Otolaryngology Case Reports 17 (2020) 100214 Available online 18 August 2020 2468-5488/© 2020 Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). An atypical cervical median mass in an infant: A lipoblastoma François Chalard a, * , J´ erˆ ome Nevoux b , Nathalie Bosson b , Sabah Boudjemaa c , Hubert Ducou le Pointe a a Radiologie p´ ediatrique, Hˆ opital Armand Trousseau, Paris, France b ORL, Hˆ opital Bicˆ etre, le Kremlin-Bicˆ etre, France c Anatomie et cytologie pathologiques, Hˆ opital Armand Trousseau, Paris, France A R T I C L E INFO Keywords: Lipoblastoma Soft tissue tumor Neck Childhood ABSTRACT Lipoblastoma is a rare, benign tumor of embryonic fat occurring in infants and young children. Generally found in the trunk or extremities, it is rarely located in other areas such as the head and neck, where it may cause respiratory symptoms. A median, pretracheal location is extremely atypical and, to our knowledge, has never been described. Here we describe such a tumor in an 11-month-old infant. The heterogeneous, fatty content of the tumor is very suggestive of lipoblastoma, whatever its location, particularly before age 3 years. Introduction Lipoblastoma is a rare, benign tumor of infancy and early childhood. 90% of cases occur before age 3 years and males are slightly more frequently affected than are females. The tumor arises from an abnormal proliferation of embryonic white fat. Its most frequent locations are the trunk, extremities, head and neck [1]. In the head and neck, the most common sites are lateral cervical spaces (including parotid gland), cheek, skin and orbit [2]. Generally, lipoblastoma presents as a rapidly-growing, well-circumscribed, painless mass, that may occur in both superfcial and deep areas, and occasionally becomes bulky. Depending on the location, it can lead to compression-related symptoms (Horner syndrome, limb weakness, dysphagia or respiratory distress and stridor with a cervical tumor). Here we describe an 11-month-old-infant with a cervical median lipoblastoma, responsible for tracheal compres- sion and with excellent outcome after surgical excision. Case report An 11-month-old male presented a cervical mass, progressively increasing in size from age 2 months and responsible for stridor, dyspnea and feeding troubles. There was no history of trauma or infection. Clinical examination revealed a median, basicervical mass. This mass was frm, painless and motionless during swallowing. The covering skin had a normal appearance. No other symptom was present and laboratory test results were normal. Ultrasonography as frst imaging modality revealed an ovoid, tissue and heterogeneous mass, in a pretracheal location (Fig. 1). B-mode ultrasonography did not reveal calcifcation, cyst or necrosis nor did color Doppler ultrasonography reveal any vessel in the mass. The thyroid gland was in the normal position. Because tracheal compression was highly suspected, CT performed without delay established that the median, pretracheal mass signifcantly compressed the trachea and posteriorly displaced the two lobes of the thyroid gland, which was not its source (Figs. 2 and 3). Well circumscribed by a regular rim, the mass had a global negative density, testifying to its fat content. It also contained several septa and a tissue component, all moderately enhanced on CT. Again, CT did not show calcifcation, cyst or a necrotic portion. Endoscopy was performed under general anesthesia with spontaneous breathing to control the compression and to anticipate any intubation troubles (Fig. 4). With this precaution, the intubation was performed as usual. Shortly after the endoscopy, the mass was surgically freed from surrounding tissues and completely removed. Macroscopi- cally, the resected specimen weighted 14 gr and measured 4 × 3.5 × 2.5 cm. This encapsulated nodule had a pale yellow, fatty appearance on the cut surface. Histology revealed lobules of adipocytes mixed with lip- oblasts in variable proportions, separated by prominent fbrous septa, with occasional myxoid areas (Fig. 5). After surgery, the infant fully recovered and did not show any recurrence. Discussion In newborns, infants and children, classical midline cervical masses * Corresponding author. E-mail address: fchalard@netcourrier.com (F. Chalard). Contents lists available at ScienceDirect Otolaryngology Case Reports journal homepage: www.elsevier.com/locate/xocr https://doi.org/10.1016/j.xocr.2020.100214 Received 2 June 2020; Received in revised form 6 August 2020; Accepted 6 August 2020