Melanotic neuroectodermal tumor of infancy: clinical, radiological, and pathological features

Melanotic neuroectodermal tumor of infancy (MNTI) - A rare entity

Melanotic neuroectodermal tumor of infancy is a rare pigmented pediatric tumor seen at craniofacial sites with the most common site being maxilla. This tumor arises from neural crest origin with a polyphenotypic expression of epithelial, neuroblastic, and melanotic markers. It is a locally aggressive tumor with rapid, expansile, and destructive growth. The tumor has fairly high chances of recurrence and malignant transformation, if not diagnosed and treated with time. There is no standard protocol for management owing to its rarity. Hereby, we present one such case of a 2-month-old male child with rapidly enlarging upper jaw swelling. The patient was treated with wide local excision, followed by two cycles of chemotherapy. The patient is in follow-up and doing well with no evidence of any local recurrence or metastasis till date.

Appendageal tumors and tumor-like lesions of the testis and paratestis: a 32-year experience at a single institution

The testicular hilum and paratestis contain several embryologically diverse anatomic structures, including the spermatic cord, tunica vaginalis, epididymis, rete testis, and several other embryonic remnants. Several benign and malignant lesions arise from these morphologically distinct structures, and owing to their proximity, it is challenging to classify and subsequently stage these tumors. Herein, we conducted a retrospective review of the paratesticular appendageal and rete testis tumors and tumor-like lesions diagnosed at our department from 1985 to 2016. Soft-tissue lesions/tumors were excluded. A total of 146 paratesticular appendageal and rete testis tumors and tumor-like lesions were identified. Most were benign (n = 107; 73%). Adenomatoid tumor (26%) was the most common benign tumor, followed by different types of cysts (19%), mesothelial hyperplasia (18%), serous cystadenoma (5.5%), and rete testis adenoma (4%). Malignant lesions comprised 23% of the cases, with mesothelioma the most common (15%), followed by adenocarcinoma of the rete testis (4%), serous cystadenocarcinoma (2%), and papillary and clear cell adenocarcinoma of the epididymis (2%). Finally, serous borderline tumors and melanotic neuroectodermal tumor (retinal anlage tumors) comprised the remaining 4% of cases. In conclusion, a wide range of benign and malignant lesions can arise from the paratesticular region. Awareness of these lesions and their histologic spectrum is crucial to avoid diagnostic pitfalls and to allow pathologists to establish a correct diagnosis and subsequent treatment plan.

Melanotic neuroectodermal tumor of infancy in ovary: A rare case report

RATIONALE

Melanotic neuroectodermal tumor of infancy (MNTI) is an extremely rare benign pigmented neoplasm of neural crest origin with rapid expansile growth and a high recurrence rate. It is predominantly found in infants of <1 year of age, involvement of the head-and-neck region is the most common presentation though it is reported at other sites including mediastinum, shoulder, thigh, foot, epididymis, uterus and ovary. The patient reported here is the third case of MNTI presenting in an ovary, and the first reported in the infant ovary.

PATIENT CONCERNS

A 33-month-old girl was presented to our unit for a huge abdominal mass.

DIAGNOSIS

MNTI was eventually diagnosed by histological manifestations supplemented with immunohistochemical findings.

INTERVENTIONS

Exploratory laparotomy and complete resection were conducted successfully.

OUTCOMES

Postoperative course was uneventful and no recurrence was displayed in the 6-month follow-up.

LESSONS

This case emphasizes that pediatric surgeons and pathologists must always consider the possibility of MNTI while dealing with ovarian neoplasms in infants. Although considered to be a benign tumor, proper treatment and close clinicoradiological follow-up of this tumor are of great importance.

Melanotic neuroectodermal tumour of infancy: A report of two cases

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Shedding light on the aggressive nature and rare incidence of Melanotic Neuroectodermal Tumour of Infancy (MNTI).

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Detailing different clinical and radiographic features of MNTI.

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Outlining the management of MNTI and postoperative follow-up regimen.

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Emphasising the importance of early diagnosis and surgical intervention in Melanotic Neuroectodermal Tumour of Infancy.

