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AJR Teaching File: Facial Mass in a Child

Annette C. Douglas-Akinwande1, Chewarat Wirojtananugoon1 and Eyas M. Hattab2

1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd., Rm. 0279, Indianapolis, IN 46202.
2 Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN.


Figure 1
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  		Fig. 1A —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. Soft-tissue window setting of head CT scan shows well-circumscribed mass that is isodense to muscle.

 

Figure 2
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  		Fig. 1B —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. Axial unenhanced CT image obtained with bone window setting shows erosion of right mandibular ramus and right temporal bone.

 

Figure 3
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  		Fig. 1C —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. Axial unenhanced T1-weighted image shows hypo- to isointense, well-circumscribed mass in right masticator space.

 

Figure 4
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  		Fig. 1D —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. Coronal T2-weighted image shows mixed-signal (isointense to hyperintense) lesion in right masticator space.

 

Figure 5
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  		Fig. 1E —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. Coronal contrast-enhanced fat-saturated T1-weighted image shows homogeneous enhancement and extension of mass into right infratemporal fossa.

 

Figure 6
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  		Fig. 1F —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. H and E–stained sections show low cellular lesion characterized by intersecting broad bands of spindle cells in variably collagenous stroma. Tumor consists of bland spindle-shaped cells (proliferating fibroblasts). Mitotic activity and necrosis are absent. Abundant collagen was present on trichrome preparation. Reticulum stain showed minimal amount of reticulin. Immuno staining for Ki-67 showed low proliferative activity (< 1% nuclear staining).

 

Figure 7
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  		Fig. 1G —3-year-old girl with medical history of shunted hydrocephalus, seizures, and cranial reconstruction for cranial synostosis at 7 months of age who presented to emergency department after a fall. H and E–stained sections show low cellular lesion characterized by intersecting broad bands of spindle cells in variably collagenous stroma. Tumor consists of bland spindle-shaped cells (proliferating fibroblasts). Mitotic activity and necrosis are absent. Abundant collagen was present on trichrome preparation. Reticulum stain showed minimal amount of reticulin. Immuno staining for Ki-67 showed low proliferative activity (< 1% nuclear staining).

 

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