Snoring as main symptoms of peripheral primitive neuroectodermal tumor in oropharynx:a case report with review of literature

IntroductionIn children, snoring is often associated with hypertrophied tonsils and adenoids. There was a case in a girl who did not suffer from hypertrophy adenoids, but from a peripheral primitive neuroectodermal tumor (pPNET) in the oropharynx. pPNET often occurs in the deep soft tissues of the trunk, paravertebral, lower limbs and retroperitoneum. It is rarely located in children's oropharynx and makes snoring.Patient concernsWe report a case of a 4-years-old girl who complained of slurred speech and snoring. Her serum showed normal results, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in oropharynx. By using histology and immunohistochemistry, cluster of differentiation 99 (CD99), vimentin, friend leukemia integration 1 (FLI-1), integrase interactor-1 and α-smooth muscle actin were positive, but epithelial membrane antigen, erythroblast transformation-specific (ETS) related gene (ERG), NK homeobox 2.2, Wilms’ tumor 1 and S100-protein were negative. And the rearrangement of the Ewing sarcoma breakpoint region 1 (EWSR1) gene was proved in the test of fluorescent.DiagnosisShe was diagnosed as a peripheral primitive neuroectodermal tumor.Interventions and outcomeThe girl had been treated with surgery and chemotherapy. She has been well for 24 months without any signs of disease.ConclusionIn children who snore, we should not only think of hypertrophied adenoids, but also the possibility of pPNETs in oropharynx. CT scan or MRI should be conducted in time, as well as histology and immunohistochemistry to avoid misdiagnosis.