Visual Diagnosis: A 31/2-year-old Boy With Sickle -Thalassemia and a Groin Mass

Abstract

1. Aditi Bagchi, MD* 2. Ashraf Elnawawi, MD† 3. Swayam Sadanandan, MD‡ 1. *Resident (PGY-3), Pediatrics, The Brooklyn Hospital Center, Brooklyn, NY. 2. †Attending Physician, Department of Pathology, The Brooklyn Hospital Center, Brooklyn, NY. 3. ‡Associate Chairperson, Department of Pediatrics, Chief, Division of Pediatric Hematology and Oncology, The Brooklyn Hospital Center, Brooklyn, NY. * Abbreviations: CFP: : calcifying fibrous pseudotumor IMT: : inflammatory myofibroblastic tumor A 3½-year-old boy with a history of sickle β-thalassemia presents to the hematology/oncology clinic for evaluation of a mass in his left groin. The child’s mother had noted a small lump in his left inguinal region 2 years ago. At that time, the pediatrician recommended observing the lump and monitoring any progression. Subsequently, the family moved out of town and did not seek further medical attention until now. Two weeks ago, his mother thought the mass had grown in size and brought him to a nearby hospital for evaluation. He was prescribed a 5-day course of oral antibiotics for a presumed local infection. However, there was no significant change in the size of the mass; so his mother brought him to the hematology/oncology clinic. There is no history of groin pain or erythema, abdominal pain, fever, weight loss, or change in bowel or bladder habits. There is no history of trauma. The child was born at term after an uncomplicated pregnancy and delivery, but newborn screening indicated sickle cell disease. On further evaluation, his mother was found to have β-thalassemia trait and his father had sickle cell trait. The patient was diagnosed as having sickle β-thalassemia and placed on penicillin prophylaxis and folic acid supplementation. Since then, he has had four hospitalizations for febrile illnesses but no history of documented bacteremia. He has not had any vaso-occlusive crises. His motor milestones are appropriate for age, with the exception of speech delay. On physical examination, the child is well nourished …