Melanotic Neuroectodermal Tumor of Infancy

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, benign but locally aggressive neoplasm of neural crest origin, typically arising in the anterior maxilla of infants under 1 year of age. Clinically, it often mimics an eruption cyst, leading to potential diagnostic delay.

A 4-month-old male presented with a painless, rapidly enlarging swelling in the left anterior maxilla. Clinical, radiographic, and histopathologic evaluations were performed. Excisional biopsy under general anesthesia was chosen as definitive management. Preoperative urinary vanillylmandelic acid (VMA) levels were measured to assess catecholamine metabolism.

Radiographs showed an expansile osteolytic lesion with displacement of the primary central incisor. Histopathology demonstrated biphasic cell populations-large melanin-containing epithelioid cells and small primitive neuroblast-like cells. Immunohistochemical staining was positive for HMB-45, vimentin, and cytokeratin, confirming MNTI. Urinary VMA was normal. The lesion was completely excised, and the patient has remained recurrence-free on long-term follow-up.

Although benign, MNTI exhibits rapid growth and can cause significant bony destruction. Accurate diagnosis and prompt surgical excision with clear margins are essential to prevent recurrence. Awareness of this entity among clinicians is crucial when evaluating rapidly expanding maxillary masses in infants.