Unusual presentation of angiomyomatous hamartoma in an eight-month-old infant: case report and literature review

We report an 8-month-old patient with a cervical, anterior midline mass. Ultrasonographic images showed features suggesting a partly cystic lesion, with a preoperative suspect of thyroglossal duct cyst. Histological examination, performed after surgical removal of the mass, led to a diagnosis of lymph node angiomyomatous hamartoma (AH).AH, a rarely occurring benign lymph node lesion, has been reported in the neck lateral region only twice. This case, presenting as a palpable neck midline mass, is the first reported case occurring in infancy. Although rare, AH should be included in the differential diagnosis of head and neck masses.Palpable neck masses are a common clinical concern in pediatric patients, and differential diagnosis includes a wide range of pathologies, such as congenital, inflammatory, tumoral and traumatic lesions. Malformative neck masses in childhood are branchial cleft cysts, ectopic thymus, teratomas, cystic lymphangioma, aberrant thyroid tissue and others [1-6]. Thyroglossal duct cyst is a congenital anomaly related to persistence of thyroglossal duct, presenting as a midline cyst, near the hyoid bone with variable sonographic appearances [7,8]. AH is a rare, benign lymph node pathology consisting of a fibrous transformation of the hilar region, also with presence of vessels and smooth muscle cell proliferation. Of 28 cases hitherto reported, only two were located in the lateral neck region, both in adult patients, and the lesion has been more frequently found in the inguinal and femoral region [9-11].Ultrasonography (US) is an accurate, cost-effective, non-invasive preoperative analysis, usually sufficient to make correct preoperative diagnoses, even if the accuracy of this imaging method may have limitations, because of the variability of the sonographic appearances [12,13]. Computed tomography and magnetic resonance imaging play a supplementary diagnostic role. Obviously, surgical excision with histological examination allows a definite diagn