scholarly journals Right Ethmoidal Sinus Schwannoma: Case Report of a Common Entity with an Unusual Presentation

2020 ◽  
Vol 7 (8) ◽  
pp. C94-98
Author(s):  
E M Kavitha ◽  
L Swapna ◽  
B N Kumarguru ◽  
S Kranthi Kumar ◽  
M Udaya Kumar
Keyword(s):  
Tumor Cells ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Unusual Presentation ◽  
Anterior Cranial Fossa ◽  
Blurred Vision ◽  
Diagnostic Dilemma ◽  
Ethmoidal Sinus ◽  
History Of ◽  
Cranial Fossa

Schwannomas are benign, encapsulated nerve sheath tumors arising from Schwann cells. Approximately, 25-40% of all Schwannomas occur in the head and neck region, acoustic nerve being the most frequent site. The tumors originating from nasal cavity or paranasal sinuses are rare and constitutes only four percent. A 40-year-old male presented with history of blurred vision of right eye and protrusion of right eye ball since 6 months. It was associated with history of watering and redness. Examination of right eye revealed mild proptosis and ptosis. Computed Tomography [CT] scan showed a large expansile cystic lesion measuring about 5.2x5.6x6.5cm involving entire right ethmoidal sinus. It showed expansion into anterior cranial fossa, roof and medial wall of right orbit. Radiological opinion suggested mucocele of right ethmoidal sinus. Intra-operatively, tissue specimen was sent for squash smear cytology. Cytology smears showed features suggestive of spindle cell tumor. Possibility of Schwannoma was considered. The specimen was subsequently subjected to histopathological examination. Microscopy showed tumor tissue composed of tumor cells arranged in alternate hypercellular and hypocellular pattern. Hypercellular areas showed occasional verocay bodies. Hypocellular areas showed loosely arranged spindle shaped tumor cells. Histopathological features were suggestive of Schwannoma. On Immunohistochemistry (IHC), neoplastic cells were positive for S-100 and negative for EMA. Ethmoidal sinus schwannoma extending into anterior cranial fossa is an unusual presentation. Clinically, it poses a diagnostic dilemma. Squash smear cytology is challenging, but helpful in establishing the correct diagnosis. Histopathology is confirmatory and immunohistochemistry is supportive.

Development of anterior cranial fossa dural arteriovenous malformation following head trauma

1997 ◽  
Vol 86 (2) ◽  
pp. 291-293 ◽  
Author(s):  
Tatsuya Ishikawa ◽  
Kiyohiro Houkin ◽  
Kouichi Tokuda ◽  
Susumu Kawaguchi ◽  
Takeshi Kashiwaba
Keyword(s):  
Head Trauma ◽  
Anterior Cranial Fossa ◽  
Content Type ◽  
Sagittal Sinus ◽  
First Case ◽  
History Of ◽  
Cranial Fossa ◽  
Ethmoidal Arteries ◽  
Dural Avm ◽  
Fine Print

✓ Dural arteriovenous malformations (AVMs) are considered to be acquired lesions that develop secondary to venous obstruction, which sometimes happens in head trauma. However, there has been a report of an anterior cranial fossa dural AVM that occurred independently of a history of head trauma, and there has been speculation that these malformations are congenital. The authors recount their experience with a patient who had an anterior cranial fossa dural AVM that was discovered incidentally. The lesion was fed by the bilateral anterior ethmoidal arteries and drained into the superior sagittal sinus via frontal cortical veins. The patient had a history of severe head trauma that had occurred 30 years earlier. This is the first case report in which a previous head trauma is strongly believed to be the cause of an anterior cranial fossa dural AVM. The authors postulate that anterior cranial fossa dural AVMs can develop secondary to a head trauma.

scholarly journals An Unusual Presentation of Leiomyosarcoma Posing a Diagnostic Dilemma: A Case Report

2020 ◽  
Author(s):  
Smita Singh ◽  
Kusha Sharma ◽  
Vipan Kumar ◽  
Partap Yadav
Keyword(s):  
Smooth Muscle ◽  
Head And Neck ◽  
Histopathological Examination ◽  
Smooth Muscle Actin ◽  
Correct Diagnosis ◽  
Neck Region ◽  
Temporal Region ◽  
Diagnostic Dilemma ◽  
First Case ◽  
Painless Mass

Leiomyosarcoma (LMS) is a malignant tumour of smooth muscle origin commonly seen in genital and gastrointestinal location. However, its presence in the head and neck region in a young child is extremely rare. Authors present a unique case of LMS in a one year and five-month-old child who presented with a painless mass in the right temporal region of the head. Histopathological examination revealed a highly cellular tumour arranged in intersecting fascicles of spindle cells with brisk mitotic activity and interspersed areas of necrosis. On Immunohistochemistry (IHC), the tumour cells were positive for Smooth Muscle Actin (SMA), Desmin and Vimentin and negative for S100 and Myogenin. A diagnosis of LMS was thus, made. Head and neck sarcoma is a broad entity encompassing plethora of differentials with closely overlapping morphological features which renders them diagnostically challenging, this can be resolved by employing various immunohistochemical stains readily available in all laboratories. This case highlights the combined role played by histopathology and immunohistochemistry in arriving at the correct diagnosis. To the best of our knowledge, this is the first case of LMS reported in the temporal region of head and is distinct with respect to its rare incidence, location and age at presentation. LMS at this site may masquerade as deceptively benign painless mass and may not be suspected initially, however one should bear in mind that these are moderate-to-high grade tumours and any delay in management may portend poor prognosis. Timely and aggressive surgical management is thus, the mainstay of treatment and critical to patient survival.

