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Hamadi H, Idrissi TEAE, Gallouli A, Benantar L, Aniba K. Melanotic neuroectodermal tumor of infancy arising in the skull: a case report. Pan Afr Med J 2024; 47:62. [PMID: 38681111 PMCID: PMC11055195 DOI: 10.11604/pamj.2024.47.62.42413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/04/2024] [Indexed: 05/01/2024] Open
Abstract
Melanotic neuroectodermal tumor of infancy is a rare and usually benign neoplasm occurring in children of young age. This pigmented tumor typically presents in the head and neck region, but other locations may be involved. We report in this article a rare case of a 3-month-old girl presenting with a slowly growing mass localized in the anterior fontanelle. The patient's magnetic resonance imaging (MRI) showed a mass extending both extracranial and intracranial, and compressing the adjacent structures. The patient underwent subtotal resection of the mass and a histological study confirmed the diagnosis of melanotic neuroectodermal tumor of infancy. The patient presented later on with a recurrence. An early diagnosis and surgical management for these tumors remain the only guarantees to limit the progression and prevent their recurrence and metastasis.
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Affiliation(s)
- Hajar Hamadi
- Department of Neurosurgery, Ibn Tofail Hospital, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy in Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Taib El Amrani El Idrissi
- Department of Neurosurgery, Ibn Tofail Hospital, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy in Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Ayman Gallouli
- Department of Neurosurgery, Ibn Tofail Hospital, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy in Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Lamia Benantar
- Department of Neurosurgery, Ibn Tofail Hospital, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy in Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Ibn Tofail Hospital, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy in Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Abstract
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.
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Affiliation(s)
- Zan Liu
- Department of Pediatric Surgery, Hunan Children's Hospital
| | - Ming Li
- Department of Pediatric Surgery, Hunan Children's Hospital
| | - Xianglian Tang
- Department of Pediatric Surgery, Hunan Children's Hospital
| | - Yaling Xiao
- Department of Pediatric Surgery, Hunan Children's Hospital
| | - Zhenghui Xiao
- Emergency Center of Hunan Children's Hospital, Changsha, Hunan, China
| | - Yong Li
- Department of Pediatric Surgery, Hunan Children's Hospital
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Soles BS, Wilson A, Lucas DR, Heider A. Melanotic Neuroectodermal Tumor of Infancy. Arch Pathol Lab Med 2018; 142:1358-1363. [DOI: 10.5858/arpa.2018-0241-ra] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Melanotic neuroectodermal tumor of infancy, albeit rare and generally regarded as benign, is an important tumor to recognize because of its rapid growth, potential for local recurrence, and small round blue cell morphology, which can lead to misdiagnosis of a malignant neoplasm.
Objective.—
To review its clinical presentation and immunomorphologic findings, and discuss common entities in the differential diagnosis.
Data Sources.—
The study involved PubMed searches, including multiple review articles, case studies, retrospective studies, selected book chapters, and University of Michigan cases.
Conclusions.—
Melanotic neuroectodermal tumor of infancy most commonly occurs in the bones of the head and neck region during the first year of life, but it can also present in other locations, including the central nervous system, testes, ovaries, and subcutaneous soft tissues. Histologically, it is composed of a biphasic population of cells, consisting of epithelioid melanin-producing cells and primitive neurogenic cells in a fibrocollagenous stroma. These microscopic findings, especially in small biopsies, can lead to a broad differential diagnosis that includes malignant small round blue cell tumors and malignant melanoma. Melanotic neuroectodermal tumor of infancy commonly has an infiltrative growth pattern, and anatomic constraints often lead to incomplete resection and local recurrence, requiring multiple surgical operations. Because melanotic neuroectodermal tumor of infancy can mimic a more aggressive and aggressively treated malignancy, recognition of this rare tumor is very crucial for pathologists.
