Alimentary tract malignancies in children

Alimentary tract malignancies in children are unusual. From 1952 to 1996, 54 patients (55 cases) underwent surgery at The Children's Hospital, Columbus for intestinal malignancy. Their records were reviewed retrospectively. The mean age at diagnosis was 9.3 years (range, 1 to 17 years). There were 35 boys and 19 girls (M:F ratio, 1:8). Mean follow-up was 108 months. Laparotomy was performed in all but one child. The primary tumor sites included the colon (31 cases), small bowel (12 cases), appendix (9 cases), and stomach (3 cases). Seventy-five percent of the tumors were non-Hodgkin's lymphomas (41 cases), followed by appendiceal carcinoid (9 cases), colon adenocarcinoma (3 cases), and gastric sarcoma (2 cases). Lymphoma occurred in 28 of 31 nonappendiceal large bowel tumors and was the only tumor type seen in the small intestine. There were 21 Burkitt's, 11 lymphoblastic, 6 small cell, and 5 large cell lymphomas. There was a statistically significant increase in the frequency of small bowel lymphoma after 1982 (10 of 20) in comparison with that before 1982 (2 of 21), P < .05. This coincided with an increase in Burkitt's lymphoma from 5 of 21 (pre-1982) to 16 of 20 (post-1982), and a decrease in lymphoblastic lymphomas from 7 of 21 (pre-1982) to 2 of 20 (post-1982), P < .05. Localized disease and complete resection favored survival in lymphoma, whereas age, sex, and urgency of operation had no influence on survival. This study highlights the predominance of lymphoma as the most common, small and large bowel tumor and highlights the emergence of nonendemic Burkitt's as a major entity in pediatric intestinal malignancy.