scholarly journals Well differentiated papillary mesothelioma of abdomen- a rare case with diagnostic dilemma

2018 ◽  
Vol 10 (02) ◽  
pp. 248-250 ◽  
Author(s):  
Aniruddha Saha ◽  
Palash Kumar Mandal ◽  
Anupam Manna ◽  
Kalyan Khan ◽  
Subrata Pal
Keyword(s):  
Young Women ◽  
Histopathological Examination ◽  
Asbestos Exposure ◽  
Papillary Adenocarcinoma ◽  
Computed Tomography Scan ◽  
Diagnostic Dilemma ◽  
Pain Abdomen ◽  
History Of ◽  
Well Differentiated ◽  
Tomography Scan

AbstractWell-differentiated papillary mesothelioma is a rare tumor occurring predominantly in the peritoneum of young women, a few with history of asbestos exposure. A 28-year-old woman presented with ascites and pain abdomen. Ultrasonography and computed tomography scan of the abdomen revealed a mass in the retroperitoneum measuring 15 cm × 12 cm. Histopathological examination along with immunohistochemistry (IHC) confirmed it to be a papillary mesothelioma in the peritoneum. It is difficult to differentiate from more common malignant mesothelioma and papillary adenocarcinoma, which also have poorer prognosis. The difficulty can be resolved by clinico-radiological correlation along with histopathological examination and IHC.

scholarly journals An unusual presentation of choriocarcinoma

2017 ◽  
Vol 6 (4) ◽  
pp. 1668 ◽  
Author(s):  
Amishrita Lakku Rao ◽  
Rama Sarala Devi
Keyword(s):  
Clinical Features ◽  
Unusual Presentation ◽  
Malignant Growth ◽  
Diagnostic Dilemma ◽  
History Of ◽  
Vesicular Mole ◽  
Uterine Body

Choriocarcinoma is the most malignant growth arising from the uterine body. Incidence of choriocarcinoma following vesicular mole is 29-83%. Diagnosis of choriocarcinoma is by histopathology only. In the present case 22year old woman with history of vesicular mole evacuation 8 months back suddenly landed in shock. During her irregular follow up, misleading ultrasonographic findings and clinical features delayed the diagnosis of advanced choriocarcinoma till it perforated through the uterus and patient landed in shock due to massive hemoperitoneum.We report this case because of its unusual presentation which led to diagnostic dilemma and mismanagement.

Tumor-to-tumor metastasis: esophageal carcinoma metastatic to an intracranial paraganglioma

2009 ◽  
Vol 110 (4) ◽  
pp. 744-748 ◽  
Author(s):  
Jian-Qiang Lu ◽  
Moosa Khalil ◽  
William Hu ◽  
Garnette R. Sutherland ◽  
Arthur W. Clark
Keyword(s):  
Esophageal Carcinoma ◽  
Tumor Metastasis ◽  
Histopathological Examination ◽  
Unique Case ◽  
Blurred Vision ◽  
Poorly Differentiated Carcinoma ◽  
History Of ◽  
Poorly Differentiated ◽  
Tumor To Tumor Metastasis ◽  
Upper Gastrointestinal

Tumor-to-tumor metastasis (TTM) is a relatively rare but well-documented phenomenon. The authors report a unique case of esophageal carcinoma metastatic to an intracranial paraganglioma. A sellar and suprasellar tumor was found using MR imaging in an 81-year-old man who presented with a 3-week history of progressive headache and blurred vision. A subtotal excision of the tumor was achieved. Histopathological examination of the tumor disclosed a neoplasm with two distinct components: one showing the classic Zellballen pattern of a paraganglioma, the other exhibiting malignant features leading to the diagnosis of a poorly differentiated carcinoma metastatic to a sellar/suprasellar paraganglioma. The primary esophageal carcinoma was not uncovered until 2 months later, after the patient presented with upper gastrointestinal bleeding. The patient died 4 months after initial presentation. This case expands the spectrum of TTM, and emphasizes the importance of TTM in the practice of pathology.

