| Abstract [eng] |
Introduction Peripheral neuroblastic tumors comprise a spectrum of neoplasms (neuroblastoma, ganglioneuroblastoma, ganglioneuroma) that primarily arise from the sympathoadrenal lineage and can cause variety of symptoms. Case presentation A 7-year-old patient with no significant past medical history presented to the emergency room. On clinical examination, right-eye miosis and ptosis were observed, along with conjunctival hyperemia, redness, and neck muscle rigidity. Auscultation demonstrated pathological breath sounds consistent with an acute upper respiratory tract infection. An anterior chest X-ray revealed a clearly defined, oval mass with calcifications at the apex of the right lung and paravertebral regions. Subsequent imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), identified a mass in the upper posterior mediastinum measuring approximately 39× 25 × 27 mm, suggestive of a neurogenic origin. Enlarged lymph nodes were also observed, while laboratory findings showed no significant abnormalities. A whole-body two-dimensional metaiodobenzylguanidine (MIBG) scintigraphy demonstrated scintigraphic evidence of an adrenergic-origin tumor in the right upper mediastinum. The solitary mass measured 40 × 27 × 26 mm and was partially calcified. No pathological findings were detected in the lungs, and there was no evidence of osseous metastasis. Based on the radiological findings, a preliminary diagnosis of paraspinal ganglioneuroma with associated Horner syndrome was made. Thoracoscopic surgery was performed, resulting in the complete excision of a tumor measuring approximately 5 cm in diameter, along with mediastinal lymph node dissection. The postoperative recovery was uneventful, with the wounds healing by primary intention and no complications occurring. Histopathological examination of the resected specimen, revealed a differentiated neuroblastoma with lymph node metastasis. Additional treatment, including adjuvant therapy was not selected for the patient. Horner syndrome resolved after the surgical treatment. At the one-year follow-up, routine chest MRI revealed new foci in the posterior superior mediastinum. Whole-body MIBG scintigraphy confirmed recurrence, and a subsequent surgical intervention was planned. Conclusion Children who develop Horner syndrome of unknown origin must undergo imaging studies to rule out a tumor in the posterior superior mediastinal region. |
