Nasal glial heterotopia or congenital hemangioma? A case report

Fetal pharyngeal glial heterotopia manifested as polyhydramnios: a rare case with difficult prenatal diagnosis

BACKGROUND

Glial heterotopia is a rare congenital developmental malformation that presents as tumor-like lesions of the nerve tissue that grow outside the nervous system, but are not true tumors. At present, most cases are reported in neonates and children and are very rarely found in fetuses. The present report describes a case of fetal pharyngeal glial heterotopia and associated imaging findings to better understand the disease in the future.

CASE PRESENTATION

A 32-year-old pregnant woman was admitted to the hospital with polyhydramnios. An ultrasound examination revealed a hypoechoic mass in the neck of the fetus. Magnetic resonance imaging showed a well-defined mass with significant compression of the esophagus and airway. The amniotic fluid index was approximately 40 cm. Considering that difficulty swallowing and breathing may occur due to compression by the mass after birth, tracheotomy and mass resection should be performed immediately. The difficulty of the tumor resection procedure and the nature of the tumor are both factors affecting the prognosis of the fetus. The pregnant woman eventually chose to induce labor. The fetal pharyngeal mass was then resected and its pathological examination indicated pharyngeal glial heterotopia.

CONCLUSIONS

Polyhydramnios due to pharyngeal glial heterotopia is extremely rare and accurate prenatal diagnosis is challenging. Clinical diagnosis of glial heterotopia in preterm fetuses is difficult. Therefore, understanding glial heterotopia is helpful to improve clinical treatment options.

Frontonasal glioma - diagnostic difficulties

Nasal glioma or nasal glial heterotopia represents a rare rare benign tumor of the median line. Prenatal and even postnatal imagingc diagnosis of congenital frontonasal masses is difficult. We describe the case of an infant presenting with a lateral nasal mass. The characteristics of the prenatal magnetic resonance imaging and the postnatal clinical examination argued in favor of a congenital hemangioma. The non-regressive aspect of hemangioma under Propranolol therapy pleaded for a possible non-involuting congenital hemangioma. To rule out other diagnosis we performed a postnatal magnetic resonance imaging that indicated a tissue lesion and ruled out an encephalocele. Surgical treatment was performed. The histologic examination revealed glial tissue and connective tissue, with immunohistochemistry confirming nasal glial heterotopia. Nasal glioma can be misdiagnosed as hemangioma. Magnetic resonance imaging and pathology with immunohistochemistry are the mainstay of diagnosis.

Intranasal glial heterotopia in an infant boy

INTRODUCTION

Nasal glial heterotopia is a rare congenital developmental disorder characterized by meningeal epithelium and/or glial components.

CASE PRESENTATION

A 2-month-old boy presented for treatment of a congenital mass in the right nasal cavity near the pharynx. The preoperative diagnosis was congenital intranasal neoplasm. Nasal endoscopic resection of the nasopharyngeal mass was performed under general anesthesia. Histological findings in the resected tissue supported a diagnosis of intranasal glial heterotopia. The surgical outcome was good and no surgical site infection occurred. During 1 year of follow-up, the patient did not exhibit recurrence of heterotopia or related symptoms.

CONCLUSION

Transnasal endoscopic surgery is recommended for patients with intranasal glial heterotopia. Thorough preoperative imaging should be performed before glioma resection. The mass should be differentiated from encephalocele to prevent cerebrospinal fluid leakage and meningitis.

Intranasal glial heterotopia in a male infant: A case report

RATIONALE

Nasal glial heterotopia is a rare type of neoplasm consisting of meningothelial and/or neuroglial elements.

PATIENT CONCERNS

A 2-month-old male was evaluated for treatment of a congenital mass in the right nasal cavity near the pharynx.

DIAGNOSES

The patient was preoperatively diagnosed with a congenital intranasal neoplasm.

INTERVENTIONS

Nasal endoscopic resection of the nasopharyngeal mass was performed under general anesthesia. Histological examination of the resected tissue provided a diagnosis of intranasal glial heterotopia.

OUTCOMES

The surgical outcome was good, with no surgical site infection. After 1 year of follow-up, the boy was asymptomatic with no recurrence.

LESSONS

Excision of a nasopharyngeal mass via nasal endoscopy resulted in no recurrence during 1 year of follow-up. Before any surgical treatment for suspected glial heterotopia, the mass should be differentiated clinically and radiologically from an encephalocele to prevent the risk of cerebrospinal fluid leakage and meningitis.