Melanotic spinothoracic schwannoma.

A dumb-bell mediastinal melanotic schwannoma is described, and the rarity of this type of tumour emphasised. The tumour was resected by simultaneous laminectomy and posterior thoracotomy. The patient is well four years after operation. The pathology of the tumour is described and the origin of melanotic cells is discussed.     

Melanotic schwannoma of soft tissues. Electron-microscopic observations and review of literature

This is a report of an unusual case of melanotic schwannoma located in the soft tissue of the shoulder. By light microscopy, the partially pigmented, encapsulated mass showed tumor lobules displaying an organoid pattern and benign cytologic features. By electron microscopy, the tumor cells disclosed numerous interdigitating blunt cytoplasmic processes invested by a thin, continuous basal lamina with formation of mesaxons and moderate amount of glycogen as well as immature and mature melanosomes. The patient was reported to be alive and well 7 years after local excision of the mass. We also reviewed 21 additional cases from the literature. The most frequent sites of involvement were: the spinal nerve roots and adjacent structures (12 cases), soft tissues (five cases), heart (one case), esophageal wall (one case), acoustic nerve (one case), and mandible (one case). Twelve patients were alive and well (follow-up periods ranging from 9 months to 13 years after surgical resection), and one died of surgical complications. Eight patients were lost to follow-up. Three patients had local recurrences due to incomplete excision of the mass. Ten tumors were studied electron microscopically and displayed characteristic features of both Schwann cells and melanocytes. This unique dual differentiation probably reflects their common ancestry from neural crest cells.     

An unusual ossified thoracic disc herniation

Summary We report an unusual ossified thoracic disc herniation occurring in a man, aged 69 years. The ruptured disc formed a large mass occupying the entire spinal canal at the T8–T9 intervertebral level. Histology confirmed that this was an ossified disc with mature bone tissue. He improved after decompression through a posterolateral approach.

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Résumé Les auteurs rapportent l'observation d'un patient de 69 ans, présentant une hernie dorsale inhabituelle d'un disque ossifié. La hernie discale constituait une grosse masse, occupant tout le canal rachidien au niveau D8–D9. L'histologie a confirmé l'existence d'un disque ossifié, fait de tissu osseux mature. L'état du malade a été amélioré à la suite d'une décompression antérieure, par voie postéro-latérale.

     

Adrenal schwannoma: A case report of an unusual incidentaloma

Introduction and importanceAdrenal schwannomas are extremely rare tumors often misdiagnosed. The patients are usually asymptomatic while some present with non-specific abdominal pain. Only a few cases are reported to date.Case presentationWe here present a case of a 55-year-old Nepalese man presented with nonspecific abdominal pain at our Outpatient Department (OPD) found to have mass on ultrasonography of abdomen. On further investigation with Contrast Enhanced Computerized Tomography (CECT) of the abdomen and pelvis, a well-defined heterogeneous adrenal mass of size (7.8 1 8.3 1 6) cm with foci of calcification was seen in the left retroperitoneum. The intraoperative finding of adrenal mass and histopathology of resected mass was suggestive of schwannoma arising from the adrenal gland which was further confirmed by immunohistochemistry.Clinical discussionAdrenal schwannoma can mimic tumors like pheochromocytoma, adrenal adenoma, cortical carcinoma, neuroblastoma, and other masses. Only 1–3% of schwannomas are retroperitoneal. Radiological findings of this tumor are non-suggestive. The histological section shows spindle cells with Antoni A and Antoni B regions while positive staining of S-100 protein in Immunohistochemistry.ConclusionThe diagnosis of adrenal schwannoma in the retroperitoneum is often challenging. The treatment of choice is surgical resection with a good prognosis.     

Axillary hibernoma: an unusual soft tissue tumor

Hibernomas are rare soft tissue tumors of brown fat differentiation. A case of a large axillary hibernoma, along with a review of its pathology, is presented. This tumor matches the largest hibernoma in the literature and is the largest in an axillary site.     

An unusual abdominal mass in an elderly patient.

