Multiple schwannomas of the facial nerve mimicking cervical lymphoma: a case report

Abstract Background In this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve. Case presentation A Caucasian patient presented with a sudden onset of left lower facial nerve palsy House–Brackmann score III for 1 month. Computed tomography imaging was performed to exclude a cerebral event and revealed multiple tumors within the left parotid gland. Duplex ultrasound and magnetic resonance imaging scans delineated multiple, hypoechoic tumors, round in shape and well defined without a hilar structure along the left mandible. For histological verification, a left-side partial parotidectomy and extirpation of an intraparotideal node was performed with use of a nerve-integrity monitor. Histomorphological analysis of the resected tissue revealed a benign schwannoma. Facial nerve function remained unchanged since the operation. The size of the nonresected tumors is currently monitored regularly by ultrasonography. Fibromatosis has been excluded. Conclusions If multiple tumors occur in the parotid gland and the angle of the jaw, schwannomas need to be considered as a differential diagnosis. To plan the right diagnostic surgical intervention and prevent nerve damage, a thorough ultrasound examination is essential in preoperative diagnostic work-up for any suspicious lesion of the parotid gland and jaw region.

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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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Metastatic Parotid Myoepithelial Carcinoma in a 7-Year-Old Boy

Case Reports in Pediatrics ◽

10.1155/2012/212746 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Issam Saliba ◽

Nazir El Khatib ◽

Antoine Nehme ◽

Selim Nasser ◽

Nabil Moukarzel

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Smooth Muscle Actin ◽

Postoperative Radiotherapy ◽

Lumbar Vertebra ◽

Myoepithelial Carcinoma ◽

Cervical Lymph Nodes ◽

Immunohistochemical Markers ◽

First Case ◽

Rare Malignancy

Myoepithelial carcinoma is a rare malignancy of the parotid gland that is usually seen in adults. We report the first case in children of myoepithelial carcinoma of the parotid gland with massive invasion of the facial nerve and metastasis to cervical lymph nodes. Due to its rarity, the treatment and the clinical course of this tumor are not well defined yet. We performed a total parotidectomy, a modified neck dissection, and a postoperative radiotherapy in 7-year-old boy. Sparing of the facial nerve was impossible; it was sacrificed and grafted with a sural nerve. Histopathology confirmed the diagnosis of a parotid gland carcinoma and immunohistochemical markers showed that the tumor cells express cytokeratin, epithelial membrane antigen, cytokeratin 7, smooth muscle actin, P63, CEA, and S100. This pattern of immunostaining is consistent with the diagnosis of myoepithelial carcinoma. On the postoperative tenth month he presented with a pulmonary and lumbar vertebra metastasis.

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Reminder of an important clinical lesson: breast cancer metastasis to the parotid gland

BMJ Case Reports ◽

10.1136/bcr-2018-226494 ◽

2019 ◽

Vol 12 (10) ◽

pp. e226494

Author(s):

Amisha Jakharia-Shah ◽

Hugh Wheatley ◽

Matthew Beesley

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Cancer Metastasis ◽

Ductal Carcinoma ◽

Primary Tumour ◽

Breast Cancer Metastasis ◽

Her2 Receptor ◽

Significant Family History ◽

History Of ◽

The Right

A 59-year-old woman presented to an otolaryngology clinic with an 8-week history of a painless lump over her left parotid gland. Her medical history included an invasive ductal carcinoma (33 mm) and a ductal carcinoma in situ (70 mm) of the right breast, for which she had a mastectomy and various adjuvant therapies. The primary tumour presented 8 years prior to the metachronous metastasis. This patient was a non-smoker and had no significant family history. Post-superficial parotidectomy pathology revealed the parotid gland tumour to be oestrogen receptor-positive and HER2 receptor-positive, thus ruling out the initial differential diagnosis of a pleomorphic adenoma. A consequential total parotidectomy with a posterolateral neck dissection was performed with sparing of the facial nerve. The patient recovered well having only encountered a self-resolving salivary fistula. She portrayed no signs of facial nerve palsy and subsequent imaging scans showed no abnormalities.

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Parotid gland cholesteatoma in a 23-year-old male: Case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x17749083 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1774908

Author(s):

Krzysztof Piersiala ◽

Hanna Klimza ◽

Joanna Jackowska ◽

Małgorzata Wierzbicka

Keyword(s):

Case Report ◽

Parotid Gland ◽

Soft Tissues ◽

Facial Nerve Palsy ◽

Parotid Tumor ◽

Resonance Imaging ◽

Stylomastoid Foramen ◽

First Case ◽

Parotid Surgery ◽

The Right

Cholesteatoma is a pathological tissue that may extend into all parts of temporal bone and rarely, as this study highlights, beyond its structures. Nevertheless, the spread outside the mastoid tip into the soft tissues of the neck or parotid space is very rare. The case of 23-year-old male with right parotid mass is presented. The patient had history (2006, 2009, and 2012) of three tympanoplastics for recurrent right ear cholesteatoma. The parotid tumor was revealed incidentally in magnetic resonance imaging in January 2016, but the imaging was inconclusive. After 6 months, the patient developed right-sided facial nerve palsy. The second look of the right ear was performed with simultaneous parotid surgery. The ear was healed and free of cholesteatoma, but the parotid mass resembled the cholesteatoma confirmed later on by histological examination. The tumor extended from stylomastoid foramen. This case was unusual as the disease had extended beyond the ear with the bony parts of the mastoid being preserved. To our knowledge, this is the first case report to describe a parotid gland cholesteatoma not being an extension of a cholesteatoma present in the tympanic cavity and entering the parotid gland via stylomastoid foramen.