Introduction

Melanotic neuroectodermal tumour of infancy (MNTI) is a benign tumour of infancy, most commonly affecting the head and neck region. First described in 1918, less than 500 cases have been reported in the literature. MNTI is aggressive in nature & has a high rate of recurrence.

Presentation of cases

In this retrospective case series, we report two cases of MNTI that presented at our unit; both cases were managed by wide excision and have been followed up uneventfully for over two years.

Discussion

MNTI has a recurrence rate of up to 20%. Patient’s age can play a significant role in recurrence rate. Although this neural crest tumour is somewhat rare in the literature, there is a consensus with regards to surgical management; the gold standard remains to be wide excision with safety margin. Select cases may benefit from adjuvant and neoadjuvant therapy.

Conclusion

Owing to its locally aggressive nature and high recurrence rate, prompt diagnosis and surgical intervention is advised in cases of MNTI. Further understanding of this tumour is needed on a microscopic level in order to determine clear prognostic factors.

Melanotic neuroectodermal tumour of infancy of the jaws: an analysis of diagnostic features and treatment

The purpose of this study was to integrate the available published data on melanotic neuroectodermal tumour of infancy (MNTI) of the jaws into a comprehensive analysis of its clinical/radiological features, with emphasis on the predictive factors associated with recurrence. Eligibility criteria included publications with sufficient clinical/radiological/histological information to confirm the diagnosis. A total of 288 publications reporting 429 MNTI cases were included. MNTIs were slightly more prevalent in males and markedly more prevalent in the maxilla. Most of the lesions were asymptomatic, presenting cortical bone perforation and tooth displacement. Nine lesions were malignant, with metastasis in five cases. Enucleation was the predominant treatment (67.2%), followed by marginal (18.4%) and segmental resection (6.1%). Eighty-one of 356 lesions (22.8%) recurred. Recurrence rates were 61.5% for curettage, 25.3% for enucleation alone, 16.2% for enucleation+curettage, 20.0% for enucleation+peripheral osteotomy, 11.3% for marginal resection, 10.0% for segmental resection, 30.0% for chemotherapy, and 33.3% for radiotherapy. Enucleation and resection presented significantly lower recurrence rates in comparison to curettage. Curettage appears not to be the best form of treatment, due to its high recurrence rate. As resection (either marginal or segmental) is associated with higher morbidity, enucleation with or without complementary treatment (curettage or peripheral osteotomy) would appear to be the most indicated therapy.

Use of Technological Aids in the Resection of a Rare Maxillofacial Tumor of Infancy

Melanotic neuroectodermal tumor of infancy is a rare maxillofacial tumor, usually presenting within the first year of life, often a benign locally aggressive lesion, with wide local excision providing the best opportunity of cure. In past reports, direct tissue visualization guided resection, with occasional need for reoperation to clear margins. In this case report, a method is presented to achieve clear margins in surgery using virtual surgical planning and surgical stealth navigation.

Melanotic neuroectodermal tumour of infancy: A case report and differential diagnosis

Melanotic neuroectodermal tumour of infancy is an uncommon pigmented neoplasm of neural crest origin. It was first described in 1918 by Krompecher, known as congenital melanocarcinoma at that time. Although it is generally agreed upon that it is a benign entity, it is locally aggressive and has a significant recurrent risk, reported to be between 10-15%. There have also been prior reports of malignant behaviour in these tumours, although extremely rare. The majority of cases of this tumour (about 70%) arise from the maxilla and its occurrence in the cranial vault represents approximately 15.6% of cases. We describe a rare case of melanotic neuroectodermal tumour of infancy, with simultaneous involvement of the cranial vault and petrous temporal bone, in a four-month-old child, complicated by post-surgical pseudo-meningocele. This case illustrates the diagnostic dilemma in differentiating reactive osseous sclerosis from direct tumour infiltration, both of which can occur in the context of melanotic neuroectodermal tumour of infancy. The discussion places emphasis on differential diagnoses and useful radiological features to assist in clinching the diagnosis of melanotic neuroectodermal tumour of infancy.

