The role of radiology in head and neck tumours in children

Abstract

Head and neck malignancy is rare in children. However, distinguishing malignant tumours from the more common and numerous benign causes of neck masses in childhood is crucial as many malignant conditions have an excellent prognosis with appropriate oncological management. Ultrasound, computed tomography and magnetic resonance imaging all have crucial roles in the diagnosis of head and neck malignancy in children and there is an emerging role for positron emission tomography, particularly in the management and follow-up of lymphoma. We describe the imaging appearances of the common malignant tumours arising in the extracranial head and neck in children, focusing on lymphoma, rhabdomyosarcoma and nasopharyngeal carcinoma. The clinical presentation and radiological appearances of benign tumours in the head and neck in children may overlap with those seen in malignant disease. We describe the imaging appearances of juvenile angiofibroma, vascular abnormalities involving the extracranial head and neck and cervical teratomas. Advances in both imaging techniques and cancer staging systems, many of the latter aimed at avoiding over-treatment and treatment-related complications, will lead to an increasingly central role for imaging in childhood head and neck cancer.

Figure 1

NHL involving the Waldeyer ring. Contrast-enhanced axial CT section showing circumferential soft tissue thickening of the nasopharynx (arrows). This proved to be extranodal NHL of Waldeyer ring.

Figure 2

HL. Coronal short time inversion recovery (STIR) sequence showing a large confluent high signal nodal mass involving the left side of the neck.

Figure 3

Parameningeal RMS in a 6-year-old girl. T1-weighted post-gadolinium axial MRI shows an avidly enhancing mass in the left sphenoid sinus extending into the posterior nasal space and pterygopalatine fossa (arrow). Histologically this mass was rhabdomyosarcoma but similar MRI appearances may be due to angiofibroma.

Figure 4

Orbital RMS. T2-weighted axial MRI shows a predominantly intraconal right-sided orbital mass of intermediate signal intensity causing proptosis of the right globe.

Figure 5

Orbital RMS. T1-weighted post-gadolinium axial MRI in a different patient showing avid enhancement of a left orbital mass proven to be RMS.

Figure 6

Parameningeal RMS. Coronal T1-weighted post-gadolinium image shows a large avidly enhancing mass involving the skull base.

Figure 7

Nasopharyngeal carcinoma. (A) T1-weighted post-gadolinium sagittal MRI showing a large, poorly enhancing soft tissue mass expanding the nasopharynx and extending into the oropharynx and prevertebral space. (B) Following chemotherapy this T1-weighted sagittal MRI shows no detectable residual soft tissue mass. (Images courtesy of Dr Beth McCarville.)

Figure 8

Neuroblastoma. (A) Sagittal STIR image shows intermediate to high signal intensity soft tissue mass (arrows) in the base of the right neck, extending into the right apical region. (B) MIBG study shows avid uptake in the right-sided neck mass (normal salivary gland uptake is seen).

Figure 9

JA. Axial CT (bone algorithm) shows abnormal soft tissue expansion of the left nasal cavity and pterygopalatine fossa with anterior bowing of the posterior left maxillary wall (open arrow) and involvement of the left medial and lateral pterygoid plates (solid arrows).

Figure 10

JA. Axial T1-weighted post-gadolinium MRI shows an enhancing soft tissue mass in the sphenoid and ethmoid sinuses with extension into the middle cranial fossa.

Figure 11

Infantile haemangioma. (A) Axial T2-weighted MRI shows bilateral superficial, plaque-like facial haemangiomas (arrows) in a 10 month-old girl. (B) The same lesion shows uniform enhancement on an axial T1-weighted sequence following gadolinium administration.

Figure 12

Cervical teratoma. (A) T2-weighted axial MRI shows a large multiloculated lesion in the anterior neck. The mass is of mixed signal intensity with some high signal (fluid-filled) areas. The trachea lies in close proximity to the posterior aspect of the mass but is not obviously compressed on this image. (B) T1-weighted axial MRI following contrast administration. The wall and multiple internal septations show avid enhancement.