Posterior mediastinal myofibroblastic tumor in a 6-year-old

Abstract

In the posterior mediastinum neurogenic tumors are the most encountered in children. Primary lung tumors are far less common. Inflammatory myofibroblastic tumor is the most described lesion in this latter group. Our patient is a 6-year-old female who presented in the pediatric emergency department due to prolonged low grade fever. No severe clinical findings or medical antecedents emerged on primary examination. Plain chest X-ray revealed an upper lobe shadowing of the left lung and the patient was admitted in the pediatric ward where she received intravenous broad spectrum antibiotics for 6 days but withdrawal of fever was not accomplished. Computed Tomography depicted a large mass of the left posterior mediastinum and magnetic resonance imaging confirmed a 6×6.5cm solid mass of unclear origin. Esophagography showed an imprint on the upper part of thoracic esophagus. A left thoracotomy and total mass excision were performed without any major intra- or postoperative complications being reported. Pathology report defined an inflammatory myofibroblastic tumor. Enlargement of inflammatory myofibroblastic tumors is not always proportional to clinical presentation severity. Diagnosis is usually reached by exclusion and total surgical excision is indicated as primary treatment.