Differential Diagnosis for a Child with Submucosal Mass on MLB, Unwell, Weight Loss, Hoarseness, and Bilateral Neck Positive on Biopsy
- Single Most Likely Diagnosis
- Rhabdomyosarcoma: This is a common malignant tumor of the head and neck in children, which can present with a submucosal mass, weight loss, and hoarseness due to the tumor's location and potential to obstruct or invade surrounding structures. The presence of a mass on the middle line of the back (MLB) and bilateral neck involvement on biopsy supports this diagnosis, as rhabdomyosarcoma can occur in various sites and may spread to lymph nodes.
- Other Likely Diagnoses
- Lymphoma: Lymphomas, particularly non-Hodgkin lymphoma, can present with systemic symptoms like weight loss and can involve the head and neck region, including lymph nodes in the neck. A submucosal mass could be part of the disease process, especially if the lymphoma involves the nasopharynx or oropharynx.
- Squamous Cell Carcinoma (SCC): Although less common in children, SCC can occur in this age group, especially in the context of certain predisposing factors. It can present with a submucosal mass and symptoms like hoarseness if it involves the larynx or hypopharynx. However, bilateral neck lymph node involvement would be unusual for an early-stage SCC.
- Do Not Miss Diagnoses
- Thyroid Cancer: Although not as common as other diagnoses, thyroid cancer (especially papillary thyroid carcinoma) can present with a neck mass and hoarseness if it involves the recurrent laryngeal nerve. It's crucial to consider this diagnosis due to its potential for aggressive behavior and the importance of early intervention.
- Neuroblastoma: This is a malignant tumor that arises from the sympathetic nervous system and can present with a neck mass, weight loss, and hoarseness if it involves the cervical sympathetic chain and affects the laryngeal nerves. It's a critical diagnosis to consider in children due to its aggressive nature and potential for rapid progression.
- Rare Diagnoses
- Other Sarcomas (e.g., Ewing's Sarcoma, Osteosarcoma): These are rare in the head and neck region but can present with similar symptoms, including a submucosal mass and systemic symptoms like weight loss.
- Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis): This is a rare autoimmune disorder that can affect the upper respiratory tract, presenting with a submucosal mass, and can also involve the kidneys and lungs. It's less likely but should be considered in the differential due to its potential for severe complications if not treated promptly.