A novel technique to identify the nerve of origin in head and neck schwannomas

AbstractObjective:Identifying the nerve of origin in head and neck schwannomas is a diagnostic challenge. Surgical management leads to a risk of permanent deficit. Accurate identification of the nerve would improve operative planning and patient counselling.Methods:Three patients with head and neck schwannomas underwent a diagnostic procedure hypothesised to identify the nerve of origin. The masses were infiltrated with 1 per cent lidocaine solution, and the patients were observed for neurological deficits.Results:All three patients experienced temporary loss of nerve function after lidocaine injection. Facial nerve palsy, voice changes with documented unilateral same-side vocal fold paralysis, and numbness in the distribution of the maxillary nerve (V2), respectively, led to a likely identification of the nerve of origin.Conclusion:Injection of lidocaine into a schwannoma is a safe, in-office procedure that produces a temporary nerve deficit, which may enable accurate identification of the nerve of origin of a schwannoma. Identifying the nerve of origin enhances operative planning and patient counselling.

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Investigation of an EHV-1 Outbreak in the United States Caused by a New H752 Genotype

Pathogens ◽

10.3390/pathogens10060747 ◽

2021 ◽

Vol 10 (6) ◽

pp. 747

Author(s):

Nicola Pusterla ◽

Samantha Barnum ◽

Julia Miller ◽

Sarah Varnell ◽

Barbara Dallap-Schaer ◽

...

Keyword(s):

Early Stage ◽

Clinical Signs ◽

Amino Acid Position ◽

High Viral Load ◽

The United States ◽

Neurological Deficits ◽

Diagnostic Challenge ◽

Genotype I ◽

Flunixin Meglumine ◽

Nasal Secretions

Here we report on an EHV-1 outbreak investigation caused by a novel genotype H752 (histidine in amino acid position 752 of the ORF 30 gene). The outbreak involved 31 performance horses. Horses were monitored over a period of 35 days for clinical signs, therapeutic outcome and qPCR results of EHV-1 in blood and nasal secretions. The morbidity of the EHV-1 outbreak was 84% with 26 clinically infected horses displaying fever and less frequently anorexia and distal limb edema. Four horses showed mild transient neurological deficits. Clinically diseased horses experienced high viral load of EHV-1 in blood and/or nasal secretions via qPCR, while subclinically infected horses had detectable EHV-1 mainly in nasal secretions. The majority of infected horses showed a rise in antibody titers to EHV-1 during the outbreak. All 31 horses were treated with valacyclovir, while clinically infected horses further received flunixin meglumine and sodium heparin. This investigation highlights various relevant aspects of an EHV-1 outbreak caused by a new H752 genotype: (i) importance of early detection of EHV-1 infection; (ii) diagnostic challenge to assess H752 genotype; (iii) apparent benefit of valacyclovir use in the early stage of the outbreak; and (iv) weekly testing of blood and nasal secretions by qPCR in order to monitor individual infection status and lift quarantine.

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Immunohistochemical Markers of Apoptotic and Hypoxic Damage Facilitate Evidence-Based Assessment in Pups with Neurological Disorders

Veterinary Sciences ◽

10.3390/vetsci8100203 ◽

2021 ◽

Vol 8 (10) ◽

pp. 203

Author(s):

Ksenia Orekhova ◽

Sandro Mazzariol ◽

Beatrice Sussan ◽

Massimo Bucci ◽

Federico Bonsembiante ◽

...

Keyword(s):

Supportive Therapy ◽

B Cell Lymphoma ◽

Neurological Deficits ◽

Intestinal Helminth ◽

Symptom Duration ◽

Protein Markers ◽

Diagnostic Challenge ◽

Immunohistochemical Markers ◽

Initial Symptoms ◽

Metabolic Imbalance

Seizures in puppies often present a diagnostic challenge in terms of identifying and treating the underlying cause. Dog breeds with mutations of the MDR1-gene are known to show adverse reactions to certain drugs, yet metabolic imbalance exacerbated by physiologically immature organs and other contributing pathologies require consideration before arriving at a diagnosis. This study analysed the brains of two male, 5-week-old Australian Shepherd siblings that died after displaying severe neurological symptoms upon administration of MilproVet® to treat severe intestinal helminth infection. Despite the initial symptoms being similar, their case histories varied in terms of the symptom duration, access to supportive therapy and post-mortem interval. Histopathology and immunohistochemistry were used to obtain more information about the phase of the pathological processes in the brain, employing protein markers associated with acute hypoxic damage (β-amyloid precursor protein/APP) and apoptosis (diacylglycerolkinase-ζ/DGK-ζ, apoptotic protease activating factor 1/Apaf1, and B-cell lymphoma related protein 2/Bcl-2). The results seem to reflect the course of the animals’ clinical deterioration, implicating that the hypoxic damage to the brains was incompatible with life, and suggesting the usefulness of the mentioned immunohistochemical markers in clarifying the cause of death in animals with acute neurological deficits.

