Painless Tumor Research Articles

Primary Orbital Melanoma: A Case Study Highlighting the Critical Importance of Timely Diagnosis and Treatment

Primary orbital melanoma (POM) is a rare malignant tumor arising from the deep pigmented layer of the eye, potentially leading to tumor extension and metastases, particularly to the liver. Although there are fewer than 100 documented cases, diagnosis is often delayed, with an uncoded management approach and generally unfavorable prognosis. We present the case of a 57-year-old patient with no significant medical history who developed a pigmented lesion at the inner canthus of the right eye. An excision in 2023 revealed a nodular melanoma, but the patient was already lost to follow-up before the final diagnosis was obtained. In 2024, he presented for exophthalmos with signs of significant tumor extension, necessitating radical treatment including right exenteration, ipsilateral lymphadenectomy, and radio-chemotherapy. Orbital melanomas, which represent about 7% of melanomas, manifest as painless tumors and can be better assessed by MRI. Differential diagnosis includes choroidal angiomas and metastatic tumors. Treatment requires a radical surgical approach, while chemotherapy is often ineffective. Mortality is primarily due to hepatic metastases. At six months post-operation, the outcome was favorable, and the patient received an ocular prosthesis.

A Case Report and Literature Review of Metastatic Small Cell Carcinoma in Parotid Gland

Small cell lung cancer usually presents as a progressive disease in over 70% of patients. Common organs of metastasis include the liver, adrenal glands, bones, and brain. However, metastasis to the parotid gland is uncommon, as it has been discussed only in case reports. Among all parotid tumors, small cell cancer is rare, seen in only 1.7%.A 60-year-old man presented with a slow-growing, painless tumor of the left parotid gland and peripheral facial paralysis. Neck ultrasound identified a solid mass in the left parotid gland with enlarged lymph nodes in the parotid gland and ipsilateral neck lymphadenopathies with pathologic features in levels 2 and 3. Chest computed tomography (CT) demonstrated subsegmental collapse in the lingula with peribronchial cuffing in this lobe and mild cylindrical bronchiectatic changes in the left lower lobe. CT also showed multiple mediastinal lymphadenopa thies in prevascular, paraaortic, and paratracheal spaces. Core needle biopsy was done, and initial analysis revealed small cell carcinoma in the left parotid gland. Immunohistochemical analysis of the specimen demonstrated and confirmed the diagnosis. The patient was then referred to the radiation oncology unit for treatment. Chemotherapy was initiated with a combination of cisplatin and etoposide. No complications of the chemotherapy were observed after three cycles; treatment and follow-up are ongoing. No irradiation was performed after evaluation by the radiation oncology department. Due to the advanced stage of his disease, treatment is set for palliative purposes only. Small cell lung cancer diagnosed from solitary metastasis to the parotid gland is very rare. Physicians should keep pulmonary origin in mind when faced with a parotid tumor, as without careful examination, the primary focus may be overlooked, negatively impacting survival rates and the prognosis of the patient. Overall, this finding carries a poor prognosis, but the mainstay of treatment is palliation with systemic chemotherapy and possibly irradiation to control symptoms

Painless tumour in the lower jaw

Painless tumour in the lower jaw

Focus on melanotic neuroectodermal tumor of infancy

Melanotic neuroectodermal tumor of infancy (MNTI) is a very rare benign neoplasm of probable neurocristic origin. It primarily affects children in the first year of life, with the median age at diagnosis of 4.5 months (range 0–804 months). It usually presents as a fast-growing, painless tumor developing within maxilla, skull bones or mandible but other locations are also possible, especially in older children. The cornerstone of treatment of MNTI is surgery, however local relapses after incomplete tumor excision are common, particularly in patients younger than 2 months of age. Rare cases of multiple recurrent, inoperable or metastatic MNTI pose therapeutic challenges. In such clinical scenarios, various regimens of neoadjuvant chemotherapy based on schemes for neuroblastoma or Ewing sarcoma have been used with partial regressions in some patients, enabling less mutilating delayed surgery. The use of radiotherapy is limited due to very young age of patients with MNTI. No targeted therapies have been found useful so far. Long-term prognosis of localized MNTI is favorable. However, extensive or recurrent lesions can result in functional or esthetic sequelae after surgical removal. Rare cases of malignant/metastatic tumors and MNTI diagnosed in older children have unfavorable outcomes. Further collaborative studies to establish standards of management in patients with MNTI are necessary to improve outcomes and diminish sequelae of surgery. This article presents a literature review on this very rare tumor entity, re-evaluated in the light of the experience gained in the national working groups joined together within the European Cooperative Study Group in Pediatric Rare Tumors (EXPeRT).

