Case of the Month

RCOM 4

An eighteen month old boy whose parents are from Laos had fevers, ear pain, and irritability for 6 months. His birth and early developmental status had been normal. Several trips to the doctor and antibiotics for what was considered to be chronic otitis media had been ineffectual.

The child lost weight and failed to thrive. Finally he refused to walk and complained of the right hip. A radiograph of the right hip and a CT of the right hemipelvis are shown.

Evaluation revealed an enlarged liver and spleen. A CT of the lung showed bilateral lesions. A CT of the skull showed bilateral lesions that explained the chronic ear symptoms.

Histological sections from the right ilial mass are shown in medium and high power views.

What is the diagnosis?

What are the 4 cells that are characteristically seen on hematoxylin and eosin stains in this tumor?

What is the recommended treatment for the right ilial lesion?

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