Elsevier

Journal of Pediatric Surgery

Volume 35, Issue 11, November 2000, Pages 1635-1637
Journal of Pediatric Surgery

Treatment of pseudotumors with nonsteroidal antiinflammatory drugs

Presented at the 33rd Annual Meeting of the Pacific Association of Pediatric Surgeons, Las Vegas, Nevada, May 15-19, 2000.
https://doi.org/10.1053/jpsu.2000.18340Get rights and content

Abstract

Large inflammatory pseudotumors (IPT) traditionally are managed with extensive surgical resection. This approach, which often is associated with significant morbidity, has been deemed necessary because of the uncertainty of diagnosis, symptomatology, and involvement of vital structures. Also, there is a lack of other reliable therapy for this clinically aggressive yet histologically benign disease characterized by an overreactive inflammatory response. The authors treated 2 cases of abdominal IPT with nonsteroidal antiinflammatory drug (NSAID) with successful results. After a diagnosis of IPT on tumor biopsy, an NSAID trial can confirm the diagnosis and treat the disease by causing tumor shrinkage and eventual resolution. Excision remains indicated in easily resectable tumors and in nonresponders to NSAID therapy. J Pediatr Surg 35:1635-1637. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Case 1

A 6-year-old girl had a 1-year history of intermittent abdominal pain. Computed tomography (CT) scan showed a large pelvic mass suggestive of a sarcoma. The mass measured 3 × 6 × 8 cm, with ipsilateral hydroureter and hydronephrosis (Fig 1A and B).

. (A) Case 1, a 6-year-old girl with large pelvic mass (arrows). (B) Right hydronephrosis secondary to tumor obstruction (arrow). (C) CT scan 4 months into treatment shows complete tumor regression. (D) Resolution of hydronephrosis (arrow).

The patient

Discussion

IPT is characterized by the benign proliferation of myofibroblasts and inflammatory infiltrate with a resultant mass.4, 5, 6 It often is difficult to differentiate IPT from a true malignancy because of the symptomatology, physical examination, and imaging findings.7 Clinically, patients with IPT can present with fever, leukocytosis, anemia, abdominal mass, and pain.1, 2, 4, 5, 6, 7 The radiolographic and operative findings of IPT resemble a true malignancy, because often it shows adherence to

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Address reprint requests to Harry Applebaum, MD, Department of Surgery, Kaiser Permanente Medical Center, 4747 Sunset Blvd, Los Angeles, CA 90029.

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