Squamous cell carcinoma of the skin after cardiac transplantation: a clinical case

Background. Solid organ transplantation recipients have a high risk of non-melanoma skin tumors. Patients after heart transplantation are prone to a higher incidence of malignant skin tumors due to intensive immunosuppressive therapy. The most common histological type is squamous cell carcinoma, followed by basal cell carcinoma. These tumors have a more aggressive clinical course, including the frequency of recurrence and metastasis, and a tendency to multifocal lesions.
 Materials and methods. We present a clinical case of primary multiple squamous cell carcinoma with metastatic lesions of regional lymph nodes in a patient after heart transplantation.
 Results. A 67-year-old patient underwent an orthotopic heart transplant in September 2018 for ischemic cardiomyopathy. Subsequently, triple immunosuppressive therapy was administered, including tacrolimus combined with mycophenolate mofetil and prednisolone. In May 2022, a solid tumor with ulceration occurred on the skin of the right scapular region. After some time, similar tumors appeared on the skin of the temporal region on the left, the posterior surface of the auricle and the parietal region on the left. The patient later found a solid, painless tumor on the left jaw angle. As a part of the examination in the oncology dispensary, a biopsy of the scapular skin tumor, scrapings from tumors, and aspiration biopsy of the submandibular lymph nodes were performed. Histological and cytological studies of all neoplasms showed squamous cell keratinizing cancer with metastases to the submandibular lymph nodes. Additional examination methods showed no signs of progression. The diagnosis was made: primary multiple synchronous skin cancer: right scapular area, stage III, cT3N0M0; left parietal area, stage II, cT2N0M0; occipital area, stage I, cT1N0M0; left auricle, stage IV, cT1N2M0. Considering the localization of tumors, surgical treatment was performed, including of excision of tumors in the scapular and parietal regions. Radiation therapy was performed on lymph nodes with metastases. After 6 months, a tumor recurrence was detected in the irradiation area.
 Conclusion. After heart transplantation, squamous cell carcinoma of the skin is common. Usually, it affects the scalp and neck with metastases to the regional lymph nodes and is prone to recurrence. The primary treatment method is surgical and radiation therapy.

Lipoma-like hibernoma: a rare soft tissue tumor—a case series and review of the literature

Hibernomas are rare and benign lipomatous tumors which consist of lobules of cells derived from brown fat. Less than 200 overall cases are reported in the literature which necessitates the need to report more cases for better understanding of this neoplasm. Hibernomas are slowly progressing, painless tumors most frequently located in the subcutaneous thigh, upper trunk, and neck. Hibernomas generally occur in areas close to the axial skeleton where brown fat used to exist in the fetus and persisted during adulthood. They are rare to be discovered for the first time in older adults, most commonly presenting in adults 20-40 years of age. Core biopsies are simple to perform under local anesthetic and provide pathological differentiation prior to planned excision, hence are recommended, especially with larger lesions. Based on case presentation, watchful waiting for non-growing asymptomatic cases of hibernoma is possible, but more frequent follow-up and/or a core biopsy would be advised to rule out a more aggressive diagnosis. Compared with lipoma-like hibernomas, atypical lipomatous tumor/well-differentiated liposarcoma recurs and might dedifferentiate to a dedifferentiated liposarcoma with the ability to metastasize in up to 5% of the recurrences. Hibernomas, including the lipoma-like variant, are typically treated by surgical excision, rarely recur and do not metastasize. We report two rare presentations of hibernoma and lipoma-like hibernoma. Awareness of this clinicopathological entity is crucial to avoid misdiagnosis as malignant lipomatous neoplasm.

