Atypical meningioma presenting as a nasal mass-multidisciplinary management

ObjectiveTo report a case of recurrent extracranial atypical meningioma successfully managed by a multidisciplinary team.MethodsCase report and literature review concerning successful management of recurrent extracranial meningioma based on pathology and extent of resection.ResultsA 48-year-old woman who presented with a nasal mass, anosmia and headaches. Physical exam and imaging showed recurrent meningioma involving the entire anterior frontal meninges extending into the frontal bone and down into the nasal cavity via the anterior ethmoid. Combined modality surgical intervention was successful and the patient recovered suffering no neurological sequelae.ConclusionThis is a very rare presentation of meningioma that the craniomaxillofacial surgeon should consider when formulating a differential diagnosis for a nasal mass. Long-term surveillance is crucial as recurrence can have devastating consequences. Aggressive multidisciplinary care is needed to prevent future recurrences and to improve survival.     

Metastatic calcification of the nasal septum presenting as an intraoral mass: a case report with a review of the literature

Metastatic calcification is a pathologic condition characterized by deposition of calcified product in otherwise normal tissues as a result of hyperphosphatemia with or without concurrent hypercalcemia. Metastatic calcification presenting clinically as an oral lesion is extremely rare. To date, only 7 cases of metastatic calcification involving the oral soft tissues have been described. This report describes a case of metastatic calcification of the nasal septum presenting as a mass of the anterior maxillary vestibule in a patient with end-stage renal disease. The case reported is only the second example with nasal septum involvement. A brief review of the clinical and histopathologic features of previously reported intraoral cases is also presented.     

Chorioepithelioma presenting as a bleeding gingival mass.

A case is reported in which a very malignant neoplasm appeared clinically to be a pregnancy tumor or a hemangioma. There was, of course, no question as to the cause of death in this particular case. It was of interest because of the rarity of the tumor, the metastasis to the oral cavity, and the fact that the final diagnosis was established from pathologic examination. The case demonstrates, with emphasis, the great importance of biopsy and routine pathologic examination of all tissue for accurate and correct diagnosis, regardless of its clinical appearance.     

Mature teratoma presenting as a scalp mass in a newborn

Neonatal teratomas are rarely located in the scalp. We present a 10-day-old female newborn with mature teratoma of the occipital scalp. The tumor mass, which had no intracranial extension, was excised completely when the patient was 14 days old. The scalp defect was reconstructed with local flaps. No recurrence was detected 3 months after the surgery. Because the patient did not return for routine follow-up 6 months after surgery, we called the parents and learned that the patient had suddenly died. A necropsy to explain the cause of death was not available.     

A case of a nasal dermoid presenting as a median upper lip sinus

Nasal dermoids are uncommon developmental abnormalities. Median upper lip fistulas are even rarer and recognized as a separate pathology. The authors present the unusual case of a child with a sinus on the philtrum of the upper lip and a sinus tract passing all the way to the anterior skull base through the nasal septum. The authors propose that nasal dermoids and medial upper lip fistulas have a common aetiology, and may be the same entity. The authors suggest they should all be managed like nasal dermoids and have MRI scanning prior to theatre. If the lesion extends into the nose, excision by external rhinoplasty is the preferred option.     

Multiple Myeloma presenting as Gingival mass

Maxillofacial presentations in patients with multiple myeloma are not uncommon, but multiple myeloma is often overlooked. Because the symptoms are various, it is very difficult to diagnose multiple myeloma in the oral and maxillofacial region. On the basis of the pathologic and clinical findings, the patient was diagnosed with multiple myeloma. Hematologic screening and a radiographic survey further confirmed the diagnosis.     

Atypical mycobacterial infection presenting as a parotid mass in a child

A case of primary infection of the parotid lymph nodes by Mycobacterium avian intracellulare is described. The initial investigations could not exclude a parotid tumour or lymphoma necessitating a superficial parotidectomy. Surgery appears to be the treatment of choice in these lesions.     

Castleman disease as a giant parapharyngeal mass presenting with dysphagia

A giant unilateral parapharyngeal mass from the skull base to the vocal folds is presented in this case. A 20-year-old man experiencing dysphagia for 4 years was admitted, and his magnetic resonance imaging and computed tomographic scans showed a giant parapharyngeal ellipsoid mass from the left jugular foramen to the vocal folds. Its craniocaudal length was 9 cm. The left internal carotid artery was lateralized, and posterior glottic airway was narrowed by the mass. In digital subtraction angiography, 2 aberrant branches of the internal carotid artery were going inside the mass. After the excision, histopathologic evaluation showed the diagnosis, Castleman disease. This is the first case in literature presenting with the only symptom of dysphagia.     

Peripheral dentinogenic ghost cell tumour presenting as a gingival mass

A 71-year-old man presented with a gingival mass at an extraction site. The lesion was initially thought to be a peripheral ameloblastoma on incisional biopsy. It was finally diagnosed as dentinogenic ghost cell tumour after excision with a margin of sound bone. There has been no recurrence after 2 years.     

Acinic cell carcinoma of the submandibular salivary gland presenting as a large cyst

Acinic cell carcinomas are rare tumours of salivary gland origin, most commonly seen in middle-aged women and predominantly in the parotid gland. The case of a long-standing, predominantly cystic, acinic cell carcinoma located in the submandibular gland of a child is presented here. The tumour was successfully removed and there has been no recurrence.     

Meningioma presenting as an intraoral mass.

The following case report illustrates a rather rare oral lesion, an extracranial meningioma. In the dental office the lesion was seen on a periapical x-ray film as a multilocular radiolucency. The patient, however, could not be convinced of the necessity of biopsy until several years later when clinical expansion of the maxillary buccal plate was noted. Thereafter, clinical, radiographic, and histopathologic examination revealed a diffuse meningioma involving the maxillary sinus, the floor of the nose, and the maxillary gingiva. The patient has since refused complete surgical removal but remains alive and well 8 years after the lesion was first noted.     

Recurrent oral herpes simplex virus infection presenting as a tongue mass

Reactivation of herpes simplex virus resulting in oral infection is common after cardiac transplantation and usually occurs within the first month posttransplant. The clinical presentation, however, may be atypical. We present a case of a 48-year-old female who presented with a large tongue mass 1 year after cardiac transplantation. Outpatient biopsies and viral stains were nondiagnostic. Because of the high suspicion for malignancy, an excisional biopsy was performed in the operating room. Pathologic analysis was consistent with herpes simplex virus type 1 infection. The patient received antiviral therapy with resolution of infection at follow-up.     

Collagenous fibroma (desmoplastic fibroblastoma) presenting as a parotid mass

We describe the case of a 50-year-old man who was found to have a painless, slow-growing parotid mass of 10 months duration. At surgery, a well-delimited, lobulated 4x5-cm tumor was located on the deep lobe of the left parotid gland, adhering to the parotid sheath and masseteric fascia. Follow-up 6 years later has shown no evidence of recurrence. Cardinal morphologic features included multiple nodules of sparsely distributed stellate-or spindle-shaped fibroblasts within a collagenous or myxocollagenous stroma. Fascial involvement and entrapment of salivary gland were focally identified at the edges. Tumor cells were diffusely positive for vimentin with faint focal staining for alpha-smooth muscle actin. These findings satisfied the diagnostic criteria for collagenous fibroma (desmoplastic fibroblastoma). Ours represents the first report of this tumor type mimicking a parotid tumor.