Khan Adil Aziz, Ahuja Sana, Zaheer Sufian
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3528-3531. doi: 10.1007/s12070-024-04595-x. Epub 2024 Mar 13.
This case report explores a rare and aggressive Malignant Peripheral Nerve Sheath Tumor (MPNST) in a 7-year-old child affecting nasal sinuses, maxilla, and orbit, an exceptionally uncommon pediatric manifestation unrelated to Neurofibromatosis 1. The child presented with alarming symptoms-nasal obstruction, snoring, epistaxis, and difficulty swallowing-underscoring the case's urgency. Non-contrast computed tomography revealed an extensive mass infiltrating nasopharynx, nasal cavity, maxillary sinus, ethmoid sinuses, and orbit, causing destructive consequences. Histopathology confirmed a high-grade MPNST, marked by rapid growth and early metastasis, highlighting management challenges. The rarity of pediatric MPNST in the nasal cavity is discussed, emphasizing the need for a broad differential diagnosis. Treatment involves surgical resection and adjuvant chemoradiation with a grim prognosis due to diagnostic complexities and morphological mimicry in young patients.
本病例报告探讨了一名7岁儿童中罕见且侵袭性的恶性外周神经鞘瘤(MPNST),该肿瘤累及鼻窦、上颌骨和眼眶,这是一种与1型神经纤维瘤病无关的极为罕见的儿科表现。患儿出现了令人担忧的症状——鼻塞、打鼾、鼻出血和吞咽困难——凸显了该病例的紧迫性。非增强计算机断层扫描显示一个广泛的肿块浸润鼻咽、鼻腔、上颌窦、筛窦和眼眶,造成了破坏性后果。组织病理学证实为高级别MPNST,其特点是生长迅速和早期转移,突出了管理挑战。文中讨论了鼻腔小儿MPNST的罕见性,强调了进行广泛鉴别诊断的必要性。治疗包括手术切除和辅助放化疗,由于年轻患者诊断复杂且存在形态学模仿,预后严峻。