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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 105-107

Sternocleidomastoid pseudotumor: A prompt fine-needle aspiration cytology diagnosis


Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India

Date of Web Publication10-Apr-2018

Correspondence Address:
Dr. Rohi Wani
Department of Pathology, Government Medical College, Srinagar - 190 010, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_137_17

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  Abstract 


Sternocleidomastoid pseudoumor of infancy or congenital torticollis is a self-limiting pseudotumor of infancy presenting with neck mass and restriction of neck movement. It is a benign proliferation of fibrous tissue with in the sternocleidomastoid muscle leading to focal or diffuse enlargement of muscle. Its timely and correct diagnosis can be done by a simple and noninvasive technique of fine-needle aspiration cytology. It's a prompt and reliable diagnostic procedure, more importantly, to differentiate it from other neck lesions of childhood. Here, we represent a case of such tumor with cytological features and spontaneous resolution.

Keywords: Fibromatosis colli, fine-needle aspiration cytology, sternocleidomastoid pseudotumor


How to cite this article:
Wani R, Ahmad M, Bhat S, Sheikh S. Sternocleidomastoid pseudotumor: A prompt fine-needle aspiration cytology diagnosis. J Clin Neonatol 2018;7:105-7

How to cite this URL:
Wani R, Ahmad M, Bhat S, Sheikh S. Sternocleidomastoid pseudotumor: A prompt fine-needle aspiration cytology diagnosis. J Clin Neonatol [serial online] 2018 [cited 2020 Sep 27];7:105-7. Available from: http://www.jcnonweb.com/text.asp?2018/7/2/105/229666




  Introduction Top


Sternocleidomastoid tumor or fibromatosis colli or congenital torticollis is a condition in which there is swelling, diffuse, or well defined in the neck and presenting within a few weeks of birth leading to lot of anxiety to the parents and dilemma for doctors who need to differentiate it from other sinister neck lesions. It is a rare condition which occurs in 0.4% of live births. Fine-needle aspiration cytology (FNAC) provides a simple, noninvasive, reliable, and easily accessible method to diagnose this rare infancy pseudotumor.

A 32-day-old male child was referred from the Department of Neonatology to the pathology department for FNAC of a neck swelling on the left side that had been noticed by the parents on the 8th day of birth. The swelling was solitary, firm-to-hard in consistency and was not warm to touch [Figure 1]. The patient was afebrile. There was a restriction of the neck movements on the affected side. The boy is the first born child of healthy nonconsanguineous parents. The delivery of child was a full-term normal vaginal delivery although a difficult one, so the child was delivered by forceps.
Figure 1: Photograph showing swelling over the left side of neck

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Ultrasonography showed a thickened sternocleidomastoid muscle on the left side; it had a fusiform appearance and heterogeneous echotexture. The fibrillar structure of the muscle fibers was, however, maintained. In comparison, the right sternocleidomastoid muscle appeared normal. There was no cervical lymphadenopathy.

FNAC was done. A characteristic cytological picture was seen which lead to a prompt diagnosis of Sternomastoid tumor of infancy. At low power, a moderately cellular smear showed multinucleated muscle giant cells in a background of scattered spindle cells [Figure 2]. On high power spindle cells had evenly dispersed fine granular chromatin and unipolar or bipolar tail of cytoplasm. Collagen fibers were also visible. There were no inflammatory cells, and the background was clear. No significant mitosis was identified [Figure 3]. The parents were reassured, and physiotherapy was advised. Swelling regressed gradually, and there is no trace of swelling left after 3 months of diagnosis.
Figure 2: Smears showing densely staining multinucleated giant cells in a background of spindle cells. May–Grunwald–Giemsa ×100

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Figure 3: Smears showing multinucleated giant cells, fibroblasts with ovoid nuclei, and wispy cytoplasm. May–Grunwald–Giemsa ×400

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  Discussion Top


Sternocleidomastoid tumor of infancy or fibromatosis colli also known as Congenital muscular torticollis is a benign fibroblatic mass lesion of the sternocleidomastoid muscle presenting as a firm, fusiform, nontender neck mass of 1 cm –3 cm in greatest dimension in the perinatal period.[1] The lesion characteristically manifests between the second and 8 weeks of life. A well-recognized association is seen, and primiparous birth, breech presentation, forceps deliveries, and difficult labor are found. It is a self-limiting fibroblastic lesion usually presenting with torticollis and a history of birth trauma.[2] It is one of the few causes in which FNAC is indicated in a neonate to confirm the diagnosis and to differentiate it from other congenital, inflammatory, and neoplastic causes. Its differential diagnosis includes congenital lesions such as branchial cyst, thyroglossal cyst, inflammatory lesions such as tuberculous lymphadenitis and neoplastic conditions which could be benign (hemangioma, cystic hygroma) or malignant (neuroblastoma, rhabdomyosarcoma, and lymphoma).[3]

