Ceruminous Adenoma of the External Auditory Canal: A Case Report with Imaging and Pathologic Findings

Ceruminous adenomas are benign tumors that are rare in humans and present with a nonspecific symptomatology. The treatment of choice is surgical excision. We present an 87-year-old woman who presented with a reddish, tender, round, soft mass of the outer third of the inferior wall of the left external auditory canal, discharging a yellowish fluid upon pressure. Coincidentally, due to her poor general condition, this patient also showed symptoms consistent with chronic otitis media, parotitis, and cervical lymphadenopathy, such as otorrhea, through a ruptured tympanic membrane and swelling of the parotid gland and cervical lymph nodes. The external auditory canal lesion was surgically excised under general anesthesia, utilizing a transmeatal approach. The pathological diagnosis was ceruminous gland adenoma. The tumor was made of tubular and cystic structures and embedded in a fibrous, focally hyalinized stroma. Immunohistochemistry confirmed the presence of two distinct cell populations. The luminal cells expressed keratin 7, while peripheral (basal) cells expressed keratins 5/6, S100 protein, and p63. The apocrine gland-related antigen GCDFP-15 was focally expressed by tumor cells. The postoperative course was uneventful and at the 2-year follow-up no recurrence of the ceruminous adenoma was noted.

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Intrascrotal lipoblastoma in adulthood

BMJ Case Reports ◽

10.1136/bcr-2019-231320 ◽

2019 ◽

Vol 12 (12) ◽

pp. e231320

Author(s):

Mário José Pereira-Lourenço ◽

Duarte Vieira-Brito ◽

João Pedro Peralta ◽

Noémia Castelo-Branco

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

S100 Protein ◽

Surgical Excision ◽

Large Mass ◽

Histological Diagnosis ◽

Physical Exam ◽

Nodular Lesion ◽

Inferior Portion ◽

The Right

This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.

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An Exceptional Case of Intraparotid Plexiform Neurofibroma Originating from Autonomic Fibers of the Auriculotemporal Nerve

Case Reports in Medicine ◽

10.1155/2017/8327215 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Sarantis Blioskas ◽

Sotiris Sotiriou ◽

Katerina Rizou ◽

Triantafyllia Koletsa ◽

Petros Karkos ◽

...

Keyword(s):

Parotid Gland ◽

Plexiform Neurofibroma ◽

Surgical Excision ◽

Neurofibromatosis Type ◽

Exceptional Case ◽

Benign Tumors ◽

First Case ◽

Superficial Lobe ◽

The Right ◽

Auriculotemporal Nerve

Plexiform neurofibromas are benign tumors that tend to occur in patients suffering from neurofibromatosis type 1 (NF-1). This report addresses a rare case where the tumor affected the parotid gland, deriving almost exclusively from the peripheral portion of the facial nerve. A 6-year-old male was referred to us complaining about a gradually enlarging swelling over the right parotid area. Imaging localized the lesion to the superficial lobe of the parotid gland, suggesting a neurofibroma. Cosmetic disfigurement and a functional deficit led us to perform complete surgical resection. Meticulous surgical dissection as well as auriculotemporal nerve origin made complete extirpation possible with almost zero morbidity and ensured alleviation of both aesthetic impairment and pain. This is the first case of an intraparotid PN in a pediatric NF-1 patient, which originated from branches of the auriculotemporal nerve and particularly from fibers of the autonomic nervous system. Radical surgical excision was decided according to established decision-making algorithms.

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Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1125 ◽

2013 ◽

Vol 5 (2) ◽

pp. 45-49

Author(s):

Ian C Bennett ◽

Magdalena Biggar ◽

Clement Wong ◽

Michael Law

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Differentiated Thyroid Cancer ◽

