Painless expanding facial swelling

Case history A previously healthy 11-year-old girl sustained a mosquito bite on her right cheek while on holiday in rural Bangladesh. A painless lump developed at the site, and over the ensuing 2 months gradually expanded. She was otherwise completely asymptomatic; there was no family history of note. On examination, there was obvious swelling affecting the right cheek and visible abnormality of the upper gum with displacement of the right upper central incisor (figure 1). Figure 1Swelling of gum and displacement of tooth. The facial swelling measured 4x5 cm, was firm to touch, non-fluctuant, painless and non-tender; no other abnormalities were present. Blood results at presentation are shown in box 1. Box 1Blood results at presentationHaemoglobin 132 g/L (115–155). White cell count 6.92x109/L (5.0–13.0). Platelets 359x109/L. Erythrocyte sedimentation rate 7 mm/hour (0–12). C-reactive protein 2 mg/L (0–10). Calcium 2.32 mmol/L (2.1–2.6). Alkaline phosphatase 242 u/L (78–213). Lactate dehydrogenase 391 u/L (250–450). MRI scan (figure 2) showed well-defined unilocular hyperintense signal cystic lesion measuring 40x38x40 mm involving right-sided alveolar process of maxilla completely filling the right maxillary sinus. Figure 2MRI showing right-sided cyst arising from maxilla. Question 1 What is the most likely diagnosis? Burkitt’s lymphoma Ewing’s sarcoma Odontogenic keratocyst Rhabdomyosarcoma Melioidosis Soli...
Source: Archives of Disease in Childhood - Education and Practice - Category: Pediatrics Authors: Tags: Epilogue Source Type: research