Inflammatory Myofibroblastic Tumor of the Esophagus and Stomach Successfully Treated With ALK Inhibitor in a Pediatric Patient: A Case Report and Concise Review of Literature.

An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of borderline malignant potential. Nearly half of all IMTs have rearrangement of anaplastic lymphoma kinase (ALK) locus on chromosome 2p23 which can be treated with targeted therapy. Herein, we describe an unusual presentation of IMT involving an anatomical region rarely implicated in this disease process. A 15-year-old male patient came to the ER with dysphagia and coffee ground emesis. On esophagogastroscopy, a nodular luminal obstructing 30 × 50 mm mass in the lower esophagus was found, which was continuous with a large, partially circumferential gastric mass extending from the mid-body to the proximal antrum. Biopsies from esophageal and gastric masses revealed submucosal lesions composed of cytologically bland spindle and epithelioid cells, intermingled with inflammatory infiltrate, for which several immunohistochemical (IHC) stains were performed. The molecular study demonstrated ATIC::ALK fusion. Based on morphological, IHC, and molecular study findings, the diagnosis of ALK-positive IMT was rendered. Because surgical excision was deemed infeasible, the patient was started on ALK-inhibiting therapy with crizotinib. The patient responded well with no evidence of residual or recurrent disease on follow-up imaging or surveillance esophagogastroduodenoscopy. Crizotinib was ultimately discontinued after 10 months of therapy, and the patient continues to undergo surveillance imaging for monitoring of disease burden.

Helicobacter pylori Found Guilty of Obstructive Jaundice: A Pediatric Case Report.

Pediatric Helicobacter pylori infection represents a small proportion of disease that is otherwise decreasing in the developed world. Typical presentations have been well-described in the literature. We report a 15-year-old male who presented with jaundice, anemia, dark urine, and poorly characterized abdominal pain and was found to have obstructive jaundice secondary to a duodenal ulcer resulting from H. pylori infection. Obstructive jaundice is a seldom reported complication of duodenal ulcer, particularly in children. This report reviews H. pylori infection, outlines complications of peptic ulcer disease, and illustrates the rarity of obstructive jaundice as a presenting sign of duodenal ulcer in children.

Endoscopic Submucosal Dissection for Resolution of a Symptomatic Pancreatic Rest in a Pediatric Patient: A Case Report and Literature Review.

The pancreatic rest, aberrant, or heterotopic pancreas is a normal function pancreas found in the submucosal layer of the greater curvature of the gastric antrum and occasionally in the duodenum. Most of the patients are asymptomatic and the finding is usually incidental. We describe the case of a child with abdominal pain and history of recurrent ulcers that necessitated esophagogastroduodenoscopy and further evaluation with endoscopic ultrasound that confirmed a submucosal lesion consistent with a pancreatic rest. Endoscopic submucosal dissection was performed without complication, and complete symptom resolution was achieved after dissection of the pancreatic rest.

Endoscopic Management of the Ascending Colon Perforation Secondary to a Rare-Earth Magnets Ingestion in a Pediatric Patient.

Rare magnets (neodymium magnets) are high-powered magnets known to cause intestinal perforation if the intestinal mucosa is trapped in between 2 or several magnets. A bowel perforation in pediatric patients secondary to magnets is usually managed with a surgical intervention that might require enterectomy. We report a case of an 11-year-old boy who presented with abdominal pain and a finding on abdominal x-ray of radiopaque foreign bodies located in the ascending colon. He underwent colonoscopy with a finding of embedded magnets with a colonic perforation. The colonoscopy revealed embedded magnets in the colonic mucosa that were colonoscopically removed, and then, the perforated site was successfully managed with endoclipping of the perforation site in the ascending colon.

Non-Helicobacter pylori Gastric Intestinal Metaplasia in Children: A Series of Cases and Review of the Literature.

In the pediatric population, Gastric Intestinal Metaplasia (GIM) is a finding with unknown frequency and, more importantly, unknown clinical implications. The relationship between Helicobacter pylori (HP) infection and GIM is well documented, as well as an association between duodenogastric reflux and GIM. We present two cases of pediatric patients with GIM along with a review of the literature. The diagnosis of GIM may have adverse clinical implications and should be made with caution in a child. The association of GIM and adenoma/dysplasia and carcinoma is rarely seen in children, primarily because the time required for these to develop takes the individual into adulthood. Treatment, long-term consequences, and surveillance protocols are not well established in the pediatric population. Studies to evaluate the long-term natural history, treatment, and surveillance protocols in children with GIM are needed.