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Rare extracranial localizations of the head and neck schwannomas

Vojnosanitetski pregled ◽

10.2298/vsp1007596j ◽

2010 ◽

Vol 67 (7) ◽

pp. 596-599

Author(s):

Milan Jovanovic ◽

Ljiljana Cvorovic ◽

Rastislav Poljovka ◽

Aleksandar Oroz ◽

Ljubomir Pavicevic

Keyword(s):

Head And Neck ◽

Neck Region ◽

Soft Tissue Tumors ◽

Autonomic Nerves ◽

Head And Neck Region ◽

Delay In Diagnosis ◽

Benign Soft Tissue Tumors ◽

Indispensable Tool ◽

Slow Growing ◽

Nerve Of Origin

Introduction. Schwannomas are tumors of neurogenic origin, that arise from Schwann cells which surround peripheral, cranial and autonomic nerves. Schwannomas account for only 5% of all benign soft tissue tumors, and 25-45% of extracranial schwannomas are present in the head and neck region. They are usually classified according to the nerve of origin and the site within the head and neck. Case report. We presented extremely rare extracranial localizations of schwannomas and discussed about diagnosis and management of these tumors. Conclusion. Schwannomas are slow-growing tumors and late symptoms appearance may cause a delay in diagnosis and treatment of patients with these tumors. An appropriate diagnostic protocol is indispensable tool in performing a differential diagnosis of malignant from benign lesions. Choice of surgical approach depends on schwannomas localization.

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A case of Giant Perifollicular Fibroma - a Diagnostic Challenge

Serbian Journal of Dermatology and Venerology ◽

10.2478/sjdv-2020-0004 ◽

2020 ◽

Vol 12 (1) ◽

pp. 19-21

Author(s):

Raghavendra Rao ◽

Srilatha Parampalli Srinivas ◽

Varsha M. Shetty

Keyword(s):

Connective Tissue ◽

Head And Neck ◽

Neck Region ◽

Diagnostic Challenge ◽

Head And Neck Region ◽

Internal Malignancy ◽

Essential Tool ◽

Proliferative Lesion ◽

Connective Tissue Sheath

AbstractPerifollicular fibroma (PFF) is a rare proliferative lesion originating from the perifollicular connective tissue sheath. It may be congenital or acquired manifesting as skin colored to pink, asymptomatic papules of 1-5 mm in size. They are commonly distributed in the head and neck region. Multiple PFFs may be associated with internal malignancy or as a part of Birt-Hogg-Dube syndrome. Histopathology serves as an essential tool in clinching the diagnosis. Herein we report a case of giant congenital PFF.

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Glomus Coccygeum in Surgical Pathology Specimens

Archives of Pathology & Laboratory Medicine ◽

10.5858/1999-123-0905-gcisps ◽

1999 ◽

Vol 123 (10) ◽

pp. 905-908

Author(s):

Zoran Gatalica ◽

Liqiang Wang ◽

Emmanuel T. Lucio ◽

Markku Miettinen

Keyword(s):

Smooth Muscle ◽

Single Case ◽

Smooth Muscle Actin ◽

Neuron Specific Enolase ◽

Diagnostic Challenge ◽

Accurate Identification ◽

Surrounding Soft Tissue ◽

Glomus Cells ◽

Pathologic Processes ◽

Glomus Coccygeum

Abstract Background.—Rarely encountered nonpathologic structures may pose diagnostic problems and cause unnecessary special investigations. More importantly, however, they may be falsely accused as culprits in unrelated pathologic processes. Glomus coccygeum is one such structure. Glomus bodies (including coccygeal glomus) consist of modified smooth muscle cells arranged in layers around small vascular channels. When found in distal extremities, they generally do not represent a diagnostic problem; however, large glomus bodies present in a pericoccygeal location (glomus coccygeum) may cause significant problems for a surgical pathologist unfamiliar with this structure. Design.—We reviewed 37 coccygeal bones removed during rectal resection for carcinoma (rectal and uterine) and for various other reasons, among which was a single case of coccygodynia. Immunohistochemical and ultrastructural examinations were performed in selected cases. Results.—Sharply circumscribed glomus bodies composed of various proportions of glomus cells without atypia or pleomorphism and without expansile growth or infiltration of surrounding soft tissue or bone were identified in 50% of cases. Size varied significantly (maximum 4 mm), but paradoxically the smallest glomus body (less than 1 mm) was found in the case of coccygodynia. Glomus coccygeum posed a significant diagnostic challenge to the pathologists involved in these cases, as the retrospective review found that it was diagnosed correctly in only 3 cases. Conclusions.—Glomus coccygeum is a nonpathologic structure that exhibits significant variation in size and proportion of the constitutive elements. Immunohistochemical demonstration of smooth muscle actin and neuron-specific enolase in glomus cells may be beneficial for accurate identification of this organelle.

