孤立的霍纳综合征是儿童咽旁横纹肌肉瘤的唯一表现。

Molham Alahmad, Ahmad Alkheder, Arige Alassaf
{"title":"孤立的霍纳综合征是儿童咽旁横纹肌肉瘤的唯一表现。","authors":"Molham Alahmad, Ahmad Alkheder, Arige Alassaf","doi":"10.1177/01455613251352732","DOIUrl":null,"url":null,"abstract":"<p><p>Isolated Horner syndrome (HS) in young children warrants thorough investigation for occult malignancy, despite its rarity as a presenting sign. This report details a unique case of a 30 month-old male presenting with sudden-onset, isolated left HS as the sole manifestation of rhabdomyosarcoma (RMS) in parapharyngeal space. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 2.5 × 3.5 × 5 cm lesion within the left poststyloid parapharyngeal space, displacing the carotid artery anteriorly, and the internal jugular vein posteriorly. Gross total resection via a transcervical approach was performed; intraoperatively, the tumor involved the cervical sympathetic trunk, necessitating its sacrifice, resulting in persistent postoperative HS. Histopathological and immunohistochemical analysis (positive CK, PLAP, CD99) confirmed a diagnosis of embryonal RMS. The child received adjuvant chemoradiotherapy. One-year follow-up with positron emission tomography - computed tomography (PET-CT) showed no evidence of recurrence. This case underscores several critical points: (1) Isolated HS in young children necessitates urgent neuroimaging to exclude malignancy, even in the absence of palpable masses or neurological deficits; (2) The parapharyngeal space, though an exceptionally rare primary site for RMS (constituting a minor subset of head and neck cases), carries significant implications due to its proximity to the sympathetic chain, readily causing HS via mass effect; (3) MRI is pivotal for diagnosis and surgical planning in this anatomically complex region; (4) Multimodal therapy is essential for local control in embryonal RMS; (5) Sacrifice of the sympathetic trunk during resection likely leads to permanent HS, a factor for preoperative counseling. Vigilant long-term follow-up remains crucial.</p>","PeriodicalId":93984,"journal":{"name":"Ear, nose, & throat journal","volume":" ","pages":"1455613251352732"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Isolated Horner Syndrome as the Sole Presentation of Pediatric Parapharyngeal Rhabdomyosarcoma.\",\"authors\":\"Molham Alahmad, Ahmad Alkheder, Arige Alassaf\",\"doi\":\"10.1177/01455613251352732\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Isolated Horner syndrome (HS) in young children warrants thorough investigation for occult malignancy, despite its rarity as a presenting sign. This report details a unique case of a 30 month-old male presenting with sudden-onset, isolated left HS as the sole manifestation of rhabdomyosarcoma (RMS) in parapharyngeal space. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 2.5 × 3.5 × 5 cm lesion within the left poststyloid parapharyngeal space, displacing the carotid artery anteriorly, and the internal jugular vein posteriorly. Gross total resection via a transcervical approach was performed; intraoperatively, the tumor involved the cervical sympathetic trunk, necessitating its sacrifice, resulting in persistent postoperative HS. Histopathological and immunohistochemical analysis (positive CK, PLAP, CD99) confirmed a diagnosis of embryonal RMS. The child received adjuvant chemoradiotherapy. One-year follow-up with positron emission tomography - computed tomography (PET-CT) showed no evidence of recurrence. This case underscores several critical points: (1) Isolated HS in young children necessitates urgent neuroimaging to exclude malignancy, even in the absence of palpable masses or neurological deficits; (2) The parapharyngeal space, though an exceptionally rare primary site for RMS (constituting a minor subset of head and neck cases), carries significant implications due to its proximity to the sympathetic chain, readily causing HS via mass effect; (3) MRI is pivotal for diagnosis and surgical planning in this anatomically complex region; (4) Multimodal therapy is essential for local control in embryonal RMS; (5) Sacrifice of the sympathetic trunk during resection likely leads to permanent HS, a factor for preoperative counseling. Vigilant long-term follow-up remains crucial.</p>\",\"PeriodicalId\":93984,\"journal\":{\"name\":\"Ear, nose, & throat journal\",\"volume\":\" \",\"pages\":\"1455613251352732\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ear, nose, & throat journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/01455613251352732\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ear, nose, & throat journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/01455613251352732","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

孤立的霍纳综合征(HS)在幼儿隐匿性恶性肿瘤值得彻底的调查,尽管其罕见的表现迹象。本报告详细介绍了一个独特的病例,30个月大的男性表现为突然发作,孤立的左侧HS作为咽旁间隙横纹肌肉瘤(RMS)的唯一表现。磁共振增强成像(MRI)显示左侧茎突后咽旁间隙内一个2.5 × 3.5 × 5 cm的病变,向前移位颈动脉,向后移位颈内静脉。经颈椎入路行大体全切除;术中肿瘤累及颈交感干,需牺牲颈交感干,导致术后持续性HS。组织病理学和免疫组织化学分析(阳性CK, PLAP, CD99)证实了胚胎性RMS的诊断。患儿接受辅助放化疗。随访一年的正电子发射断层扫描-计算机断层扫描(PET-CT)显示无复发迹象。该病例强调了几个关键点:(1)幼儿孤立性HS需要紧急神经影像学检查以排除恶性肿瘤,即使没有可触及的肿块或神经功能缺损;(2)咽旁间隙虽然是RMS异常罕见的原发部位(仅占头颈部病例的一小部分),但由于其靠近交感神经链,容易通过质量效应引起HS,因此具有重要意义;(3) MRI对这个解剖复杂的区域的诊断和手术计划至关重要;(4)胚胎RMS局部控制需要多模式治疗;(5)切除过程中交感神经干的牺牲可能导致永久性HS,这是术前咨询的一个因素。保持警惕的长期随访仍然至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Isolated Horner Syndrome as the Sole Presentation of Pediatric Parapharyngeal Rhabdomyosarcoma.

Isolated Horner syndrome (HS) in young children warrants thorough investigation for occult malignancy, despite its rarity as a presenting sign. This report details a unique case of a 30 month-old male presenting with sudden-onset, isolated left HS as the sole manifestation of rhabdomyosarcoma (RMS) in parapharyngeal space. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 2.5 × 3.5 × 5 cm lesion within the left poststyloid parapharyngeal space, displacing the carotid artery anteriorly, and the internal jugular vein posteriorly. Gross total resection via a transcervical approach was performed; intraoperatively, the tumor involved the cervical sympathetic trunk, necessitating its sacrifice, resulting in persistent postoperative HS. Histopathological and immunohistochemical analysis (positive CK, PLAP, CD99) confirmed a diagnosis of embryonal RMS. The child received adjuvant chemoradiotherapy. One-year follow-up with positron emission tomography - computed tomography (PET-CT) showed no evidence of recurrence. This case underscores several critical points: (1) Isolated HS in young children necessitates urgent neuroimaging to exclude malignancy, even in the absence of palpable masses or neurological deficits; (2) The parapharyngeal space, though an exceptionally rare primary site for RMS (constituting a minor subset of head and neck cases), carries significant implications due to its proximity to the sympathetic chain, readily causing HS via mass effect; (3) MRI is pivotal for diagnosis and surgical planning in this anatomically complex region; (4) Multimodal therapy is essential for local control in embryonal RMS; (5) Sacrifice of the sympathetic trunk during resection likely leads to permanent HS, a factor for preoperative counseling. Vigilant long-term follow-up remains crucial.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信