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Affiliation(s)
| | | | | | - Amer Heider
- From the Divisions of Anatomic and Clinical Pathology (Dr Soles) and Anatomic Pathology (Drs Wilson and Lucas), Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor
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Prenatal Diagnosis of a Melanotic Neuroectodermal Tumor of Infancy (MNTI): A Case Report With a Favorable Outcome After Chemotherapy Failure and Incomplete Resection. J Pediatr Hematol Oncol 2018; 40:320-324. [PMID: 29016414 DOI: 10.1097/mph.0000000000000982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present the case of a woman referred to our department at 34 weeks of pregnancy with a fetal ultrasonographic scan showing a mass that had developed within the right maxilla with invasion of the orbit. A retrospective examination showed that this tumor had been present since the 12th week of pregnancy. At 39+4 weeks of gestation, a boy was born. He presented a black firm aspect in the maxilla. A computed tomographic scan and magnetic resonance imaging revealed a soft tissue swelling over the right maxilla, extending into the orbit but without invasion of the globe. Surgical biopsy confirmed a melanotic neuroectodermal tumor of infancy. The pathologic examination did not show any neuroblast-like component on the hematoxylin eosin saffron staining. Because of the extension and the size of the lesion, neoadjuvant chemotherapy was carried out. At day 21, the patient received 1 cycle of low-dose cyclophosphamide and vincristine, 2 cycles of etoposide and carboplatin, and thereafter 1 cycle of cyclophosphamide, adriamycin, and vincristin because the lesion kept growing. After stabilization of the size of the tumor, at 4 months, a maxillectomy and partial resection of the orbital floor and lateral orbital wall was performed on the patient. As a complete resection would have required orbital exenteration, surgery was performed deliberately incomplete leaving a macroscopic residue (R2). At 2.5 years of follow-up, the patient showed complete remission with no lesions evident on magnetic resonance imaging.
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Moreau A, Galmiche L, Minard-Colin V, Rachwalski M, Belhous K, Orbach D, Joly A, Picard A, Kadlub N. Melanotic neuroectodermal tumor of infancy (MNTI) of the head and neck: A French multicenter study. J Craniomaxillofac Surg 2017; 46:201-206. [PMID: 29275074 DOI: 10.1016/j.jcms.2017.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/12/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Melanotic neuroectodermal tumor of infancy (MNTI) of the head and neck is a rare entity with uncertain clinical behavior. Radical surgical resection is the current recommended treatment, however this can cause severe aesthetic and functional sequelae. The aim of this study was to clinically characterize MNTIs and to stratify risk factors that may influence locoregional recurrence. METHODS A retrospective multicenter study, including 11 patients from eight centers with a confirmed diagnosis of MNTI, was conducted. Epidemiological, clinical, radiological, pathological, and immunohistochemical examinations were reviewed. A statistical analysis using a t-test was conducted to calculate parameters correlating with tumor recurrence. RESULTS MNTIs mainly occurred in the maxilla, with a mean age at diagnosis of 3.18 months (range: 0-6 months). Primary surgery was performed on 10 patients, with a clear margin resection on two patients. Overall recurrence rate was 27% with a survival of 100% at time of follow-up. No statistical correlation between recurrence rate, age at diagnosis, localization, resection margins, and pathological and immunohistochemical characteristics could be established. CONCLUSION In our study, locoregional tumor recurrence did not seem to correlate with resection margins, so a conservative surgical approach may need to be considered to avoid functional and aesthetic sequelae.
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Affiliation(s)
- Audrey Moreau
- Department of Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Louise Galmiche
- Department of Pathology, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France; Université Paris Descartes, 75006, Paris, France
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, 94805, Villejuif, France
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France; Department of Pediatric Neurosurgery, National Reference Center for Craniofacial Malformations, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Kahina Belhous
- Department of Radiology, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Daniel Orbach
- Department of Pediatric Oncology, Institut Curie, 75248, Paris, France
| | - Aline Joly
- Department of Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Arnaud Picard
- Department of Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France; Université Paris Descartes, 75006, Paris, France; Laboratory for Oral and Molecular Pathology, INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 75006, Paris, France
| | - Natacha Kadlub
- Department of Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France; Université Paris Descartes, 75006, Paris, France; Laboratory for Oral and Molecular Pathology, INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 75006, Paris, France.
