Ectopic pleural thymoma presenting as a giant mass in the thoracic cavity

We describe a rare case of a giant thymoma that developed in the right thoracic cavity, and seemed to originate from the visceral pleura. We believe that there have been few reports of thymoma developing from such an unusual origin.     

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.     

Benign retroperitoneal schwannoma presenting as a giant adrenal tumor

We report a 51-year-old man with a primary adrenal tumor presenting as a giant juxta-adrenal benign schwannoma. The patient was initially admitted for persistent fevers and underwent a sepsis workup. Abdominal ultrasound initially revealed an incidental right suprarenal mass, which measured 10 x 10 x 11 cm, estimated by computed tomography. Following a successful laparotomy, histologic examination confirmed that this giant tumor was a benign retroperitoneal schwannoma. Postoperatively, the patient remains disease-free, undergoing rehabilitation.     

Amyloidosis presenting as a penile mass

We report a unique case of amyloidosis presenting as a localized soft tissue mass in the shaft of the penis unassociated with systemic amyloidosis, trauma, penile ulcers, syphilis or other venereal diseases. The patient presented with a penile mass and intermittent hematuria. Biopsy revealed homogeneous deposits of amorphous eosinophilic material, and histochemistry and electron microscopy demonstrated the classical features of amyloid.     

Fibromatosis presenting as a sacrococcygeal mass

Most children older than a year who present with a sacrococcygeal mass have a malignant tumor. We describe an 8-year-old child with of a sacrococcygeal soft tissue mass that was completely resected with histologic findings consistent with fibromatosis. Fibromatosis is a deep-seated, musculoaponeurotic, borderline tumor that is rare in childhood and has a high incidence of local recurrence even after margin-free resection. We review and discuss management strategies for treatment of fibromatosis in children. This case represents the first report of fibromatosis presenting as a sacrococcygeal mass.     

Histoplasmosis presenting as a neck mass

A unilateral neck mass is an unusual clinical presentation for histoplasmosis. A patient with a large, unilateral neck mass caused by Histoplasma capsulatum is presented to alert readers to such a possibility and to illustrate some of the difficulties in diagnosing and managing the disease.     

Intracerebral schwannoma presenting as classic temporal lobe epilepsy

Schwannomas of the brain parenchyma are extremely rare, occurring mostly in children and young adults. Fewer than 50 cases have been reported in the English-language literature. Isolated temporal lobe epilepsy is a rare presentation of intracerebral schwannomas, with only 2 reported cases. The authors present the case of a 51-year-old woman with a 4-year history of medication-refractory seizures, which were localized on electroencephalography to the right temporal lobe. Magnetic resonance imaging identified a mildly space-occupying, T2 hyperintense, and inhomogeneously enhancing mass in her left mesial temporal lobe. Histological, immunohistochemical, and electron microscopy examinations of the surgical specimen established a diagnosis of intracerebral schwannoma. Accurate diagnosis of intracerebral schwannomas is essential, particularly in younger patients, given the lesions' nature, amenity to resection, favorable long-term prognosis, and broad radiological differential. The etiology of these lesions remains unknown, and multiple proposed theories are reviewed.     

Lymphoma presenting as a salivary gland mass

A retrospective review of 36 cases of lymphoma presenting as a salivary gland mass was conducted over a 34-year period. A significant increase in the occurrence of lymphoma was noted in proportion to other salivary gland tumors (P less than 0.01, chi 2 analysis: 1954-1972, 11 of 714 (1.5%); 1973-1979, 9 of 201 (4.5%); 1980-1987, 16 of 265 (6.0%). The mean age was 61 years, sex distribution was equal, and 75% occurred in the parotid. Only 42% presented with signs or symptoms other than a painless mass. Glandular excision was done in early stages of the disease while biopsy was done at later stages. Frozen section analysis was accurate in all but one case and was useful in determining if biopsy were adequate. All patients were definitively treated with chemotherapy and/or radiotherapy. Several instructive points are apparent. Any patient presenting with an isolated salivary gland mass can have a lymphoma. There has, in fact, been a significantly increasing proportion of salivary gland lymphoma among the various salivary gland tumors in our patient population. In contrast to other salivary gland tumors, surgery is reserved for diagnosis and not for treatment. A lymph node biopsy may be sufficient to establish a diagnosis, in which case, glandular excision is unnecessary. Most of the patients presented with an asymptomatic isolated salivary gland mass. The presence of adjacent adenopathy, a rubbery feel to the mass, and the intraoperative appearance were the most suggestive signs of lymphoma. Frozen section analysis is helpful in determining the appropriate extent of surgery and is recommended.     

Meconium pseudocyst presenting as a buttock mass

A newborn 2.4-kg baby girl with a prenatal diagnosis of sacrococcygeal teratoma by ultrasound had a soft cystic mass extending from the infracoccygeal region into the right buttock. The cyst contained meconium leading to a large retroperitoneal cavity. The cyst was drained through an extended buttock incision, and healed without a site of bowel perforation ever identified. Meconium pseudocyst should be included in the differential diagnosis of sacrococcygeal and buttock tumors in the newborn.     

Ectopic thyroid presenting as a gallbladder mass

The ectopic thyroid tissue is the result of abnormality in embryological development and migration. Ectopic thyroid tissue located in or adjacent to the gallbladder wall is extremely rare with only two cases reported since 1969. These cases were all identified incidentally by pathological examination after cholecystectomy for acute or chronic cholecystitis. We here report a case of ectopic thyroid tissue presenting as a gallbladder mass in a 60-year-old woman who underwent cholecystectomy. Ectopic thyroid tissue in the gallbladder wall was confirmed by histopathology.     

Pseudomyxoma peritonei presenting as a scrotal mass

Pseudomyxoma peritonei may occur after intraperitoneal rupture of a mucinous adenocarcinoma. The liberated cells produce copious amounts of mucus, which mimics ascites. With the improved technology of computerized tomography and ultrasound, many of these cases are now being diagnosed preoperatively. Surgical debulking is the preferred therapy, while the role of chemotherapy and radiotherapy remains debatable. We report a case of pseudomyxoma peritonei presenting as a scrotal mass that was diagnosed preoperatively.     

Sparganosis presenting as a lateral neck mass

BACKGROUND: Cervical sparganosis is rare, and its rarity makes it difficult to be distinguished from tumors. A case of cervical sparganosis is reported. METHODS AND RESULTS: An 80-year-old man was initially seen with a painless lateral neck mass for 3 months, which was initially diagnosed as cervical lymphadenopathy. Laboratory studies revealed eosinophilia, and the patient recalled that he had frequently taken mountain water. Serologic study of human sparganosis by a monoclonal antibody-based competition enzyme-linked immunosorbent assay (ELISA) was positive. Surgical excision was performed, and the sparganosis was confirmed by histologic examination. CONCLUSIONS: Sparganosis should be considered in the differential diagnosis of soft tissue tumors, especially among patients who have frequently ingested mountain water and consumed raw snakes or frogs.     

Wegener's granulomatosis presenting as a renal mass

Wegener's granulomatosis is a systemic necrotizing vasculitis that usually involves the kidneys, typically causing segmental necrotizing glomerulonephritis. An association between Wegener's granulomatosis and renal cell carcinoma was recently reported. We describe a case of Wegener's granulomatosis presenting as a renal mass in a 72-year-old woman. Histologic examination of the mass revealed granulomatous inflammation, an extremely rare manifestation of this disease. We also review the incidence of renal mass in Wegener's granulomatosis and highlight the importance of excluding the coexistence of renal cell carcinoma.