scan confirmed a 2.5- cm gastric mass. She underwent a second gastroscopy with additional biopsies, this time including deeper levels of the gastric mass. Histopathologic and immunohistochemical analysis provided the diagnosis of IMT. The infant underwent a second laparotomy and the tumor was removed through an anterior gastric incision. The tumor was resected. For technical reasons, the margins could not be assessed conclusively. She recovered well from the operation and was discharged on iron supplementation. Follow-up imaging and gastroscopy at three, six, and nine months showed no recurrence of the IMT. IMT of the stomach is rare in infants but should be included in the differential diagnosis of gastrointestinal bleeding.