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Nicosia G, Spennato P, Aliberti F, Cascone D, Quaglietta L, Errico ME, Muto M, Ionna F, Cinalli G. Giant melanotic neuroectodermal tumor of infancy (melanotic progonoma) of the head and neck: report of a malignant case. J Neurosurg Pediatr 2017; 19:538-545. [PMID: 28291424 DOI: 10.3171/2016.11.peds16509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Melanotic neuroectodermal tumor of infancy is a rare congenital pigmented neoplasm of neural crest origin, locally aggressive, growing rapidly and developing during the 1st year of life. It most commonly arises from the maxilla, cranial vault, and mandible. Occasionally, it exhibits malignant behavior with local lymph nodes involvement. Cases misdiagnosed and left untreated for a long time can present challenges due to the tumor mass and infiltration. In these cases, adjuvant chemotherapy can be extremely helpful before radical excision. Authors of this report describe a 4-year-old boy from a developing country who was referred to their hospital with an ulcerated bulging lesion in the midline/right parietooccipital region, extending to the right laterocervical and parotid regions, resulting in significant craniofacial deformation. Magnetic resonance imaging of the brain revealed a highly enhancing tumor with intracranial and extracranial development extending mainly at the level of the right parietooccipital region, with lytic and hypertrophic alterations of the skull. The patient was managed with neoadjuvant and adjuvant chemotherapy and radically resective surgery on metastatic lymph nodes and the primary tumor of the skull. Scheduled radiotherapy was not performed, according to the parents' wishes. The patient returned to his native country where the lesion recurred, and he ultimately died approximately 10 months after the end of the treatment. The literature indicates that tumor removal alone has been the treatment of choice in most isolated cases, but in cases of highly advanced tumor with involvement of the skull and cervical lymph nodes, it is preferable to proceed with preoperative chemotherapy with the aim of reducing the tumor volume, allowing better technical conditions for complete surgical removal, and decreasing the risk of local recurrence or metastasis.
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Affiliation(s)
- Giancarlo Nicosia
- Departments of 1 Paediatric Neurosurgery.,Department of Neurosurgery, University of L'Aquila, Italy
| | | | | | | | | | | | - Mario Muto
- Department of Neuroradiology, Antonio Cardarelli Hospital
| | - Franco Ionna
- Division of Maxillo-Facial and ENT Oncologic Surgery, Istituto Nazionale dei Tumori, IRCCS Fondazione Pascale, Naples; and
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Ghersin ZJ, Kuo DJ. Melanotic Neuroectodermal Tumor of Infancy in the Epididymis: A Brief Report and Review of the Role of Chemotherapy in Management. J Pediatr Hematol Oncol 2016; 38:e144-6. [PMID: 26886373 DOI: 10.1097/mph.0000000000000511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Melanotic neuroectodermal tumor of infancy is a rare benign tumor of neural crest origin. The tumor generally presents in the jawbones; however, it occasionally occurs in extracranial sites. Although 95% of these tumors present within the first year of life and 15% in extracranial locations, we report an unusual case of a 15-month-old male with melanotic neuroectodermal tumor of infancy of the epididymis. The patient underwent orchiectomy without adjuvant chemotherapy or radiation. Twenty months later, there was no sign of recurrence. In addition, we discuss the role of chemotherapy and radiation and the potential importance of molecular genetics in establishing guidelines for management.
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Affiliation(s)
- Zelda J Ghersin
- *St Joseph's Children's Hospital, Paterson, NJ †Rady Children's Hospital-San Diego, San Diego, CA
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