Adult intussusception is rare and is often not included in the differential diagnosis. Patients who have previously undergone some form of gastric bypass procedure are more susceptible. We report a case of retrograde intussusception following a Roux-en-Y gastric bypass in an elderly patient, who presented with an abdominal mass. Her initial provisional diagnosis was bowel obstruction. As the number of bariatric gastric bypass procedures continues to rise, we are likely to see more of this kind of post-operative complication. Hence, it is crucial for surgeons to consider intussusception as a cause of abdominal pain, obstruction or mass in patients who have undergone some form of gastric bypass procedure.     

Vestibular schwannoma: unusual recurrence presenting as an external auditory canal mass

Vestibular schwannomas (VS) commonly are limited to the internal auditory canal (IAC) and cerebellopontine angle. Extension to labyrinth is less frequent, and involvement of the middle ear or external acoustic canal (EAC) is very rare. In this report we present the case of a 41-year-old woman with a VS, which recurred after a previous surgical removal 4 years before. The tumor involved the IAC, cochlea, vestibule, semicircular canals, cavum tympani, mastoid cells, and EAC. Total removal of the tumor was achieved by a transotic approach, without neurological sequela.     

Lymphoma presenting as a soft tissue mass. A soft tissue sarcoma simulator

Lymphoma presenting as a soft tissue mass is rare and thus may be confused with the more common soft tissue sarcoma. No previous analysis of the clinical and radiologic features of lymphomas presenting as soft tissue masses is available because most of the cases reviewed are from the pathology literature. Four patients with diagnoses of extranodal lymphomas of the soft tissues were reviewed retrospectively with respect to their clinical features, primary tumor characteristics, stage, radiographic characteristics, treatment, and followup. Mean age was 72.5 years (range, 52-85 years). The soft tissue mass occurred in the thigh (three cases) and shoulder (one case). The median size of the soft tissue mass was 6.7 cm (range, 2-15 cm) in the largest dimension, as measured on magnetic resonance imaging. These patients each had evidence of lymphadenopathy at the time of diagnosis. Lactate dehydrogenase was increased significantly in two cases and increased slightly in two other cases. One case was Stage II(E) at presentation, one was Stage III(E), and two were Stage IV. All were B cell immunophenotype. All patients died between 2 and 24 months after diagnosis, despite the use of Cytoxan, vincristine, adriamycin, and prednisone chemotherapy in each case. Clinical and radiographic features that favor extranodal soft tissue lymphoma over sarcoma include pain and tenderness, lymphadenopathy (particularly when confluent radiologically), ipsilateral extremity swelling, and elevated lactate dehydrogenase.     

An unusual cause of an enhancing retroperitoneal mass

We report an important and unusual cause of an enhancing retroperitoneal paracaval mass. Ten years after vena cava filter (VCF) placement, a 3.5-cm mass was found juxtaposed to the right kidney and vena cava. Open exploration demonstrated a venous variceal mass with perforation of the VCF through the wall of the vena cava, requiring vena cava resection and graft replacement. This is an infrequently described, potentially misleading and dangerous complication of vena cava filters. Better guidelines for such filters would be useful. We recommend an open approach in settings that could require similarly complex reconstructions.     

Tracheal mucormycosis presented as an intraluminal soft tissue mass

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.     

Cryptococcal myositis and vasculitis: an unusual necrotizing soft tissue infection

BACKGROUND: Cryptococcus neoformans var. neoformans is an opportunistic yeast that typically infects immunocompromised patients. METHODS: A case report and review of the pertinent English-language literature are presented. RESULTS: Necrotizing vasculitis associated with cryptococcal invasion was identified in 1986. Until now, only 24 cases of cryptococcal cellulitis have been reported, including one case of cryptococcal necrotizing fasciitis and one case of necrotizing vasculitis. We report an unusual case of occult disseminated cryptococcosis presenting as necrotizing cellulitis, fasciitis, and myositis. CONCLUSIONS: Cryptococcal soft tissue infection serves as a marker of disseminated cryptococcosis in immunocompromised hosts. Owing to its rarity as a cause of soft tissue infections, diagnosis is difficult and mortality is high.