Hemorrhage due to attempted excision of a frontal exophytic lesion: A cautionary tale

Background: Despite mainly benign, exophytic subcutaneous cranial masses present with a myriad of differential diagnosis possibilities, ranging from simple, superficial lesions to complex lesions involving the central nervous system. Although the gold standard imaging modality for the diagnosis of these lesions is magnetic resonance imaging, Doppler Ultrasonography can be a useful, inexpensive, and available tool for evaluation of lesions that could potentially be safely treated in the primary care setting, and lesions that would demand advanced neurosurgical care. Case Description: This patient presented with a complex exophytic plasmocytoma that was first diagnosed and erroneously approached as a subcutaneous lipoma with surgical resection in an outpatient surgical setting. This interpretive approach resulted in the failure of the procedure due to significant hemorrhage. The patient was immediately referred to neurosurgical care and transferred to our center. Admission doppler ultrasound imaging revealed absence of the frontal bone, the enriched and profuse vascularization, allowing further and proper diagnostic approach and treatment. Conclusion: Ultrasound could be a reliable, fast, and simple imaging method aiding practitioners to perform a better workup for patients with exophytic subcutaneous cranial masses.

Response to Interferon-Free Direct Antivirals (DAAS) Treatment in HCV-Related Subcutaneous Lipoma-Like Marginal Zone B-Cell Lymphoma

In 2010 a new entity termed “lipoma-like” HCV related marginal zone B-NHL was described. The etiological link between HCV infection and B-NHL has been extensively investigated in several epidemiological, biological and therapeutic studies and large experiences in literature demonstrated indolent lymphoma’s regression after antiviral therapy. HCV-related indolent NHL response to interferon-ribavirin-based antiviral therapy is well documented, while evidence of the efficacy of interferon-free direct-acting antivirals (DAAs) in this subset of lymphoma is also currently increasing. In this article we report two cases of HCV-related subcutaneous “lipoma-like” Marginal Zone B-cell lymphoma, treated with DAAs. Sustained virological response (SVR) with reduction of MZL localizations, persisting to date, were obtained in both patients. These data originally demonstrate the efficacy of DAAs in this rare entity.

Facial fibromatosis: benign and aggressive, yet treatable!

Fibromatosis or desmoid tumors are locally aggressive neoplasms that have a propensity for local invasion and recurrence. The mainstay of treatment is excision with negative margins and the role of radiotherapy is controversial. Desmoids arising in the head and neck area are rare and pose a dilemma to the surgeon due to large number of vital structures that preclude resection with wide margins. This leads to a high incidence of recurrence. We present a case of a 24-year-old male who presented with an asymptomatic left sided facial swelling causing cosmetic deformity. A subcutaneous lipoma/fibroma/neuroma was suspected and a fine needle aspiration done was inconclusive. Computed tomography revealed a subcutaneous swelling that was excised. Histopathology revealed it to be a desmoid tumor. At the end of 4-year-follow-up, he has no local recurrence.