Mediastinal neuroblastoma causing Horner's syndrome in a 7-year-old child: a case report

Peripheral neuroblastic tumors comprise a spectrum of neoplasms (neuroblastoma, ganglioneuroblastoma, ganglioneuroma) that primarily arise from the sympathoadrenal lineage and can cause variety of symptoms. A 7-year-old patient with no significant past medical history presented to the emergency room. On clinical examination, right-eye miosis and ptosis were observed, along with conjunctival hyperemia, redness, and neck muscle rigidity . Auscultation demonstrated pathological breath sounds consistent with an acute upper respiratory tract infection. An anterior chest X-ray revealed a clearly defined, oval mass with calcifications at the apex of the right lung and paravertebral regions. Subsequent imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), identified a mass in the upper posterior mediastinum measuring approximately 39 × 25 × 27 mm, suggestive of a neurogenic origin. Enlarged lymph nodes were also observed, while laboratory findings showed no significant abnormalities. A whole-body two-dimensional metaiodobenzylguanidine (MIBG) scintigraphy demonstrated scintigraphic evidence of an adrenergic-origin tumor in the right upper mediastinum. The solitary mass measured 40 × 27 × 26 mm and was partially calcified. No pathological findings were detected in the lungs, and there was no evidence of osseous metastasis. Based on the radiological findings, a preliminary diagnosis of paraspinal ganglioneuroma with associated Horner syndrome was made. Thoracoscopic surgery was performed, resulting in the complete excision of a tumor measuring approximately 5 cm in diameter, along with mediastinal lymph node dissection. The postoperative recovery was uneventful, with the wounds healing by primary intention and no complications occurring. Histopathological examination of the resected specimen, revealed a differentiated neuroblastoma with lymph node metastasis. Additional treatment, including adjuvant therapy was not selected for the patient. Horner syndrome resolved after the surgical treatment . At the one-year follow-up, routine chest MRI revealed new foci in the posterior superior mediastinum. Whole-body MIBG scintigraphy confirmed recurrence, and a subsequent surgical intervention was planned. Children who develop Horner syndrome of unknown origin must undergo imaging studies to rule out a tumor in the posterior superior mediastinal region.