An unusual intraoral lipoma - A rare case report

Lipoma is a painless tumor derived from mesenchymal connective tissue characterized by slow and circumscribed growth. Fibro-lipomas are a rare subtype of lipomas that typically present as slow-growing, painless masses composed of mature adipose tissue and fibrous tissue. Here, we report the case of a 47-year-old woman who presented with a slowly enlarging mass in the left vestibular sulcus area that had been present for several years. On examination, the mass was soft, mobile, and non-tender, measuring approximately 1 cm in diameter. The patient underwent surgical excision of the mass, and the histopathological examination confirmed the diagnosis of fibro lipoma. This case highlights the importance of considering fibro lipoma in the differential diagnosis of subcutaneous masses, especially when there is a slow-growing, non-tender mass. Although rare, fibro-lipomas should be included in the differential diagnosis of lipomas, as the treatment and prognosis may differ from those of a typical lipoma. Early recognition and surgical excision of these tumors can lead to a favorable outcome with a low risk of recurrence. Key Words Adipocytic tumor, Fibrolipoma, Lipoma, Soft tissue tumor

Juvenile Fibroma: A Case Report and Review of the Literature

Juvenile aponeurotic fibroma is a rare benign tumor which occurs in young patients and found primarily in the extremities. Clinical presentation is a unique, hard and painless tumour of the palm or sole which has a strong propensity to recur. The treatment commonly accepted for this locally recurrent tumour is complete excision with function preservation. With a close supervision to identify any recurrence or development of metastases at early stages.

EPITHELIOID SARCOMA OF WRIST IN 52 YEARS OLD FEMALE IN CHENNAI, INDIA

Epithelioid sarcoma is an uncommon kind of sarcoma that often affects young individuals and has a preference for distal upper extremity; forearm and hand. This usually begins as slow-growing, painless tumor. It can also be seen as multiple tumours. Lymphatic channels are the primary routes of dissemination for the disease’s recurrence and spread. Using polygonal cells, a biopsy is the preferred technique of diagnosis. Treatment primarily consists of wide resection. Here, we present a case of epithelioid sarcoma involving the wrist of 52-years old female. It was initially diagnosed by imprint cytology. To make an accurate diagnosis in a case with a unique history, it is necessary to consider the clinical presentation, morphologic examination, and a broad panel of immunohistochemical staining.

Pyogenic Granuloma: A Literature Review and A Case Report

Pyogenic granuloma of the oral cavity is a common, non-neoplastic, vascular tumor. The etiology is not clear and it is suggested to be attributed to different factors. It might be caused by a reaction to a stimulus such as trauma, viruses such as HSV-1, hormonal changes, as well as other factors such as tooth eruption or medication. Clinically it appears as a painless tumor that tends to bleed easily, with red color and rarely may be accompanied by a periodontal abscess and bone loss. Biopsy is the most common tool used for the diagnosis. Its treatment is usually surgical excision and lately the use of lasers for its excision has emerged. Special care should be given to pregnant women where the treatment varies. The aim of this review is to present the background of oral pyogenic granuloma and the case report presents the situation, histological image and treatment of an adult woman patient.

이하선에 재발한 호산성 과립세포종과 결절성 호산성 과립세포증식증 1예

Oncycytoma is a tumor which is abundunt with granular and eosinophilic cytoplasm and mitochondria. It can be found in various organs such as the kidney, thyroid gland, pancreas, and breast. Salivary gland is reported to be involved with oncocytoma in less than 1% among the salivary gland tumors. A 65-year-old female visited presenting with recurrent lump of the left parotid gland. She had been diagnosed with oncocytoma after left superficial parotidectomy 8 years ago. Physical examination revealed multiple painless tumors in the left parotid gland. Ultrasound and computed tomography showed multiple mass in the left parotid gland. The patient had a revision parotidectomy. Pathology confirmed an oncocytoma and nodular oncocytic hyperplasia. We report a rare case of recurrent oncocytoma and nodular oncocytic hyperplasia from the parotid gland and report the case with related literature. (J Clinical Otolaryngol 2021;32:302-307)

Dramatic radiotherapy response of a giant T4 cutaneous squamous cell carcinoma of the scalp with extensive bone destruction: a case report