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Cutaneous angiosarcoma of the head and neck resembling rosacea: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20940419 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2094041

Author(s):

Alan Wong ◽

Javier Flores

Keyword(s):

Case Report ◽

Endothelial Cell ◽

Head And Neck ◽

Punch Biopsy ◽

Cell Tumor ◽

Diagnostic Challenge ◽

Early Metastasis ◽

Delays In Diagnosis ◽

Early Diagnostic

Angiosarcoma is a malignant endothelial cell tumor that involves a variety of anatomic sites with the skin being the most common. Cutaneous angiosarcoma is a diagnostic challenge as it can be confused with lesions such as rosacea, hemangiomas and hematomas. Since the tumor has a propensity for early metastasis and extensive intradermal spread, early diagnostic intervention via punch biopsy may prevent delays in diagnosis and improve tumor resectability and prognosis. We present a case of cutaneous angiosarcoma on the nose and cheeks of a 75-year-old male that resembled rosacea.

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Component-resolved diagnostics in the clinical and laboratory investigation of allergy

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563219877434 ◽

2019 ◽

Vol 57 (1) ◽

pp. 26-35

Author(s):

Emma L Callery ◽

Catherine Keymer ◽

Nicholas A Barnes ◽

Anthony W Rowbottom

Keyword(s):

Clinical Symptoms ◽

Clinical History ◽

E Proteins ◽

Diagnostic Challenge ◽

Accurate Identification ◽

Allergen Specific Immunotherapy ◽

Technological Advances ◽

Specialist Centre ◽

Life Threatening

The diagnosis and management of allergy is complex; the clinical symptoms associated with allergic reactions span a broad spectrum of severity, from mild hay fever-type symptoms through to life-threatening anaphylaxis. Obtaining an allergy-focused clinical history is therefore vital for identifying possible allergic triggers and directing testing. However, this focus could be changing as scientific and technological advances have paved the way for developments within in vitro testing for allergy. With knowledge of allergens at the molecular level expanding, there are now the facilities to characterize the sensitization profiles of allergy sufferers and determine the specific molecules (or components) against which the allergen-inducing immunoglobulin type E proteins have been produced. This technology is termed component-resolved diagnostics. We know that accurate identification of immunoglobulin type E specificity, the source of the causative allergen, and knowledge of potential allergic cross-reactivities are required for optimal clinical management of allergy patients. These factors can make allergy a diagnostic challenge outside of a specialist centre, and contribute to the difficulties associated with requesting and interpreting allergy tests. The incorporation of component-resolved diagnostics into current practice has provided a platform for patient-tailored risk stratification and improved the application of allergen-specific immunotherapy, revolutionizing specialist management of these patients. This review discusses the roles of each type of testing in allergy management and predictions for future pathways.

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Schwannomas of ear, nose, throat and neck

Surgical Techniques Development ◽

10.4081/std.2019.7550 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Nilam U. Sathe ◽

Sheetal Shelke ◽

Ankur Pareek ◽

Kamini Chavan

Keyword(s):

Head And Neck ◽

Management Strategy ◽

Cranial Nerves ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Neck Masses ◽

Needle Aspiration Cytology ◽

Nerve Of Origin ◽

Tomography Scan ◽

Nose And Throat

Schwannoma is a benign tumour of nerve sheath origin with latent malignant potential. All cranial nerves can give rise to schwannoma except for olfactory and optic nerves, which are devoid of Schwann cell. Schwanommas are usually asymptomatic and present late owing to compression of nerve of origin. We present our study of 19 cases of schwannoma arising from unusual sites in head and neck, having varied presentation and the challenges faced in management of these cases. These cases presented in detail to the department of Ear, Nose and Throat, KEM Hospital, and were thoroughly evaluated clinically and radiologically to formulate a management strategy. Schwannoma of the head and neck is a rare entity but should be considered as differential diagnosis in unilateral nasal mass cases, palatal masses, anterior and lateral neck masses. Nerve of origin may not always be clear preoperatively but the possibility of postoperative loss of nerve function should be kept in mind. Radiological investigations like computed tomography scan and magnetic resonance imaging play a pivotal role in management. In case of nonvascular neck tumours, fine needle aspiration cytology is crucial but has low accuracy in the diagnosis of neural tumors. Histopathology of excised tumour remains the gold standard in diagnosis.

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