Extensive Melanotic Neuroectodermal Tumor of Infancy

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare childhood neoplasm with an alarming but classical clinical presentation. We present the case of a 2-month-old male infant treated with surgery for an aggressive MNTI on the alveolar process of the maxilla. Radiographic examination showed a diffuse osteolytic radiolucent lesion in the right maxilla, and displacement and dysmorphic changes in the developing primary tooth buds. The patient remained well without evidence of recurrence for 6 months after surgery. We discussed clinicopathological features, management alternatives, and outcome.

Interim prosthodontic management of surgery-induced dental agenesis: a clinical report of 8 years of treatment

The prosthodontic management of a 7-year-old girl with induced dental agenesis is described. The mandibular posterior tooth germs had been removed during surgical excision of a melanotic neuroectodermal tumor of infancy, at the age of 2 months. The ongoing prosthodontic treatment, now in its eighth year, was implemented by regular follow-up of the operation outcome and by targeted orthodontic intervention. The treatment plan included the provision of four successive interim removable partial dentures. Care was taken to preserve the oral structures, adapt to the morphological changes, and satisfy the needs of the child. Due to the unfavorable biomechanical conditions, retention and stability problems were encountered. These were resolved by engaging the mechanism of neuromuscular adaptation through optimization of the shape of the denture base. For children and adolescents with extensive dental agenesis, prosthodontic management with interim removable dentures supports function, restores esthetics, and provides a solid basis for the definitive treatment.

Melanotic neuroectodermal tumor of infancy

Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon lesion with remarkably consistent histopathologic features that arises primarily in the pediatric population. We describe a MNTI arising in the anterior maxilla of a 6-month-old boy.

Neurogenic tumors of soft tissue

Neurogenic tumors are an uncommon yet important category of soft tissue tumors in children and adolescents because of their frequent association with various genetic syndromes. The heterogeneous cellular composition of the peripheral nerve and the wide metaplastic capacity of the neural crest and its derivatives generate a variety of neoplasms with neurogenic differentiation. This article reviews the clinicopathologic features and differential diagnosis of neurogenic tumors in the first two decades of life, and highlights use of selected ancillary methods for diagnosis.

Melanotic neuroectodermal tumour of infancy: CT and MR findings

BACKGROUND

Melanotic neuroectodermal tumour of infancy (MNTI) is a rare neoplasm of neural crest origin.

OBJECTIVE

To describe three further cases of MNTI, with emphasis on CT and MRI findings.

MATERIALS AND METHODS

Data for children with histologically confirmed MNTI following biopsy or surgery were retrieved. Three children with available imaging at the time of diagnosis were included in the study.

RESULTS

All three children had primary tumour in the head and neck region: one in the maxilla, one in the occipital bone (extra-axial but with intracranial extension) and one with an unusual tumour growing exophytically from the subcutaneous tissues adjacent to the occipital bone. All tumours were iso/hypointense both on T1- and T2-weighted MRI, and showed marked contrast enhancement in their non-ossified components. CT allowed identification of bone destruction and remodelling.

CONCLUSION

Our findings are consistent with previously reported cases of MNTI regarding age at presentation and location in the head and neck region. Our MR findings did not demonstrate the typical pattern of T1-shortening expected from melanin deposition.

Melanotic neuroectodermal tumour of infancy: report of two cases and review of the literature

Melanotic neuroectodermal tumour of infancy (MNTI) is an uncommon tumour affecting predominantly the craniofacial bones of the newborn infants. The neural crest origin of the tumour has been confirmed. MNTI is generally accepted as a benign tumour despite of its rapid and locally infiltrative growth. Recurrence rate varies between 10% and 60%, and malignant behaviour has been reported in 6.5% of MNTIs. Systematic review of the literature revealed 445 MNTIs published between 1918 and 2010. We present additional two cases of MNTI from our Department, typical in all terms, which equals a total number of 447 reported cases. One of our cases revealed histological features consistent with malignant behaviour, but at present, 18 months after the surgical excision, there is no evidence of recurrence. Biological behaviour of MNTI cannot be predicted by gross or histologic characteristics, thus early diagnosis and careful follow-up after the complete surgical excision is required.

