Make the Diagnosis: Winter 2013

A 14-year-old female presents for a routine sports physical. She is a long-time patient of your practice and has been previously healthy, to include normal growth and development and onset of menses at 12 years of age. Her height is at the 75th percentile and weight at the 65th percentile, both leveling off over the last 12 months. On exam you notice a mass in her anterior neck, midway between her chin and clavicles, about 1 cm off the midline to the left. The mass is about 1.5 cm in greatest dimension. On the same side, you palpate lymph nodes along the anterior edge as well as posterior to her sternocleidomastoid. The midline mass moves with swallowing and none of these lesions are painful. You do not feel any mass on the right, however, you palpate several smaller lymph nodes under the angle of her jaw. The remainder of her exam is normal.

The family is surprised by your findings. On more directed questioning she is asymptomatic, denies weight loss, night sweats, hoarseness, and dysphagia. She has not traveled recently and has no new pets at home. There are no cancers with increased incidence in the family. Her last exam for an acute illness about 6 months ago did not document similar findings.

Congratulations to Theodore S. Tapper, MD, of Philadelphia, Pa, for sending in the first correct answer to last issue’s challenge. The correct answer was neuroblastoma, the topic of the first article in this issue.