BackgroundPatients with large cutaneous squamous cell carcinoma of the scalp are a treatment challenge. We report a case of dramatic radiotherapy response of a patient with a giant cutaneous squamous cell carcinoma of the scalp with extensive skull destruction and suspected infiltration of the dura mater and superior sagittal sinus. This case is the first report of this kind in the literature that shows that large bone defects can heal with the resolution of tumor and inflammation by secondary intention without surgical reconstruction. We want to put an end to concerns about radiocurability of tumors with extensive bone involvement, and show sustained complete response after definitive radiotherapy and programmed cell death protein-1 inhibiting antibody therapy.Case presentationA 74-year-old White man presented with a 7.2 × 6.8 × 5.5 cm painless tumor on the right parietal region of the scalp. Medical imaging revealed widespread destruction of the skull and suspected infiltration of the dura mater and superior sagittal sinus. Biopsies showed cutaneous squamous cell carcinoma (cT4a cN0 cM0, stage IVA). The patient was treated with a total dose of 60 Gy, at 2 Gy per daily fraction with volumetric modulated arc therapy using 6 megavoltage photons. The biologically effective dose (alpha/beta 10 Gy) was 72 Gy. The tumor response correlated with dose received. The patient had a massive tumor necrosis secondary to tumor shrinkage after 18 fractions (36 Gy, biologically effective dose 43.2 Gy). Leakage of cerebrospinal fluid did not occur. Radiotherapy did not hamper the patient’s quality of life. The patient had a clear regression of the initial tumor on the final day of radiotherapy. The bone defect healed by secondary intention without surgical interventions. The patient achieved a complete response with a good cosmetic result after 82 days follow-up. He started a programmed cell death protein-1 inhibiting antibody therapy with cemiplimab 2 months after radiotherapy, and is now at 10 months follow-up without evidence of recurrence.ConclusionDefinitive radiotherapy is a safe and highly effective therapy for giant tumors of the scalp with extensive bone destruction. We report a sustained complete response with a good cosmetic result after secondary wound healing.

Low-grade fibromyxoid sarcoma with heterotopic bone formation: case report and review of the literature

Abstract Introduction/Objective Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon soft tissue malignancy with deceptively bland histologic appearance, and a tendency for late recurrence and metastasis. Cases with significant heterotopic ossification are rare. This presentation aims to characterize the features of LGFMSs showing heterotopic ossification reported in the literature, and further review the morphologic spectrum of this malignant neoplasm. Methods/Case Report We report the case of a 42-year-old male presenting with a 20-year history of a painless tumor in his left upper thigh. Computed tomography images showed coarse punctate peripheral calcifications, and the mass was resected. The tumor cells were immunohistochemically positive for MUC4, and positive for FUS (16p11.2) gene rearrangement by fluorescence in situ hybridization. Lamellar and woven bone with admixed adipose tissue was seen. Immunohistochemistry also showed focal weak to moderate staining for TLE-1. An English literature search using the terms “Evans tumor”, “low-grade fibromyxoid sarcoma”, “ossification”, “osseous metaplasia”, “bone metaplasia” and “bone formation” was performed. Nine cases were identified. The majority of subjects were males, with a mean age of 38 years (range of 12-61 years). The duration of symptoms before diagnosis ranged from a few months to 10 years. The tumor size ranged from 2.5 and to more than 12 cm. In a minority of subjects, calcifications were identified on imaging studies. Histologically, bone metaplasia was mainly seen at the periphery of the tumor. The majority of cases had a chromosomal translocation (FUS-CREB3L2 in 5 cases and EWSR1-CREB3L1 in one). Results (if a Case Study enter NA) NA Conclusion LGFMS is a tumor that can occur in a wide range of anatomical sites, and should be included in the differential diagnosis of any spindle cell neoplasm with hypocellular areas and bland cytology. Pathologists and clinicians should be aware of the rare possibility of heterotopic ossification in this tumor type, which can be radiologically detected as calcification and then confirmed histopathologically.

Diagnóstico de linfangioma cavernoso de face em paciente adulto: relato de caso clínico

The authors present a case of a 18 (eighteen) years old male patient, presenting a recurrent painless tumour on the left side of his face, growing both intra and extraorally- It caused progressive limitation of mandibular mobilitv. Histopathological result of cavernous lymphangioma differed from the previous findings seen on magnetic resonance imaging.

Malignant peripheral nerve sheath tumour in an unusual location of the urinary bladder: case report and review of literature