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Primary Cutaneous Follicle Center Lymphoma (PCFCL) with Parotid Gland Involvement

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.186 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S84-S85

Author(s):

S Ayub ◽

Z Al-Duwal ◽

D Sellers ◽

A Rosenberg

Keyword(s):

Parotid Gland ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Lymphoma Cells ◽

Diffuse Infiltration ◽

First Case ◽

History Of ◽

The Right

Abstract Introduction/Objective Primary cutaneous follicle center lymphoma (PCFCL) is the most common primary cutaneous B-cell lymphoma. It arises from mature germinal center B lymphocytes. Here we report two cases of PCFCL with parotid gland involvement. Methods First case is a 66-year-old male with an enlarging forehead mass for nine months and a painless nodule on the right pre-auricular skin. Second is a 39-year-old male with a history of a recurring scalp spindle cell B-cell lymphoma now presenting with an enlarging lesion on the scalp and “fullness” in the right neck. There was no nodal or other extranodal involvement found in either case. Skin and parotid gland biopsies were obtained in both cases. Results Case one: The skin and parotid gland demonstrated sheets of predominantly medium sized infiltrating lymphoma cells, positive for CD20, Bcl-6, CD5 (dim) and Bcl-2 (dim), and negative for CD10, Bcl-1, and MUM-1. The epidermis was spared. Case two demonstrated medium sized, spindle shaped lymphoma cells. The skin showed a vague follicular growth pattern, sparing the epidermis. The parotid gland showed diffuse infiltration by lymphoma cells, positive for CD20 and Bcl-6, Bcl-2 (dim) and no definite positivity for CD10. Fluorescent in situ hybridization for t(14;18) translocation was absent in both cases. Conclusion Dissemination of PCFCL to extracutaneous sites is uncommon (~10% of cases) and to our knowledge, has not been reported in the parotid gland. Here we present two unique cases, which in the absence of nodal disease, prove the diagnosis of PCFCL with parotid gland involvement.

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Concomitant Anomalous Branching of Facial Nerve and Double Parotid Duct: A Case Report

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.372 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Amro Mohamed Soliman ◽

Elvy Suhana Ramli ◽

Srijit Das ◽

Norzana Abd Ghafar

Keyword(s):

Case Report ◽

Oral Cavity ◽

Parotid Gland ◽

Facial Nerve ◽

Branching Pattern ◽

Anterior Border ◽

Parotid Duct ◽

Male Cadaver ◽

The Right

The facial nerve divides within the parotid gland into upper temporozygomatic and lower cervicofacial branches. The two branches further subdivide and emerge from the parotid gland as five main branches. We observed a rare anomalous branching pattern of the facial nerve along with double parotid duct on the right side of a 50-year-old male cadaver. The two parotid ducts emerged at the level of the anterior border of parotid gland then united to form one single duct thereby opened into the oral cavity. The first duct (D1) emerged from the upper one third of the anterior border of the parotid gland and traversed horizontally for 9 mm to join the second duct. Knowledge of anomalous branching pattern of facial nerve and double parotid ducts may be beneficial for maxillofacial surgeons.

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Behandlung akuter embolischer Verschlüsse der A. subclavia und A. axillaris mit einem Rotationsthrombektomie-Katheter

VASA ◽

10.1024/0301-1526.32.2.111 ◽

2003 ◽

Vol 32 (2) ◽

pp. 111-116 ◽

Cited By ~ 9

Author(s):

Zeller ◽

Frank ◽

Bürgelin ◽

Sinn ◽

Horn ◽

...

Keyword(s):

Subclavian Artery ◽

Brachial Artery ◽

Left Subclavian Artery ◽

Axillary Artery ◽

Duplex Ultrasound ◽

Sudden Onset ◽

Femoral Access ◽

Thrombectomy Device ◽

The Right ◽

Pain At Rest

Acute embolic or local thrombotic ischaemia of the upper limbs can be treated by embolectomy or by endovascular techniques. We report here on the endovascular thrombectomy of acute embolic occlusions of subclavian and axillary arteries in two patients using a rotational thrombectomy device and give an overview about the actual literature. Two female patients, each with a history of multi-vessel coronary disease and intermittent atrial fibrillation, complained of sudden onset of pain at rest and paleness of the left and right arm, respectively. Duplex ultrasound showed a localized embolic occlusion of the left subclavian artery and the bifurcation of the brachial artery in the first patient and a localized embolic occlusion of the distal right subclavian and axillary artery in the second patient. In the first patient, the left subclavian artery was reopened using a 8F-Rotarex device via the femoral access, while the bifurcation of the brachial artery was reopened by local thrombolysis using 25 mg rt-PA because of the insufficient length of the thrombectomy device of 80 cm. In the second patient, the right subclavian and axillary arteries were reopened using a 6F-Rotarex device. Follow-up examinations before discharge and after 6 months showed normalized perfusion of the arms of both patients.

