Neck soft tissue perineuroma in a child

Objectives: The aim of the present study was to describe clinical, radiologic, and histological features of a neck soft tissue perineuroma in a child. Study Design: Case review Methods: Chart of a 13-year-old girl referred to a tertiary care pediatric hospital for assessment of neck mass was reviewed. Data included relevant history and physical examination, diagnostic work up, and management. Results: The child has been having a neck mass located on level 5 for 5 months. Parents noticed that the mass appeared after having an upper respiratory tract infection. She was diagnosed with lymphadenopathy. After receiving an unknown antibiotic, the mass has not resolved. The mass had slowly increased in size. Physical examination revealed a well-appearing child in no respiratory distress. There was a neck mass located on level five. Palpation of the mass showed smooth, rubbery, nontender, and nonpulsatile mass. The mass appeared to be attached to skin. MR imaging documented subcutaneous, welldefined lesion in the supraclavicular region just posterior to the sternocleidomastoid muscle. The mass showed intense uniform enhancement. Upon resection of the mass, histologic evaluation showed well circumscribed, unencapsulated cellular lesion that focally entraps dermal appendages. The lesion was strongly positive for CD34, GLUT-1, EMA and Claudin. Focal positivity was also present in SMA and S-100. Calponin and Factor 13a were negative. The final diagnosis was soft tissue perineuroma. At 10 month follow-up, the surgical site was healed with no evidence of recurrence. Conclusions: Soft tissue perineuroma, a rare and slowly growing tumor, needs to be considered in the differential diagnosis of neck mass in children.