Massive juvenile ossifying fibroma arising from the middle turbinate

2020 ◽  
Vol 13 (4) ◽  
pp. e234432
Author(s):  
Valentinos Sofokleous ◽  
Konstantina Chrysouli ◽  
Efthymios Kyrodimos ◽  
Evangelos Giotakis
Keyword(s):  
Histopathological Examination ◽  
Therapeutic Option ◽  
Correct Diagnosis ◽  
Middle Turbinate ◽  
Ossifying Fibroma ◽  
Endoscopic Endonasal ◽  
Juvenile Ossifying Fibroma ◽  
History Of

A 19-year-old man presented with a long-standing history of nasal obstruction, which gradually became worse over the past 2 years. Nasal endoscopy revealed a sizeable rounded mass covered by a normal-looking mucosa. Imaging studies showed a mass arising from the left middle turbinate that extended throughout the expanse of the anterior skull base. The tumour was resected via an endoscopic endonasal approach. Histopathological examination revealed a psammomatoid juvenile ossifying fibroma. The patient remains free of recurrence after almost 3 years of follow-up. Only four cases of ossifying fibroma with middle turbinate localisation have been reported in the literature so far, with our case representing the fifth and most extensive case. Clinical, radiological and histological findings should all be considered for establishing the correct diagnosis. An endoscopic approach represents an excellent therapeutic option. Long-term clinical and radiological surveillance is required due to the risk of recurrence.

scholarly journals Unusual presentation of a rectal foreign body: a diagnostic dilemma

2019 ◽  
Vol 6 (7) ◽  
pp. 2587
Author(s):  
Pei Pei Lee ◽  
Jitt Aun Chuah ◽  
Ratha Krishnan Sriram
Keyword(s):  
Foreign Body ◽  
Acute Urinary Retention ◽  
Foreign Bodies ◽  
Correct Diagnosis ◽  
Medical Attention ◽  
Pelvic Cavity ◽  
Diagnostic Dilemma ◽  
Rectal Foreign Bodies ◽  
History Of ◽  
Abdominal Perineal Resection

Rectal foreign bodies present a challenge to surgeons from obtaining the correct diagnosis to managing the patient due to a wide array of presentation. Diagnostic dilemmas often arise as patients are sometimes unwilling to disclose the actual history and seek medical attention late. We present a case of a 65 year old Asian gentleman who present with history of per-rectal bleeding, tenesmus, acute urinary retention, constitutional symptoms with investigations suggestive of rectal malignancy. Intraoperatively identified a rubber-like foreign body tightly packed in the pelvic-cavity with severe injury to the rectum requiring abdominal-perineal resection. 

‘Bone within bone appearance’ in a pathological fracture

2020 ◽  
Vol 13 (12) ◽  
pp. e238567
Author(s):  
Sathish Muthu ◽  
Eswar Ramakrishnan ◽  
Girinivasan Chellamuthu
Keyword(s):  
Histopathological Examination ◽  
Subtrochanteric Fracture ◽  
Fracture Site ◽  
The Body ◽  
Diagnostic Dilemma ◽  
History Of ◽  
Similar Appearance ◽  
The Right

A 60-year-old man presented to our hospital with complaints of pain and deformity on his right thigh for the past 2 days following a history of accidental slip and fall. Radiological investigations suggested a pathological type 2 Seinsheimer subtrochanteric fracture of the right femur with a ‘bone within bone’ appearance, which posed a diagnostic dilemma as this radiological appearance is seen in a spectrum of conditions. Radiographic skeletal survey failed to identify a similar appearance elsewhere in the body. Laboratory investigations pointed in favour of bone mineral disease, and histopathological examination of the bone narrowed it down to Paget’s disease. The fracture was fixed with a contralateral distal femur locking compression plate. The fracture site failed to show signs of union until 6 months postsurgery and hence the patient was advised for grafting procedure. The patient deferred surgery and remains without major complications until 18 months of follow-up.

scholarly journals Unique position of a pancreatic head insulinoma during laparoscopic enucleation: case report

2020 ◽  
Vol 7 (9) ◽  
pp. 3095
Author(s):  
Abdullah M. Alshamrani ◽  
Hisham M. Ghabbani ◽  
Omar M. Alobaid ◽  
Abdullah J. AlShehri ◽  
Khalid M. Alzaraa ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Serum Insulin ◽  
Delayed Diagnosis ◽  
Young Patients ◽  
Pancreatic Head ◽  
Serum Glucose ◽  
High Serum ◽  
Blurred Vision ◽  
History Of ◽  
Laparoscopic Enucleation

Insulinomas are benign pancreatic neuroendocrine tumors that require surgical intervention as a therapeutic measure. We describe an 18-year-old male patient who presented to the emergency department with a history of syncope, blurred vision, and diaphoresis. His blood sugar level was low upon admission, and a 72-hour fasting plasma glucose test showed low serum glucose, high serum insulin, and high C-peptide. An abdominal computed tomography scan and magnetic resonant imaging revealed a solitary tumor in the pancreatic head with no sign of ductal dilatation. Laparoscopic enucleation was performed, and a histopathological examination revealed findings consistent with insulinoma. The patient’s postoperative course was uneventful, and his follow-up examination was unremarkable. In conclusion, physicians should have a high clinical suspicion index for insulinomas, especially in young patients with a history of syncope, blurred vision, and diaphoresis, in order to avoid delayed diagnosis.

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