Melanotic neuroectodermal tumor of infancy (MNT1) arising in the skull. Short review of two cases

INTRODUCTION

Melanotic neuroectodermal tumor of infancy (MNT1) is a rare congenital pigmented neoplasm of neural crest origin, locally aggressive, and rapidly growing that develops during the first year of life. It most commonly arises from the maxilla, the cranial vault, and the mandible. Early diagnosis and radical surgery are critical for a long-term outcome.

METHODS

A literature search through PUBMED revealed 43 cases of MNT1 arising in the skull. We reviewed the available literature and studied the presenting symptoms, diagnostic procedures, treatment, rates of recurrences, malignancy, and data of follow-up. We report two further cases of infants aged 4 and 10 months, respectively, with MNT1 arising from the cranial vault who underwent radical excision of the lesion.

CONCLUSION

Melanotic neuroectodermal tumor of infancy should be included in the differential diagnosis of skull lesions in infants. Radical surgery must be considered as the treatment of choice and close follow-up for at least 2 years is necessary.

Melanotic neuroectodermal tumor of infancy: discussion of a case and a review of the imaging findings

Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon melanin-containing mesenchymal tumor of neural crest origin. What make this tumor unique and interesting is its characteristic predilection for anterior maxilla (premaxilla) and the presence of pigment melanin which gives the tumor distinct clinicopathological, immunohistochemical, ultrastructural and imaging features. Although first described almost a century ago, to the authors’ knowledge, only a few hundred cases of MNTI have been reported worldwide in the English medical literature. The pool of documented radiological findings is even more sparse as not more than a dozen cases could be abstracted from an Internet search of the radiology literature. We document a case of MNTI and describe the imaging findings with intent to contribute to its small but accruing radiological data.

Melanotic neuroectodermal tumor of infancy: a case report

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare pigmented tumor generally occurring in the head and neck region in children 12 months of age or younger. Approximately 380 instances of this tumor are reported in the medical literature. We presented a case of MNTI that occurred in the left temporal bone of a 2-month old female infant. And, the clinical assessment, histologic diagnosis, and management is reviewed.

Punção aspirativa por agulha fina no diagnóstico de linfadenopatias e tumores sólidos em crianças e adolescentes

OBJETIVO: Avaliar a importância diagnóstica da punção aspirativa por agulha fina (PAAF) em crianças e adolescentes portadores de linfadenopatias e tumores sólidos. MÉTODOS: Análise retrospectiva dos pacientes com idade igual ou inferior a 18 anos, atendidos no Centro de Pediatria Cirúrgica do Hospital Universitário de Brasília, Universidade de Brasília, no período de julho de 2000 a julho de 2005. Foram calculados: sensibilidade, especificidade, precisão (acurácia) diagnóstica, valor preditivo positivo e valor preditivo negativo. RESULTADOS: Em 50 pacientes estudados, os resultados da PAAF mostraram sensibilidade de 90,9%; especificidade de 100%, precisão diagnóstica de 95% e valores preditivos positivo e negativo de 100% e 90%, respectivamente. CONCLUSÃO: Em nossa experiência, a PAAF é um método preciso, simples e seguro, útil no diagnóstico de linfadenopatias e tumores sólidos em crianças e adolescentes.

Orbital melanotic neuroectodermal tumor of infancy successfully treated with chemotherapy and subtotal excision

Melanotic neuroectodermal tumor of infancy is a rare condition that typically presents within the first 6 months of life. It rarely metastasizes but is locally aggressive. Melanotic neuroectodermal tumor of infancy has been reported under several other names including retinal anlage tumor and melanotic progonoma. Most commonly, melanotic neuroectodermal tumor of infancy originates in the maxilla. Tumors in previously reported orbital cases have arisen from adjacent structures or from orbital bone. Recommended treatment of melanotic neuroectodermal tumor of infancy has consisted of complete excision with wide tissue margins, although success has been reported after incomplete resection. For those patients in whom surgical resection is not possible, various chemotherapy approaches have been reported with mixed results ranging from failure to sustained tumor regression. We report a case of orbital melanotic neuroectodermal tumor of infancy adherent to sclera and successfully treated with chemotherapy and subtotal excision.