BackgroundMalignant peripheral nerve sheath tumour (MPNST) is a rare malignant soft tissue neoplasm of ectomesenchymal origin. They usually arise from a major or minor peripheral nerve branch or its sheath and also from somatic soft tissues. The most common sites of origin include the extremities and trunk but can sometimes arise an unusual site resulting in the demise of the patient before any intervention.Case presentationWe report a case of 58-year-old male who presented with complaints of weight loss of a year duration, abdominal swelling of 10 months duration and easy fatigability of 3 weeks duration. Digital rectal examination revealed a huge firm mass 6 cm from the anal verge which was non-tender. Abdomino-pelvic ultrasound scan revealed an irregular heterogeneous mass in the posterior wall of the urinary bladder measuring 15.1cmx 14.0 cm with bilateral dilatation of the renal pelvi-calyceal system and ureters. His clinical condition continued to deteriorate while on hospital admission, and he died on the12th day of admission. Post-mortem examination showed a rough ovoid tumour mass firmly adherent to the posterior wall of the bladder with compression of both ureters. Histological and immunohistochemical analysis of the tumour revealed the diagnosis of a MPNST. The final anatomical diagnosis and cause of death was that of a malignant peripheral nerve sheath tumour of the urinary bladder with obstructive uropathy and severe sepsis.ConclusionMPNST can arise at unusual sites other than its common location in the extremities and the existence of neurofibromatosis may not be present. High index of suspicion of MPNST should be raised in rapidly growing painless tumour in and around a nerve tissue. Prompt radio-imaging with biopsy and expert immunohistochemical analysis of lesions will lead to early diagnosis and intervention. Molecular targeted therapies following surgery for MPNST should be developed to improve prognosis and patient outcomes.

Recurrence lumbar lipoma

Lumbar hernias of the lateroposterior abdominal wall have a low prevalence, being described in the scientific literature as sporadic cases or short series. Initially, they manifest as a painless tumor that can be confused with other more frequent pathologies such as soft-tissue tumors, lipomas, hematomas, or abscesses. We present the case of a 72-year-old female patient who, after removal of a lumbar lipoma by dermatology, was referred to our clinic for recurrence of tumor. An ultrasound scan showed a recurrence of the lipoma. The anamnesis and physical examination suggested lumbar hernia. Computerized axial tomography scan confirmed the clinical diagnosis, and surgery was indicated.

A rare clinical presentation of human <i>Dirofilaria repens</i> infection as a pseudo-tumour of the epididymis – Case Report

Introduction. Epididymal dirofilariasis is one of the unusual manifestations of this zoonosis. In Slovakia, this is the third case out of 20 Dirofilaria repens infected patients in whom the worm (the parasite) was identified in the epididymis. The patient felt a painless tumour about 2 cm in size on the left testicle. During ultrasound examination, the radiologist observed a cyst containing a live worm within the epididymis. After mechanical stimulation, the movement characteristic for filarial worms (´filarial dance sign´) appeared. An orchiectomy was performed at the Department of Urology in the University Hospital in Kosice. Histopathology confirmed a parasitic cyst with a worm, and based on characteristic morphological features, the parasite was identified as Dirofilaria repens. Objective. The aim of case report is to alert physicians to the possibility dirofilarial infection of the epididymis, where tumors and cystic structures often occur and to present clinical signs of the disease.

Infantile Digital Fibromatosis—Which is Better for a Child: a Surgical or Observational Approach?

The golden standard of infantile digital fibromatosis treatment has not been established. This publication aims to present the process of sustained treatment of a 4-month-old boy with a red, firm, swollen, painless tumor of the third and fourth right toes and syndactyly of these. The lesion was surgically resected due to continued growth, but after 1 year of observation, local recurrence was noticed and an observational approach was implemented with satisfactory effect.

An axillary granular cell tumor: A rare neoplasm at an unusual site

A granular cell tumor (GCT) is a rare neoplasm occurring usually in submucosal and subcutaneous tissues anywhere in the body, affecting mainly the head and neck. GCTs at unusual anatomic sites, such as the breast or the axillary extension, could be taken for invasive carcinoma. We report the case of a 30-year-old male who presented himself with an axillary nodule. A physical examination revealed a firm and painless subcutaneous tumor on ulcerated skin. Lymphoma and lymph node metastasis were suspected. An imaging survey was negative outside the axillary nodule. The tumor was surgically removed. A microscopic examination showed the typical features of a benign GCT. Surgical margins were negative. No recurrence has been observed within a 6-month follow-up period. A GCT can mimic a malignancy since it presents itself as an axillary nodule, and requires complete surgical resection with clear margins.

Giant hand osteolipoma: Case Report

AbstractHand lipomas are rare in the hand, and they account for less than 1% of tumors. Osteolipoma is a rare variant of lipoma that is associated with bone metaplasia. It presents as a painless tumor that can cause symptoms when compressing adjacent structures. Magnetic resonance imaging (MRI) is the imaging study of choice. The treatment is surgical resection, with no recurrences being reported. We present the case of a patient with a giant subfascial hand osteolipoma, which, to the best of our knowledge has not yet been reported in the literature.