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Salivary Duct Carcinoma Metastasizing to the Small Bowel

Tumori Journal ◽

10.1177/030089169608200521 ◽

1996 ◽

Vol 82 (5) ◽

pp. 502-504 ◽

Cited By ~ 3

Author(s):

Božo Krušlin ◽

Mira Ščukanec-Špoljar ◽

Viktor Šeparović ◽

Spomenka Manojlović ◽

Dražn Janković ◽

...

Keyword(s):

Small Bowel ◽

Acute Appendicitis ◽

Parotid Gland ◽

Metastatic Tumor ◽

Salivary Duct Carcinoma ◽

Salivary Duct ◽

Duct Carcinoma ◽

First Case ◽

Prominent Symptom ◽

The Right

We report a case of salivary duct carcinoma in a 47-year-old woman. The patient presented with symptoms simulating acute appendicitis. Surgery revealed metastatic tumor in the wall of the small bowel. Two months later, a tumor of the right parotid gland was resected, and histologic analysis revealed a salivary duct carcinoma. To our knowledge, this is the first case of salivary duct carcinoma metastasizing to the small bowel with manifestations of metastatic disease as the prominent symptom.

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Recurrent Multinodular Pleomorphic Adenoma of Parotid Gland- A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49465:14907 ◽

2021 ◽

Author(s):

Priya Kanagamuthu ◽

Swetha Thirumurthi ◽

S Rajasekaran ◽

S Prabakaran ◽

RB Namasivaya Navin

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Previous History ◽

Significant Risk ◽

Superficial Parotidectomy ◽

Parotid Region ◽

Superficial Lobe ◽

History Of ◽

The Right

Pleomorphic adenoma or benign salivary gland tumours predominantly affects the superficial lobe of parotid gland. It is a slow growing swelling with or without facial nerve involvement with female predilection in third and fifth decade of life. The origin of the tumour is both epithelial and connective tissue and hence it is of pleomorphic nature. After surgery, its recurrence rate varies considerably and seems to depend more on the surgical technique used. A 49-year-old male patient, presented with complaints of swelling in front of right ear and right parotid region for past eight years. He gave previous history of similar swelling in the right parotid region and history of previous surgery done elsewhere in 2009. Right superficial parotidectomy was done following which he was asymptomatic for two years. On examination of right parotid- a multilobulated irregular swelling was present in right parotid region and the swelling extended till the right ear lobule. The swelling hid previous surgical scar. Facial nerve was clinically intact. Fine Needle Aspiration Cytology (FNAC) was suggestive of Pleomorphic Adenoma. Magnetic Resonance Imaging (MRI) with contrast revealed that the lesions were arising from superficial lobe of the parotid gland. Right superficial parotidectomy was planned. Mass was excised and sent for histopathological examination and was reported to be Pleomorphic Adenoma. Patient is still on follow-up and no recurrence has been noted. The rate of recurrence depends on tumour spillage, intra-surgical rupture, or any histopathological feature. There is significant risk for local recurrence if the microscopic finger like formation (pseudopodia) of tumour tissue extends beyond the main mass.

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Role of early surgical intervention in outcome and prognosis of spontaneous cerebellar hemorrhage with intraventricular extension

Eastern Green Neurosurgery ◽

10.3126/egn.v3i01.38962 ◽

2021 ◽

Vol 3 (01) ◽

pp. 28-32

Author(s):

Jemesh Singh Maharjan

Keyword(s):

Clinical Presentation ◽

Surgical Intervention ◽

Sudden Onset ◽

Cerebellar Hemorrhage ◽

First Case ◽

Spontaneous Intracranial Hemorrhage ◽

Poor Outcomes ◽

The Right ◽

Early Surgical Intervention

Spontaneous cerebellar hematomas represent 5 to 13% of all cases of spontaneous intracranial hemorrhage. The main controversy involves deciding which cases require surgical evacuation of the hematoma versus other options, such as ventricular drainage only or conservative treatment. Furthermore, because the clinical course is variable in some cases, timing of such treatment should be carefully considered. The duration from the onset of hemorrhage also plays an important role in prognosis and recovery of the patient. Both the clinical presentation and subsequent course vary among cases. Unpredictable rapid deterioration in consciousness levels has been recognized. The majority of patients with such decline in consciousness experience the deterioration primarily within 72 hrs after onset⁠. Acute presentation was observed to be correlated with poor outcomes. In our report, the first case presented with sudden onset of headache in the right frontal region of head with vertigo. He came to hospital within 6 hours of onset. However, the second case had an onset of symptoms around 72 hours before the presentation.

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