Various modalities are used for the diagnosis, including radiographic studies, FNAC, and open biopsy. FNAC is a reliable, safe, and cost-effective method, and can provide a rapid and reliable diagnosis of sternomastoid tumor of infancy.[1] Cytologic features of fibromatosis colli are bland-appearing fibroblasts and degenerative atrophic skeletal muscle in a clean background. Besides these, large number of muscle giant cells; numerous bland, bare nuclei; and parallel clusters of fibroblasts and collagen are seen. The cytological differential diagnosis includes all types of benign proliferation of infancy. Nodular fasciitis can be excluded by the absence of inflammatory cells and pleomorphic proliferating fibroblast. Infantile fibromatosis shows infiltrative pattern affecting the adjacent muscle. Low-grade fibrosarcoma/infantile fibrosarcoma rarely affects neck region and shows considerable cellularity and atypia.[2]

Confirmatory, noninvasive diagnosis of fibromatosis colli can be made by FNAC alone; invasive diagnostic and therapeutic measures are best avoided. Excision biopsy may not be necessary and should be reserved for cases with a strong clinicopathologic suspicion of malignancy.[4] The typical clinical setting and characteristic cytological findings are definitive of diagnosis.[2] FNAC is considered the first-line investigation in the diagnosis of infantile fibromatosis colli and helps in excluding other causes. It is a rapid, cheap, and reliable diagnostic procedure which helps in avoiding more invasive and costly procedures. Radiological imaging modalities, such as ultrasonography and computed tomography, may be helpful in the diagnosis. However, the cost and availability of these procedures limit its use.[3] Although in a retrospective study of 13 cases of infants with lateral neck masses, the diagnosis was established in all the cases by ultrasonography; making ultrasonography the best imaging modality and the first one to be done.[5]

The condition is generally self-limited. Most of the cases respond to conservative management. When diagnosed early, it is managed in a nonsurgical manner which involves passive stretching and physiotherapy. Surgical intervention maybe required only in refractory cases or in a child >1 year of age.[3] In this case also the swelling regressed completely and spontaneously within a period of few weeks. There are reports of spontaneous regression even without physiotherapy.[5],[6]


  Conclusion Top


FNAC provides a confirmatory, noninvasive, and rapid diagnosis of sternocleidomastoid tumor. Its further importance lies in simplicity, cost-effectiveness and availability of the technique even in remote areas. Being a relatively rare condition doctor should be aware of this entity and can always send the infant for FNAC so that the patient is saved from undue delay, anxiety, and invasive techniques.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

Authors would like to acknowledge the immense help received from scholars whose articles are cited and included in the references of this manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar B, Pradhan A. Diagnosis of sternomastoid tumor of infancy by fine-needle aspiration cytology. Diagn Cytopathol 2011;39:13-7.  Back to cited text no. 1
[PUBMED]    
2.
Baisakh MR, Mishra M, Narayanan R, Mohanty R. Cytodiagnosis of sternocleidomastoid tumor of infancy. J Cytol 2012;29:149-51.  Back to cited text no. 2
  [Full text]  
3.
Khan S, Jetley S, Jairajpuri Z, Husain M. Fibromatosis colli – A rare cytological diagnosis in infantile neck swellings. J Clin Diagn Res 2014;8:FD08-9.  Back to cited text no. 3
    
4.
Sharma S, Mishra K, Khanna G. Fibromatosis colli in infants. A cytologic study of eight cases. Acta Cytol 2003;47:359-62.  Back to cited text no. 4
    
5.
Bouraoui IH, Arifa N, Gaha M, Kermani W, Dali KM, Jemni H, et al. Sternocleidomastoid pseudotumor of infancy: A report of thirteen cases. JBR-BTR 2012;95:6-9.  Back to cited text no. 5
    
6.
Adamoli P, Pavone P, Falsaperla R, Longo R, Vitaliti G, Andaloro C, et al. Rapid spontaneous resolution of fibromatosis colli in a 3-week-old girl. Case Rep Otolaryngol 2014;2014:264940.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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