Intraoperative Ultrasound ◽

Surgical Excision ◽

Ultrasound Guided ◽

Cervical Lymph Nodes ◽

Intraoperative Localization

ABSTRACT As a result of sensitive thyroglobulin assays and widespread use of cervical ultrasound, endocrine surgeons are encountering patients with impalpable suspicious or frankly metastatic cervical lymph nodes in the follow-up phase after treatment for welldifferentiated thyroid cancer. The surgical excision of impalpable disease of recurrent or persistent thyroid cancer can represent a significant challenge which may require some means of intraoperative localization to ensure that affected nodes are removed. Surgeon-performed intraoperative ultrasound (IOUS) can be used for guiding excision of suspicious but impalpable cervical nodes. The IOUS-guided excision technique is described. The successful application of IOUS to localize and guide resection of impalpable nodal recurrences of papillary thyroid carcinoma in two patients is reported. The utilization of IOUS to guide resection of impalpable pathological nodes in the context of thyroid carcinoma is a safe and practical technique which avoids the need for additional localization procedures and unnecessary potential morbidity for the patient. How to cite this article Biggar M, Wong C, Law M, Bennett IC. Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer. World J Endoc Surg 2013;5(2):45-49.

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Cervical Adenitis

Pediatrics in Review ◽

10.1542/pir.7.1.13 ◽

1985 ◽

Vol 7 (1) ◽

pp. 13-24

Author(s):

Andrew M. Margileth

Keyword(s):

Cervical Lymphadenopathy ◽

Staphylococcal Infection ◽

The Body ◽

Cervical Lymphadenitis ◽

Neck Node ◽

Cervical Lymph Nodes ◽

Cervical Adenitis ◽

Viral Illness ◽

Infection And Inflammation ◽

Reactive Hyperplasia

Children with acutely tender and inflamed cervical lymph nodes are observed commonly by family physicians and pediatricians. Cervical lymphadenitis is usually associated with a systemic viral illness and subsides within a few days to 2 weeks. Bacterial adenitis, seen less often, is usually due to (β-hemolytic streptococcal or to staphylococcal infection. However, when a neck node remains enlarged following a systemic illness or when a nontender regional cervical node (adenopathy) persists longer than 2 or 3 weeks with or without associated illness, the physician and parents become worried. Concern is enhanced if the nodes increase in size or number. Infection and inflammation are the most common causes for persistent chronic (3 or more weeks' duration) lymphadenopathy in children. Whereas neoplasm is rare (1.4%) in the child or adolescent less than 17 years of age with a superficial lump on any part of the body, maligancy (Hodgkin disease, lymphoma, neuroblastoma) was found in 31 (13%) of 239 enlarged cervical nodes in similar-aged children at the same institution. Congenital and acquired cysts, pilomatrixomas, and benign neoplasms (lipoma, neurofibroma, lymphangioma) account for the majority of noninflammatory lesions in the neck in children and adolescents. However, most cervical lymphadenopathy in children is due to adenitis or reactive hyperplasia in response to an infection.

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Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1729900 ◽

2021 ◽

Author(s):

Ahmed Elgendy ◽

Eslam Elhawary ◽

Mohamed M. Shareef ◽

Marwa Romeih ◽

Ahmed Ebeed

Keyword(s):

Prospective Study ◽

Color Doppler ◽

Cervical Lymphadenopathy ◽

Ultrasound Elastography ◽

Pathological Examination ◽

Benign Lesions ◽

Surgical Biopsy ◽

Cervical Lymph Nodes ◽

Benign Nature ◽

A Prospective Study

Abstract Introduction We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. Material and Methods A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. Results Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. Conclusion Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

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Role of Adjuvant Radiosurgery after Thoracoscopic Microsurgical Resection of a Spinal Schwannoma

Case Reports in Neurological Medicine ◽

10.1155/2012/345830 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Toba N. Niazi ◽

Christian A. Bowers ◽

Meic H. Schmidt

Keyword(s):

