Diagnostical Challenges of Tumor-Like Conditions of Cervical Neural Arch in Childhood

Abstract

Introduction Neck pain is a rare symptom in childhood. However, if exists permanently, require a thorough checkup, because very often some serious pathology it is in the background. We present two consecutive cases of young patients with neck pain, where the differential diagnosis was challenging, and has proved two different tumor-like pathologies. Material and Methods The first case concerns a 17 years old boy, who represents a pain localizing to the scruff region, mainly during night and to have a rest. MR imaging showed a high intensity changes on T2-weighted, and low intensity changes on T1-weighted pictures at the top of C.7. spinous process. According to SPECT/CT and bone scan an osteoid osteoma was suspected. The second case concerns a 7 years old boy, who had been complaining for few months a temporary, however a sharp pain also at the scruff region, consequently during extension of the neck. MR showed especially on STIR pictures edema at the region of C.4, 5. spinous process. Bone scan proved a slightly increased uptake, also with the suspicion of osteoid osteoma, however the CT scan was negative. Results In the first case, based on the results of the radiological examinations, we have decided on “en bloc” resection of the malformation. The histology revealed pigmented villonodular synovitis (PVNS), which is according to the literature a really rare finding in this region, and require surgical solution. After the surgery, the patient became complaint free, with full function of his neck. On one year follow up MRI was negative regarding recurrence. On the second case pediatricians have excluded any organic rheumatologic disease, and although the inflammatory laboratory tests (We, CRP) were negative, they reckon the malformation as a chronic osteomyelitis and administered a prolonged antibiotic course under strict control for ten weeks. Because of the continuous improvement of the young boy during this therapy, biopsy was not necessary. After three months the patient became also complaint free, and the one year follow up MRI also revealed a normal status. Conclusion In case of permanent neck pain in childhood it is mandatory to perform a thorough checkup to find the reason behind these complaints to be able to exclude any tumor, or tumor-like malformations. If there are any morphological changes on the radiological examinations, the differential diagnosis could be very challenging, requiring individual therapeutical plan. The first proposed examination should have to be MR imaging.