Neuromuscular and vascular hamartoma: is it a true hamartoma?

Neuromuscular and vascular hamartoma (NMVH) is a very rare gastrointestinal tract lesion. Twenty NMVH cases have been published in the English literature since its first description by Fernando and McGovern in 1982.1 There is no age or gender predilection for NMVH. The clinical presentations of NMVH patients are usually non-specific, including chronic abdominal pain, intermittent bowel obstruction, occult bleeding and iron deficiency anaemia. Three of the 20 reported cases were incidental findings on CT scan or colonoscopy. Radiologically, the involved bowel may demonstrate a stricture with thickened walls, intussusception, or a polypoid mass. All but one case occurred in the small bowel. The two NMVH cases we reported here also showed non-specific clinical and radiologic features. The first patient came to our institute for evaluation of over 1 year of intermittent abdominal pain. She had a history of anaemia and arthritis. Her workup included abdominal and pelvic CT scans, sub-sequential small bowel follow through and antegrade double-balloon enteroscope, which suggested intussusception without obstruction and a long intraluminal lipomatous lesion of the mid-ileum. The lesion was resected. Our second patient had multiple medical problems and several surgeries in the past. An incidental pedunculated polyp at terminal ileum was revealed at a routine screening colonoscopy. The lesion was biopsied and showed prominent smooth muscle that was initially interpreted as consistent with leiomyoma. A right hemicolectomy was performed and three polypoid mass lesions were identified. Grossly, NMVH may occur as single or multiple …