AN 8-DAY-OLD male infant weighing 2892 g was referred to the hospital for evaluation of a chest wall mass. He had been delivered vaginally by vacuum extraction. The course of the pregnancy was unremarkable and the patient's mother received routine prenatal care.
On physical examination, the patient appeared well developed and was in no apparent distress. Vital signs were stable. A firm, immobile, nontender chest mass was located slightly to the left of the sternum. The mass measured 1.5 cm in diameter and projected 0.5 cm from the contour of the chest. Findings from the remainder of the examination were unremarkable.
Multiplanar imaging of the chest wall indicated a well-defined heterogeneous mass that appeared to grow from the intercostal muscles, invaded the intercostal muscles posteriorly, and displaced the pleura. The mass measured 1 × 2.5 × 2.5 cm in the anteroposterior, transverse, and cephalocaudal dimensions (Figure 1 and Figure 2). It did not involve the pericardium, but bony invasion of the ribs and sternum could not be completely excluded.
The next day, an incisional biopsy was performed. Histological study of the mass showed a predominant population of large polygonal cells and a smaller number of admixed multinucleate giant cells (Figure 3). Both the mononuclear and multinuclear cells had a moderate to large amount of lightly eosinophilic cytoplasm. The nuclei in the mononuclear and multinucleate cells were slightly enlarged and irregular, but significant hyperchromasia was not present and nucleoli were inconspicuous. The mitotic rate was low at fewer than 2 mitoses per 10 high-power fields. The lesion infiltrated skeletal muscle. Stains for fungi and mycobacteria were negative. The mononuclear and multinucleate cells were strongly positive on a vimentin stain. Actin, desmin, S100, factor VIII, and cytokeratin stains all were negative.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.