Mesenchymal hamartomas of the pediatric head and neck

July 5, 2012
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Abstract

We describe the fifth published report of a mesenchymal hamartoma presenting as a cheek mass. A 5-month-old infant was brought to our institution for evaluation of an enlarging left-sided congenital cheek mass. Over time, the lesion had begun to cause significant facial asymmetry and oral incompetence. Radiologic imaging revealed an approximate 2.5 x  3.5-cm, noncystic lesion located in the left buccal space, separate from the mandible and surrounding the salivary glands. Magnetic resonance imaging (MRI) sequences demonstrated an isointense, T1-weighted lesion with avid gadolinium uptake, and increased intensity of T2-weighted sequences. The patient subsequently underwent biopsy and subtotal resection through a left gingivobuccal incisionwith the goal of improving lip contour and facial symmetry.Histologic examination revealed an admixed arrangement of mature smooth muscle, vascular, adipose, and neural tissue elements within a slightly myxoid stroma, consistent with a mixed mesenchymal hamartoma. An 8-month postoperative MRI demonstrated near-total removal without evidence of regrowth. While rare, hamartomas should be included in the differential diagnosis of a slow-growing pediatric head and neck mass. Gross total resection may provide cure; however, given this lesion’s benign nature, less-than-complete resection should be considered when lesions infiltrate opposing critical structures. Thorough clinical and histologic evaluation is critical to avoid overly aggressive treatment and unnecessary morbidity.

Introduction

Hamartomas are non-neoplastic, tumor-like masses characterized by haphazard overgrowth of local tissue. They are thought to result from inborn errors that occur during embryonic development and are present from birth.1-5While they may develop from any of the three germinal layers, mesodermal-derived overgrowth is most common.3 Potential for growth is generally limited and usually parallels gross total-body development. Reports of spontaneous growth arrest at the time of puberty have been published but are uncommon.6,7

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CitationEar Nose Throat J. 2012 July;91(7):E6-E9