Stereotactic Radiosurgery ◽

Treatment Modality ◽

Surgical Excision ◽

Primary Treatment ◽

Benign Tumors ◽

Noninvasive Treatment ◽

Thoracic Spinal ◽

Primary Treatment Modality ◽

Microsurgical Resection ◽

Spinal Schwannoma

Stereotactic radiosurgery to benign tumors of the spine has not been advocated as a primary treatment modality because of the favorable prognosis for these lesions after gross-total resection. There is even less evidence regarding its use as an adjuvant to neurosurgical resection of benign recurrent spinal disease. We describe the case of a 30-year-old man with a thoracic spinal schwannoma who had an interval increase of his lesion five months after thoracoscopic microsurgical resection. The patient opted for noninvasive stereotactic radiosurgery in lieu of additional surgical excision and has had stable disease 15 months after radiosurgical treatment with the linear accelerator (LINAC) system. In this setting, stereotactic radiosurgery provided a useful adjunct to thoracoscopic microsurgical resection. Future Class I and II evidence should be sought to evaluate the utility of stereotactic radiosurgery as a primary treatment modality or as an adjuvant for microneurosurgical resection of benign spinal lesions in patients who want noninvasive treatment after disease recurrence or who harbor medical comorbidities that would preclude them from being safe surgical candidates.

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Histomorphological Pattern of Cervical Lymphadenopathy

Journal of Enam Medical College ◽

10.3329/jemc.v3i1.13837 ◽

2013 ◽

Vol 3 (1) ◽

pp. 13-17 ◽

Cited By ~ 1

Author(s):

Md Atiqur Rahman ◽

Md Mamun Ali Biswas ◽

Syeda Tasfia Siddika ◽

Abdul Mannan Sikder

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Hodgkin Lymphoma ◽

Cervical Lymphadenopathy ◽

Histological Evaluation ◽

Cervical Lymph Nodes ◽

Female Ratio ◽

Study Results ◽

Metastatic Neoplasm ◽

Age And Sex

Background: Enlarged palpable cervical lymph nodes as a primary presenting sign are very common and may be due to inflammatory lesions and tumors. Correlation between clinical findings and laboratory data is essential in arriving at a diagnosis. In patients presenting with cervical lymphadenopathy, excision biopsy provides material to establish an early diagnosis. We designed this study in our population for histological evaluation of cervical lymph node biopsies that might be important in the management of these patients. Objective: Histopathological evaluation of different diseases involving the cervical lymph nodes in relation to age and sex of the study population. Materials and Methods: It was a cross sectional study conducted in the department of Pathology, Enam Medical College & Hospital, Savar, Dhaka during the period from January 2006 to December 2010. A total of 107 patients were evaluated for specific cause of cervical lymphadenopathy in relation to age and sex. Lymph node biopsies of all patients of both sexes and all age groups were included in the study. Results: Among the 107 subjects 58 (54.2%) were males and 49 (45.8%) were females with a male to female ratio of 1.2:1. The age of the patients ranged from 2 to 85 years with a mean age of 32.68 ± 18.01 years. Of the 107 lymph node biopsies, 34 cases (31.8%) were reactive lymphadenitis, 41 cases (38.3%) were tuberculosis, 2 cases (1.9%) were non-caseous granuloma, 6 cases (5.6%) were Hodgkin lymphoma, 8 cases (7.5%) were non-Hodgkin lymphoma, 12 cases (11.2%) were metastatic neoplasm and 4 cases (3.7%) were other specific lesions. Conclusion: The commonest cause of cervical lymphadenopathy was tuberculosis, followed by reactive lymphadenitis, lymphoma and metastatic neoplasm. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13837 J Enam Med Col 2013; 3(1): 13-17

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Transcanal Endoscopic Ear Surgery with Piezoelectric Device for External Auditory Canal Lesions

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2020.01109 ◽

2021 ◽

Vol 64 (7) ◽

pp. 511-516

Author(s):

Chan Young Lee ◽

Seung Ho Kim ◽

Jeong Hwan Choi

Keyword(s):

External Auditory Canal ◽

Cold Water ◽

Surgical Excision ◽

Cystic Mass ◽

Surgical Removal ◽

Ear Surgery ◽

Dental Surgery ◽

Piezoelectric Device ◽

External Auditory Canal Cholesteatoma ◽

Conductive Hearing

External auditory canal exostosis (EACE) is prone to occur in patients frequently exposed to cold water, which causes earwax impaction, recurrent otitis externa, and conductive hearing loss. The main treatment for symptomatic EACE is surgical excision. External auditory canal cholesteatoma (EACC) is a bone-destructive cystic mass caused by accumulation of plugs of desquamated keratin debris in the external auditory canal (EAC), which is also mainly treated with surgical removal. The main difficulties in the surgical removal of obstructive EACEs or EACCs are related to the adjacency of EAC skin, tympanic membrane, temporomandibular joint, and the blockage of the medial EAC landmarks during the operation. The piezoelectric device (PZD), which has long been used to cut bony structures in dental surgery, has clinical advantages here with regards to accurate exclusive bone cutting ability and minimal heat production. We report a series of cases that managed EAC lesions using PZD.

