Fibrous hamartoma of infancy (FHI) of the parotid region in a 3-year-old female presenting as a huge parapharyngeal tumor: A very rare case presentation

Bhartendu Bharti,Kranti Bhavana,Punam Bhadani,Ragini Raina,Swati Suneha

doi:10.5348/101167z01rr2020cr

Abstract

Introduction: Fibrous hamartoma of infancy (FHI) is a rare, benign tumor arising from the lower dermis and subcutaneous tissue. It usually occurs in children below two years of age and is often misdiagnosed as being of malignant nature. It most commonly effects the lower extremities, very rarely involves the head and neck region, and is commonly found in males. Microscopically, it is a poorly circumscribed and non-capsulated tumor comprising of interlacing fascicles of pale eosinophilic myofibroblasts and stellate shaped fibroblasts with island of mature adipocytes. Case Report: We report a very rare case of FHI of parotid gland in a 3-year-old female child, posing a diagnostic difficulty for management. The site, size, and age of presentation of the tumor were unique. This tumor is common in males but our case was a female child. Our patient presented with involvement of the parotid, submandibular and upper neck area with a huge size of around 7 × 8 cm which was causing mild swallowing difficulty due to intraoral swelling in the child. Cytopathology from the lesion demonstrated spindle cell lesion, the differential diagnosis of which is often malignant in pediatric age group. We took a biopsy for confirmatory diagnosis and after histopathological diagnosis of FHI proceeded with complete surgical excision. Conclusion: Treatment of choice for these benign tumors is complete surgical excision, with excellent prognosis.

Highlights

Fibrous hamartoma of infancy (FHI) is a rare, benign tumor arising from the lower dermis and subcutaneous tissue
Fibrous tumor of infancy very rarely occurs in the parotid region and primary FHI of the parotid region has not been reported in such young age group making this case a unique one International Journal of Case Reports and Images, Vol 11, 2020
The case which we describe here had this lesion affecting the parotid and upper neck region making it a very rare site of involvement

Summary

INTRODUCTION

Fibrous hamartoma of infancy (FHI) is a rare benign tumor of subcutis and lower dermis which usually occurs within first two years of life [1, 2]. A 3-year-old female child presented to our outpatient department with chief complaint of a swelling in the right parotid region. It was of insidious onset which gradually progressed over one year to its present size. On clinical examination the child was found to have a swelling approximately 7 × 8 cm in size arising from the right parotid region. It had a smooth surface, which extended inferiorly up to thyroid gland, medially reaching up to midline and posteriorly encroaching the posterior triangle of neck (Figure 1). Histopathological examination (HPE) of the complete specimen confirmed it to be a case of FHI (description of which is enumerated above)

DISCUSSION

CONCLUSION