RT Journal Article
SR Electronic
T1 Painless expanding facial swelling
JF Archives of disease in childhood - Education & practice edition
JO Arch Dis Child Educ Pract Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 121
OP 123
DO 10.1136/archdischild-2020-320371
VO 107
IS 2
A1 Heaton, Paul Anthony
A1 Zaborowski, Krzysztof Piotr
A1 Holwill, Stephen David
A1 Merrick, Graham David
A1 Paul, Siba Prosad
YR 2022
UL http://ep.bmj.com/content/107/2/121.abstract
AB Case history A previously healthy 11-year-old girl sustained a mosquito bite on her right cheek while on holiday in rural Bangladesh. A painless lump developed at the site, and over the ensuing 2 months gradually expanded. She was otherwise completely asymptomatic; there was no family history of note. On examination, there was obvious swelling affecting the right cheek and visible abnormality of the upper gum with displacement of the right upper central incisor (figure 1).Figure 1 Swelling of gum and displacement of tooth.The facial swelling measured 4×5 cm, was firm to touch, non-fluctuant, painless and non-tender; no other abnormalities were present. Blood results at presentation are shown in box 1.Box 1 Blood results at presentationHaemoglobin 132 g/L (115–155).White cell count 6.92×109/L (5.0–13.0).Platelets 359×109/L.Erythrocyte sedimentation rate 7 mm/hour (0–12).C-reactive protein 2 mg/L (0–10).Calcium 2.32 mmol/L (2.1–2.6).Alkaline phosphatase 242 u/L (78–213).Lactate dehydrogenase 391 u/L (250–450).MRI scan (figure 2) showed well-defined unilocular hyperintense signal cystic lesion measuring 40×38×40 mm involving right-sided alveolar process of maxilla completely filling the right maxillary sinus.Figure 2 MRI showing right-sided cyst arising from maxilla.Question 1 What is the most likely diagnosis?Burkitt’s lymphomaEwing’s sarcomaOdontogenic keratocystRhabdomyosarcomaMelioidosisSolitary cystic ameloblastomaQuestion 2 What is the appropriate next step?Fine needle aspiration of cystExcision of lesionBone marrow aspirationMagnetic resonance imaging of thorax and abdomenStart intravenous ceftazidime Answers can be found on page XX