A 9-year-old girl presented with a 1-month history of cervical lymphadenopathy, hemoptysis, and headaches that was accompanied by a 4-kg weight loss. Physical examination revealed bilateral, posterior, cervical masses that were firm and measured 10×4×2 cm and 5×3×1.5 cm on the left and right sides, respectively. No other lymphadenopathy was present. Examination of the oropharynx showed bilaterally enlarged tonsils. Results of neurologic, cardiopulmonary, and abdominal examinations were within normal limits.
Results of laboratory studies were as follows: hemoglobin, 124 g/L; hematocrit, 0.38; white blood cell count, 12.3×109/L with a normal differential; platelets, 500×109/L; and lactate dehydrogenase, 1784 U/L.A biopsy of the cervical mass was performed (Fig 1). A magnetic resonance image with contrast of the head and neck was obtained (Fig 2). Additional studies of the biopsy specimen included analysis for the presence of Epstein-Barr virus (EBV) by
Desouky S, Voelkerding K, Gilbert-Barness E. Pathological Cases of the Month. Am J Dis Child. 1993;147(1):75-76. doi:10.1001/archpedi.1993.02160250077024