Child with painless neck swelling.
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Contrast CT scan of the neck shows a large left carotid space lesion that displaces the neck vessels anteriorly, compressing the left jugular vein, deviating the thyroid gland and trachea to the right side and extending to the upper mediastinum. Large cystic component of the lesion is seen. No calcification.
Clinical diagnosis and history: Excisional biopsy of mediastinal mass.
Section shows a poorly differentiated malignant tumor composed of sheets of small to medium sized cells with indiscernible to small amounts of cytoplasm and poorly defined outlines, round to elongated nuclei with salt and pepper chromatin and distinct nucleoli in a background of neutrophil- like material. Mitotic figures are increased, the tumor cells arranged in vague nodular pattern with incomplete fibrous septa in between. Focal areas of necrosis with viable tumor cells arranged around blood vessels. focal areas of large spindle pleomprphic undifferentiated cells are also seen.
Morphological features suggestive of poorly differentiated neuroblastoma. Immuno-stains are highly recommended to confirm diagnosis and to exclude other possibilities
Poorly differentiated malignant tumor with morphological features mostly consistent with poorly differentiated neuroblastoma
1 case question available
Neuroblastomas are the most common extra-cranial pediatric solid tumor. It occurs in the neck in 1-5% of patients. Calcification occurs in 80-90%
Pediatric cervical lesions are mostly inflammatory. Other less common non-inflammatory lesions are; cystic hygroma, branchial cyst and thyroglossal duct cyst, which have specific locations.
A carotid space lesion in a pediatric patient could be cervical neuroblastoma, lymphoma or teratoma.
No calcifications seen in this case. Large areas of necrosis are noted with low density.
After mass excision, the lesion proved to be neuroblastoma.