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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 33 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 33

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Nine year old male with a neck mass

Clinical History:
The patient was a 9 1/2 year old male who was noted to have a neck mass 4 days prior to admission. Upon further questioning, the patient stated he had noticed the lump in his neck 3 months ago. The patient denied dysphagia, dyspnea, or pain.

Clinical Physical Exam:
Large, immobile mass across the base of the neck.

Clinical Labs:

Clinical Differential Diagnosis:
Lymphoma, thyroid mass

Imaging Findings:
Chest film showed an anterior mediastinal mass. A chest CT exam showed the extent of the mass, and showed it to be calcified. An ultrasound exam further demonstrated the calcifications.

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Imaging Differential Diagnosis:
Lymphoma, thyroid tumors, teratoma

Operative Findings:
The patient was taken electively to the operating room where a 7.5 cm x 5 cm x 4 cm hard, nodular tumor mass was resected from the neck and anterior mediastinum. The mass did not involve any surrounding structures.

Pathological Findings:
Pathological examination showed a spindle cell tumor with the cells being separated by collagen, with occasional mitoses being seen. There was a pseudocapsule to the tumor. The tumor was felt to be of thymic mesenchymal cell origin and was felt to be a solitary fibrous tumor of the mediastinum.

Final Diagnosis:
Solitary Fibrous Tumor of the Mediastinum

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course and is currently free of symptoms. Biologic behavior of the tumor was difficult to predict, but it was thought the tumor might have been cured surgically due to the cytologic benign appearance and lack of mitotic activity of the tumor.

Similar Cases:
Case 34, Case 37, Case 38, Case 39, Case 40, Case 41, Case 60


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