Solitary intestinal myofibroma an unusual cause of neonatal intestinal obstruction

Abstract

Congenital solitary myofibroma is an exceptional tumor of newborn period and presents as solitary or multiple lesions usually confined to soft tissues. It induces intestinal obstruction or perforation, which most frequently involves the jejunum and ileum. However, jejunoileal atresia is the most frequently encountered cause of small bowel obstruction in the neonatal period. We report a new case of solitary myofibroma located in the wall of the ileum, measuring 2.3 cm2 in size, about 25 cm from the ileocecal junction, in a 17-day-old baby girl who presented with abdominal distention and bilious vomiting. Laparotomy was performed on the patient and the tumor was removed; the patient did well after surgery. Despite all the common causes of intestinal obstruction-intestinal atresia, Hirschsprung disease, anorectal anomaly, malrotation, and meconium passage problem in the neonatal period-myofibroma of the small bowel has to be considered because treatment is fairly easy and prognosis is excellent.

Figure 1

Operative view of the lesion.

Figure 2

Overview of the specimen shows the luminal obstruction by thickened wall.

Figure 3

On the left side, unremarkable small bowel is present with normal mucosal villi, submucosa, and muscular smooth muscle wall. On the right side, there is a lesion that causes thickening of the bowel wall and in the picture it extends from the mucosa through the submucosa into the muscularis propria. The mucosa overlying the lesion is ulcerated (hematoxylin and eosin, 20×).

Figure 4

A high microscopic power of the lesion showing hypercellularity and spindle tumor cells with elongated plump nuclei containing several mitotic figures (arrows). Tumor necrosis and nuclear pleomorphism are not present (hematoxylin and eosin, 40×).