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Rare Presentation of Self-Limiting Kikuchi–Fujimoto Disease in Relapsing Nature

Case Reports in Medicine ◽

10.1155/2020/9785104 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Karo Servatyari ◽

Hero Yazdanpanah ◽

Chamara Dalugama

Keyword(s):

Lymph Nodes ◽

Wide Spectrum ◽

Clinical Manifestations ◽

Cervical Lymphadenopathy ◽

Excision Biopsy ◽

Presentation Of Self ◽

Rare Presentation ◽

Cervical Lymph Nodes ◽

One Year ◽

Loss Of Appetite

Background. Kikuchi–Fujimoto disease (KFD) is a rare, benign, and self-limiting disease that is commonly associated with cervical lymphadenopathy and fever. The disease has a wide spectrum of clinical manifestations, and definitive diagnosis is based on the histological appearance in the excision biopsy of the lymph nodes. Recurrence of KFD is reported rarely. Case Presentation. A 56-year-old Iranian woman with a background history of thrombocytopenia presented with fever, malaise, loss of appetite, and weight loss with cervical lymphadenopathy. The excision biopsy of the cervical lymph nodes confirmed the diagnosis of KFD, and she made a full recovery with improvement of symptoms, regression of cervical lymph nodes, and normalization inflammatory markers. One year after remission, she presented with similar clinico-biochemical profile, and repeat biopsy confirmed KFD. Conclusion. Although the rate of recurrence of the disease is very low, the treating physician should consider the possibility and confirm it histologically.

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A Study of FNAC of Cervical Lymph Nodes

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v7i1.2267 ◽

1970 ◽

Vol 7 (1) ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

G Shakya ◽

S Malla ◽

KN Shakya ◽

R Shrestha

Keyword(s):

Lymph Node ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Cervical Lymph Node ◽

Cervical Lymphadenopathy ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Cervical Lymph Nodes ◽

Fine Needle ◽

Needle Aspiration Cytology

Background: Fine Needle Aspiration Cytology (FNAC) is a reliable and least expensive method suitable for developing countries like Nepal for the investigation of lymphadenopathy. Knowledge about the pattern of lymphadenopathy is useful in pathological reporting as well as in many clinical settings with diagnostic dilemma. This is a baseline study to investigate the pattern of cervical lymphadenopathy by lymph node FNAC in Nepalese population. Methods: A retrospective study was conducted by critically analyzing the case reports on cervical lymph node FNAC from three years' records (July 2005 to June 2008) at the National Public Health Laboratory, Teku, Kathmandu. Review of all cytological reports were done according to standard guidelines and the diagnosis was classified and correlated with patients' age and ethnicity to explore the pattern and association. Results: Of 508 cervical lymph node FNAC cases, 50.4% was reactive non-specific, 22.4% was tubercular, 4.8 % malignant, 10% chronic granulomatous and the remaining was acute suppurative (12.4%). Highest incidence of malignancy was seen in the fifth decade (50%). Whereas, tubercular lymphadenopathy was found with increasing frequency through childhood (10.5%) and adolescence (21.7%) to young adulthood (30.4%), probably indicative of waning immunity of BCG vaccination. Ethnic groups comprising of Tamang, Sherpa and Bhote had the highest incidence of malignant as well as tubercular lymphadenopathy. Conclusion: The relationship of malignant and tubercular lymphadenopthy with age and ethnicity deserves further study. Efforts at preventing tubercular and early diagnosing malignant lymphadenopathy and reducing morbidity in general will find great usefulness in such associations. Key words: Cervical Lymphadenopathy, Fine Needle Aspiration Cytology, Pattern DOI: 10.3126/jnhrc.v7i1.2267 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 1-5

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