Christopher M. Pepper’s research while affiliated with Great Ormond Street Hospital for Children NHS Foundation Trust and other places

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Publications (3)


‘A series of parapharyngeal glial heterotopia mimicking lymphatic malformation’
  • Literature Review

September 2015

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22 Reads

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8 Citations

International Journal of Pediatric Otorhinolaryngology

Nora Haloob

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Christopher Pepper

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Otolaryngologists will most frequently encounter extra-cranial glial tissue within the nasal cavity, where it is known as a ‘nasal glioma’, and may communicate with the dura. However, glial tissue can also present extra-nasally in the form of a neck mass with no intracranial connection. In these rare cases, they can present soon after birth as an enlarging neck mass, causing compressive symptoms with airway obstruction and feeding difficulties. In this way, it is often initially misdiagnosed as a more common lesion such as a lymphatic malformation, teratoma, branchial anomaly or vascular malformation. As with many congenital head and neck masses, offering the most the appropriate management relies heavily on radiological imaging and, where possible, histopathology from a diagnostic biopsy. Once the diagnosis of extra-nasal glial heterotopia has been confirmed, the gold standard management is complete surgical excision. We review three cases of extra-nasal glial heterotopia presenting to our institution over an eleven year period as a large neck mass, which mimicked other congenital neck lumps, and discuss them in the context of those in the literature. We highlight how their clinical and radiological features can easily be confused with lymphatic malformations, and the potential implications of misdiagnosis. Raising awareness of this diagnostic confusion will highlight the need for management of these cases within an appropriate paediatric multidisciplinary setting.


Head and neck teratomas in children-A series of 23 cases at Great Ormond Street Hospital

August 2015

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103 Reads

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54 Citations

International Journal of Pediatric Otorhinolaryngology

Victoria Rebecca Carol Alexander

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Joseph George Manjaly

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Christopher M. Pepper

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[...]

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Objective: Head and neck teratomas are rare and malignant change is rarer still. This is a report detailing all of the teratomas treated by the ear, nose and throat or craniofacial teams over the last 28 years at our institution. Examining the common presenting and radiological features as well as our success rates compared to the current literature. Method: A retrospective review of all cases presenting to our institution with a head and neck teratoma were analysed. Data regarding the following characteristics were collected: antenatal history, clinical features, biological serum makers, radiological and pathological characteristics. Surgical treatment, rates of reoccurrence and the degree of post-operative follow up were also analysed. Results: 23 cases in total were included: 8 cervical, 6 nasopharyngeal, 5 thyroid, 2 thymus, 2 temporal. One had malignant change. The majority of children presented at birth with respiratory distress, 5 cases were picked up antenatally and one case presented at 10 years of age. All were treated surgically; with complete excision in 20 patients. No clinical recurrence occurred but further surgery was performed for radiologically suspected residual disease in one case. Discussion: This is the largest detailed case series in literature in regard to head and neck teratomas. Illustrating that this is frequently a benign disease process disease in the head and neck region and has an excellent long term prognosis following surgery. In the situation of incomplete resection careful meticulous follow up with radiological imaging and a multidisciplinary team approach is a safe and viable alternative.


Primary cervical ganglioneuroblastoma

April 2015

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31 Reads

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12 Citations

International Journal of Pediatric Otorhinolaryngology

Ganglioneuroblastomas represent a histological subgroup of the rare neuroblastic tumours with intermediate malignant potential arising from neural crest progenitor cells of sympathetic nerves. Diagnosis can often be difficult based on imaging alone. We describe 4 cases of children presenting with a solitary neck mass with histology ultimately revealing ganglioneuroblastoma. A retrospective case note review was carried out of all patients with cervical ganglioneuroblastoma seen at Great Ormond Street Hospital, UK. Mean age at presentation was 5 years. Based on imaging, the initial diagnoses for three of the cases were: lymphatic malformation, carotid body tumour, paraganglioma, respectively, whilst the remaining case had an immediate incisional biopsy revealing the correct diagnosis. All cases were managed by surgical excision with no evidence of recurrence after a median follow up of 6 years. Otolaryngologists should be aware of ganglioneuroblastoma when establishing the differential diagnosis of a child presenting with a neck mass. Biopsy is recommended as the gold standard investigation to avoid an incorrect diagnosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Citations (3)


... Immature teratomas are potentially malignant and often found in early infancy with embryonic elements within the tissue. 8 Mature teratomas are considered benign but they can cause symptoms and complications depending on their location of presentation. Prior studies by Barksdale et al and Kadlub et al have suggested that age of diagnosis is an important prognostic feature independent of tumor location. ...

Reference:

Unilateral Periorbital Swelling in a Pediatric Patient
Head and neck teratomas in children-A series of 23 cases at Great Ormond Street Hospital
  • Citing Article
  • August 2015

International Journal of Pediatric Otorhinolaryngology

... N asal neuroglial heterotopia (NGH), or nasal glioma, is a developmental midline mass of neurogenic origin characterised by the presence of dysplastic non-teratomatous extracranial glial tissue losing its intracranial communication (1) . The incidence of congenital nasal masses has been reported as 1 per 20,000 to 40,000 live births (2) . Reid first described the nasal glioma in 1892, whereas Schmidt was the first to present a comprehensive description of this entity and coined the term glioma in 1900. ...

‘A series of parapharyngeal glial heterotopia mimicking lymphatic malformation’
  • Citing Article
  • September 2015

International Journal of Pediatric Otorhinolaryngology

... 5 In the literature of the past few decades, there have been 8 reports describing 15 cases of primary cervical GNB, 5 of which are located in the retropharyngeal space. [6][7][8][9][10][11][12][13] In this report, we present the case of an 8-year-old girl with a cervical GNB located in the retropharyngeal space. ...

Primary cervical ganglioneuroblastoma
  • Citing Article
  • April 2015

International Journal of Pediatric Otorhinolaryngology