Endoscopic features of smooth muscle tumors in children with AIDS

Background: Smooth muscle tumors are the second most common malignancy enco untered in children with acquired immunodeficiency syndrome (AIDS). This st udy reviewed the incidence and endoscopic appearance of smooth muscle tumor s in the gastrointestinal tract of children with AIDS undergoing endoscopy. Methods: Retrospective review of all endoscopic records (n = 70) of childre n with AIDS from August 1988 to December 1997 at a tertiary care inner city hospital. Results: Three children with advanced AIDS (4%) were found to have smooth m uscle tumors, all of which had the typical appearance of submucosal nodules with central ulceration. Some were hemorrhagic. They measured less than 1 to 4 cm in diameter. Two children had multiple tumors. All lesions except f or one were located in the colon. Colonic biopsies revealed a leiomyoma in one patient and a smooth muscle tumor of uncertain malignant potential in a nother. The forceps biopsy of the single gastric mass was not deep enough t o make the diagnosis of a smooth muscle tumor. A nonmalignant smooth muscle tumor grew from less than 5 mm to more than 4 cm in 1 year and was removed surgically. All three children are alive without any evidence of local spr ead or distant metastases despite no specific therapy for the smooth muscle tumor. Conclusions: Smooth muscle tumors in the GI tract of children with AIDS are relatively common. Further study of the long-term outcome for children inf ected with the human immunodeficiency virus who have these lesions are need ed to establish prognosis and management guidelines.