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Case report
Radiological diagnostic dilemma in a child with small aggressive facial mass, time to increase the differentials: an inflammatory myofibroblastic tumour
  1. Waleed Mohamed Samy Fawzy1,
  2. Adeena Khan1,
  3. Syed Shahid Habib2 and
  4. Mohammed Abdulmuhsen Alessa3
  1. 1Radiology and Medical Imaging, King Saud University Medical City, Riyadh, Saudi Arabia
  2. 2Clinical Physiology, King Saud University Medical City, Riyadh, Saudi Arabia
  3. 3ENT, Head and Neck, King Saud University Medical City, Riyadh, Saudi Arabia
  1. Correspondence to Dr Adeena Khan; khan.adeena{at}yahoo.com

Abstract

A 5-year-old girl with left facial swelling in the medial maxillary region close to the nasal ala was brought by her parents to our head and neck clinic. They have visited other doctors for similar presentation in the last 6 months, which started as redness and swelling, with occasional epiphora. The redness resolved after medical treatment, with slight regression of swelling, although it did not disappear. CT and MRI showed a locally aggressive, small enhancing soft tissue mass involving the left anteromedial maxillary wall, the nasal bone and the orbital floor. The mass involved the bony course of the nasolacrimal duct, which was the aetiology of the epiphora. The head and neck team performed an incisional biopsy through a sublabial approach. Concurrently, a nasolacrimal duct stent was inserted by an ophthalmologist. Histopathology was consistent with inflammatory myofibroblastic tumour with positive stains for CD68, CD163 and anaplastic lymphoma kinase-1. The tumour was excised and presently the patient is on periodic follow-up with head and neck and ophthalmology clinics.

  • ear
  • nose and throat/otolaryngology
  • pathology
  • radiology

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Footnotes

  • Contributors WMSF planned the case report, interpreted the imaging, wrote the radiological part of the manuscript and did the final review. AK interpreted the imaging, wrote the radiological part of the manuscript, and did the computer work and final review. SSH helped in writing the manuscript, did its critical analysis and finalised the manuscript. MAA wrote the ENT part of the manuscript and did the final review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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