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Cases
Cervical Mass in a Newborn
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Background
This 15-day-old boy of Indian origin presents with a 4 X 3-cm mass on the right side of his neck. The mass is firm, noncystic, and nontender. The patient was born by means of normal vaginal delivery after an uncomplicated pregnancy. The mass does not increase in size over the next 2 weeks. The baby is afebrile and has no respiratory symptoms or dysphagia. His complete blood count (CBC) shows no abnormalities.
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down for Hint and Answer
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***** HINT *****
CT scanning of the neck reveals a solid swelling adjacent to the sternocleidomastoid (SCM) muscle.
***** ANSWER *****
Neuroblastoma: Cervical neuroblastoma usually appears as a large cervical tumor and may be associated with stridor, dysphagia, and sympathetic ganglia compression (Horner syndrome). It is the most common extracranial solid tumor, representing 8-10% of childhood cancers. The patient's age at diagnosis is typically less than 5 years.
Neuroblastomas constitute most primary tumors in the abdomen, but they represent less than 2-3% of those in the neck. Investigations for this tumor include tests of urine and serum catecholamine, homovanillic acid, vanillyl mandelic acid, and neuron-specific enolase. Other useful studies may include CT or MRI, metaiodobenzylguanidine (MIBG) bone scanning with or without technitium-99m, tumor biopsy, and bone marrow aspiration.
The differential diagnosis of cervical neuroblastoma includes
- Fibromatosis colli (SCM tumor of infancy)
- Branchial cleft cyst
- Vascular lesion (hemangioma or lymphangioma)
- Dermoid and/or teratoma
- Inflammatory (bacterial, viral, or granulomatous) process
- Neoplastic lesions (lymphoma, carcinoma, or sarcoma)
In this case, the tumor was localized to the neck and completely excised. Abdominal CT and MRI revealed no other pathology. The patient has been followed up every 6 months and, so far, remains asymptomatic after 24 months. The excellent prognosis of localized neuroblastoma in neonates suggests a need for restrictive surgical indications, with well-established anatomic and imaging criteria.
For more information on neuroblastoma, see the eMedicine articles Neuroblastoma (within the Pediatrics specialty) and Neuroblastoma (within the Surgery specialty).
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References
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Arvai K, Toth J, Nemeth T, et al. Cervical neuroblastoma in an infant. Magy Onkol. 2004;48(1):89-95.
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Gorincour G, Dugougeat-Pilleul F, Bouvier R, et al. Prenatal presentation of cervical congenital neuroblastoma. Prenat Diagn 2003;23(8):690-3.
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Haddad A, Azouz EM, al-Jedher S, Baruchel S. Metastatic neuroblastoma presenting as amandibular mass. Can Assoc Radiol J. 1992;43(6):436-40.
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Haddad M, Triglia JM, Helardot P. Localized cervical neuroblastoma: prevention of surgical complications. Int J Pediatr Otorhinolaryngol. 2003;67(12):1361-7.
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Herman TE. Cervical neuroblastoma, stage IV-S. J Perinatol. 2001;21(7):470-2.
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Michalowski MB, Rubie H, Michon J, et al. Neonatal localized neuroblastoma: 52 cases treated from 1990 to 1999. Arch Pediatr. 2004;11(7):782-8.
Author:
Ted L. Tewfik, MD, FRCSC, Director and Professor, Department of Otolaryngology, Montreal Children's Hospital and McGill University, Canada, and M.D. Schloss, MD, Professor of Otolaryngology, McGill University, Canada
eMedicine Editor:
Sat Sharma, MD, Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
Source
http://emedicine.com
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