Isolated Plexiform Neurofibroma of the Nasal Tip - A Rare Case Report

A 28-year-old female patient presented at ENT OPD with complaints of a slowly growing mass over nasal tip since last 5 years. There were no complaints of pain, nasal obstruction, or epistaxis. There were no skin changes or ulceration over the swelling and sensation was preserved. There was no history of similar kind of swelling in other parts of the body. History of trauma or any form of surgical intervention were excluded. Family history was insignificant. The swelling did not respond to any medications. The patient attended for cosmetic reason solely. Clinical examination showed a soft non-tender 4 cm by 4 cm mass over nasal tip and supratip area. Mobility of the mass was restricted and fixed to the alar cartilages. There was no evidence of café au lait spots or any other skin lesions. Anterior rhinoscopy was unremarkable. Diagnostic nasal endoscopy was also performed but no abnormality was detected. CT scan showed non-specific infiltrative subcutaneous lesions. T1W MRI showed an ill-defined hypodense mass over the nasal tip which was abutting the alar cartilages which showed mild enhancement with contrast (figure 1). T2W MRI showed hyperintense and or hypodense central focus (target sign). FNAC was done and report was suggestive of neurogenic tumour, most probably neurofibroma.

Robot-Assisted Thoracoscopic Surgery of Neurogenic Tumours in the Apical Chest: A Case Series

Background: Superior posterior mediastinal tumours may arise in the apical chest. However, the removal of such tumours via conventional minimally invasive approaches remains challenging. In this paper, we demonstrate our experience of robotic-assisted thoracoscopic surgery (RATS) for patients with neurogenic apical chest tumours (ACT). Methods: We retrospectively included 15 consecutive patients who underwent the resection of posterior mediastinal neurogenic tumour wherein the upper extent of the tumour extended upwards to the sternoclavicular joint plane based on chest imaging findings. The clinical characteristics and perioperative outcomes of these patients were collected and analysed.Results: Between April 2017 and June 2020, a total of 15 consecutive cases with ACT underwent radical surgical resection through RATS by our team. These patients showed encouraging short-term outcomes after surgery and there was no conversion to thoracotomy. The median tumour size was 4.0 (2.1-10.6) cm. Five large tumours (> = 5.0 cm) were completely resected. The median overall time of surgery was 100 (range, 30–240) minutes. In only one case, a patient experienced massive bleeding (> 500 mL) with a left schwannoma (10.6*5.8*4.8 cm). This resulted in intraoperative haemorrhage because of significant adhesion around the lesion. However, this case was successfully managed by robotic manoeuvres. The median hospital stay was 3 (range, 4–7) days. The median duration of the chest tube was 2 (range, 1–3) days. One case suffered from a non-permanent Horner’s syndrome and recovered within seven months. No patients developed brachial plexus-associated complications. No death occurred during the perioperative period. Conclusions: RATS is a safe and effective alternative modality for the treatment of ACT. The technique extends conventional thoracoscopic indications for posterior mediastinal lesions including apical chest lesions.

Role of Radiology in the Diagnosis of an Uncommon Site of a Common Gossypiboma

A 53 year old man presented with right sided neck swelling which was tender on palpation along with symptoms such as high grade fever and sweating since 4 days. No significant and relevant personal and family history was present. Patient had a successful operative history for a benign neurogenic tumour in right infratemporal fossa 1.5 months back. Patient was relatively asymptomatic before 10 days. He then gradually developed a swelling at the operative site which sooner became tender and was accompanied with high grade fever 4 days back. Patient also complained of mild restriction of neck movements as well. He then came for detailed examination and then was referred for MRI examination as a part of protocol. Radiological Features Routine MRI examination showed a well-defined circumscribed lesion at operative site in right infra temporal fossa which appeared to be peripherally thick walled hypo intense in T1W images (green arrow Fig. 1) and hyper intense in T2W images (green arrow Fig. 2). On further sequences it was noted that a diffuse hypo intense central part is noted in all sequences which was prominent in GRE (Gradient Recalled Echo) images showing again hyper intense thick wall (pink arrow in Fig 3) and central hypo intensity (blue arrow in Fig. 3) suggesting multiple air foci. Haemorrhage was excluded in view of lack of T1W hyper intensity. On STIR (Short Tau Inversion Recovery) images no significant other information was gained about the lesion (green arrow in Fig. 4). Observing the whole examination at first it looked like an abscess but due to lack of diffusion restriction and surrounding soft tissue swelling, this differential is ruled out

Schwannoma of the Submandibular Gland

Introduction Mesenchymal tumours of submandibular gland are extremely rare. Schwannoma of the salivary glands is a particularly rare form of an extracranial neurogenic tumour. Case Report Here, we present an unusual case of schwannoma of submandibular gland in a 16 year old girl, who underwent total excision of mass with submandibular gland excision with no cranial nerve deficits. The details of the histopathologic features are present . Discussion Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumour. Our case indicates good prognosis in a case of submandibular gland schwannoma after surgical excision.

Leiomyosarcoma of the Right Gonadal Vein: Review of the Approach and Prognostic in a Rare Case

Background. Venous leiomyosarcoma is a mesenchymal tumour that represents 5-7% of soft tissue sarcomas. It originates in the smooth muscle cells of the vessel wall and is frequently located in the inferior vena cava. Primary leiomyosarcomas of the gonadal vein are rare, with only 10 cases reported in the literature. Case report. We present the case of a 51-year-old woman diagnosed with a right retroperitoneal mass by computed tomography (CT). The differential diagnosis was between a neurogenic tumour and a mesodermic tumour. The tumour was dissected from the vena cava and right ureter by laparoscopy without performing resection en bloc. Histologic examination of the surgical specimen showed a high-grade leiomyosarcoma of the right gonadal vein. The postoperative course was uneventful. Three cycles of chemotherapy with epirubicin-ifosfamide were performed. Discussion and conclusions. Venous leiomyosarcoma is an aggressive tumour, and prognosis is poor due to haematogenous spread. No chemotherapy or radiotherapy has yet proven effective in improving survival, and complete surgical excision is currently considered to offer the best chance of cure. Despite the more conservative treatment approach used in the present case, the patient is alive three years after surgery and has a good quality of life. Although it was not used in this patient, the standard procedure for optimal survival is resection en bloc.