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Pediatric Subcutaneous Scalp Mass: A Case Report and Review
Peter M Debbaneh1, Youran Zou2, Shane Zim1
1Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, CA, USA.
Insights
Infantile myofibroma, a rare fibrous tumor, typically presents as a solitary head and neck mass. Early diagnosis and understanding potential multicentricity are key for appropriate management of this distinct pediatric condition.
Area of Science:
- Pediatric Oncology
- Dermatopathology
- Medical Imaging
Background:
- Infantile myofibroma is a rare fibrous tumor predominantly affecting the head and neck region in infants.
- While often presenting as solitary nodules managed conservatively, multicentric disease can lead to significant morbidity.
Observation:
- A case study of a 3-month-old female with an enlarging scalp mass diagnosed as infantile myofibroma via MRI and biopsy.
- The tumor was characterized as a firm, mobile, nontender subcutaneous lesion.
Findings:
- Histological, genetic, and imaging features of infantile myofibroma were reviewed.
- Biopsy is essential; conservative management is suitable for non-multicentric cases.
- Skeletal radiography and abdominal ultrasound are recommended for evaluating potential visceral involvement, despite a lack of official guidelines.
Implications:
- Accurate diagnosis and understanding the clinical course of infantile myofibroma are crucial for the differential diagnosis of infantile skin and subcutaneous masses.
- This knowledge aids in guiding appropriate management strategies, particularly in distinguishing solitary from multicentric presentations.
- Further research into standardized evaluation and treatment protocols is warranted given the absence of official guidelines.
Abstract:
Infantile myofibroma is a unique fibrous tumor encountered in the head and neck. Although the majority of cases are solitary nodules that require only conservative management, awareness of the possibility of multicentric disease is important considering its substantial morbidity. A 3-month-old girl presenting with an enlarging 2.5-cm firm, mobile, nontender subcutaneous scalp mass was evaluated with magnetic resonance imaging and biopsy, revealing a diagnosis of infantile myofibroma. The literature was reviewed for supporting evidence of recommended management in a disease with no official treatment guidelines. Histological, genetic, and imaging characteristics are reviewed. Although biopsy is mandatory, conservative management can be employed for cases without multicentric involvement. Although there are no official guidelines for the evaluation of visceral involvement, skeletal radiograph and abdominal ultrasound are recommended. Infantile myofibroma is a distinct clinical entity with predilection for the head and neck. Its unique immunohistopathology and clinical course should be well understood and should be included in the differential diagnosis of infantile skin and subcutaneous masses.
