Calvarial Melanotic Neuroectodermal Tumor of Infancy with Rhabdomyosarcomatous differentiation—A Rare Case

Calvarial Melanotic Neuroectodermal Tumor of Infancy with Rhabdomyosarcomatous differentiation—A Rare Case:



Publication date: January 2021

Source: World Neurosurgery, Volume 145

Author(s): Jeyaseelan Nadarajah, Ajay Garg, Sandeep Bohara, Kanwaljeet Garg, Leve Joseph Devaranjan Sebastian, Vaishali Suri, Sameer Bakhshi, Manmohan Singh




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World Neurosurgery
Volume 145, January 2021, Pages 134-141

Case ReportCalvarial Melanotic Neuroectodermal Tumor of Infancy with Rhabdomyosarcomatous differentiation—A Rare Case
Author links open overlay panelJeyaseelanNadarajah1AjayGarg1SandeepBohara2KanwaljeetGarg2Leve JosephDevaranjan Sebastian1VaishaliSuri3SameerBakhshi4ManmohanSingh2Show more
https://doi.org/10.1016/j.wneu.2020.08.137Get rights and content


Background

Malignant neuroectodermal tumor of infancy is a rare neural crest cell-derived neoplasm of infants. Histologically, melanotic neuroectodermal tumor of infancy usually consists of 2 types of cells: neuroblast-like and melanocyte-like cells. Here we present a rare case of melanotic neuroectodermal tumor of infancy containing a third type of cell population, that is, rhabdomyoblasts in addition to the above two.

Case Description

We report a case of a 10-month-old female child who was brought to us with complaints of swelling over the right forehead for the last 9 months, which started increasing in size rapidly 3 months before presenting to us. Noncontrast computed tomography scan showed a large well-defined extra-axial lesion in the right frontotemporal region. The child underwent an open biopsy under general anesthesia. Histopathological sections showed a malignant small round cell tumor consisting of hyperchromatic cells lying in sheets and lobules separated by fibrous septae. The patient underwent 7 cycles of neoadjuvant chemotherapy over a period of 2 months. The patient underwent right frontotemporal craniotomy and gross total excision of the lesion as a definitive surgery. Postoperatively, the patient was stable, and there was no new deficit. Histopathology revealed neuroblast-like and melanocyte-like cells with rhabdomyosarcomatous differentiation. The patient received chemotherapy in the postoperative period. The patient had recurrence of the tumor and died 8 months after the surgery.

Conclusions

Calvarial malignant neuroectodermal tumor of infancy with rhabdomyosarcomatous differentiation is a rare entity with no cases being reported before. Neoadjuvant chemotherapy with surgical excision can be a promising modality of treatment.