Slow-growing Tumors Research Articles

Germline findings in cancer predisposing genes from a small cohort of chordoma patients

IntroductionChordoma is a rare slow-growing tumor that occurs along the length of the spinal axis and arises from primitive notochordal remnants (Stepanek et al., Am J Med Genet 75:335–336, 1998). Most chordomas are sporadic, but a small percentage of cases are due to hereditary cancer syndromes (HCS) such as tuberous sclerosis 1 and 2 (TSC1/2), or constitutional variants in the gene encoding brachyury T (TBXT) (Pillay et al., Nat Genet 44:1185–1187, 2012; Yang et al., Nat Genet 41:1176–1178, 2009).PurposeThe genetic susceptibility of these tumors is not well understood; there are only a small number of studies that have performed germline genetic testing in this population.MethodsWe performed germline genetic in chordoma patients using genomic DNA extracted by blood or saliva.ConclusionWe report here a chordoma cohort of 24 families with newly found germline genetic mutations in cancer predisposing genes. We discuss implications for genetic counseling, clinical management, and universal germline genetic testing for cancer patients with solid tumors.

Surgical resection of double advanced pancreatic neuroendocrine tumors with multiple renal cell carcinoma associated with von Hippel-Lindau disease.

Von Hippel-Lindau (VHL) disease, an autosomal dominant genetic disorder caused by a germline mutation, is associated with non-functional and slow-growing pancreatic neuroendocrine tumor (PNET) and kidney cancer. We describe the case of a 46year-old man with a 35mm mass in the pancreatic head causing stricture of the bile duct and main pancreatic duct, a 55mm mass in the pancreatic tail causing obstruction of the splenic vein (SV), and multiple masses of > 36mm on both kidneys. We performed a two-stage resection. First, a total pancreatectomy with superior mesenteric vein (SMV) resection and reconstruction and retroperitoneoscopic right partial nephrectomy (NP) for five lesions was performed, followed by retroperitoneoscopic left partial NP of the five lesions 6months later. Postoperative histopathological examination revealed NET G2 in the pancreatic head with SMV invasion and somatostatin receptor type 2A (SSTR2A) positivity, NET G2 in the pancreatic tail showed SV invasion and negative SSTR2A, and multiple clear cell renal cell carcinomas (RCC) were also noted. Multiple liver recurrences occurred 22months after primary surgery. The patient remains alive 41months after primary surgery. Kidney cancer generally determines VHL prognosis; however, we experienced dual-advanced PNETs with a more defined prognosis than multiple RCC associated with VHL.

Clinical management and outcome of head and neck paragangliomas (HNPGLs): A single centre retrospective study.

Head and neck paragangliomas (HNPGLs) are rare, usually benign, slow-growing tumours arising from neural crest-derived tissue. Definitive management pathways for HNPGLs have yet to be clearly defined. To review our experience of the clinical features and management of these tumours and to analyse outcomes of different treatment modalities. Demographic and clinical data were obtained from The Northern Ireland Electronic Care Record (NIECR) as well from a prospectively maintained HNPGL database between January 2011 through December 2023. There were 87 patients; 50 females: 37 males with a mean age of 52.3 ± 14.2 years old (range 17-91 years old). 58.6% (n = 51) of patients had carotid body tumours, 25.2% (n = 22) glomus vagal tumours, 6.8% (n = 6) tumours in the middle ear, 2.2% (n = 2) in the parapharyngeal space and 1.1% (n = 1) in the sphenoid sinus. 5.7% (n = 5) of patients had multifocal disease. The mean tumour size at presentation was 3.2 ± 1.4 cm (range 0.5-6.9 cm). Pathogenic SDHD mutations were identified in 41.3% (n = 36), SDHB in 12.6% (n = 11), SDHC in 2.2% (n = 2) and SDHA in 1.1% (n = 1) of the patients. Overall treatment modalities included surgery alone in 51.7% (n = 45) of patients, radiotherapy in 14.9% (n = 13), observation in 28.7% (n = 25), and somatostatin analogue therapy with octreotide in 4.5% (n = 4) of patients. Factors associated with a significantly higher risk of recurrence included age over 60 years (p = .04), tumour size exceeding 2 cm (p = .03), positive SDHx variants (p = .01), and vagal and jugular tumours (p = .04). The majority of our patients underwent initial surgical intervention and achieved disease stability. Our results suggest that carefully selected asymptomatic or medically unfit patients can be safely observed provided lifelong surveillance is maintained. We advocate for the establishment of a UK and Ireland national HNPGL registry, to delineate optimal management strategies for these rare tumours and improve long term outcomes.

Dermoid cyst of the posterior cerebral fossa mimics vascular pathology: A case report and review of the literature

Background: Intracranial dermoid cysts are rare benign, slow-growing tumors derived from ectopic cell rests incorporated in the closing neural tube. Radiologically, dermoid cysts are typically hypodense on computed tomography and hyperintense on T1WI and hypointense on T2WI in Magnetic resonnance imaging. Case description: We present a case of a 35-year-old female presented with chronic progressive headache, vomiting and blurred vision. Imaging studies revealed a spontaneously hyperdense mass lesion in the posterior fossa in CT scan; T1 WI hyperintensity and T2 hypointensity on MRI. Surgical excision of the tumor lesion was performed through a suboccipital craniotomy. The histopathological examination was typical for a dermoid cyst. The patient’s symptoms resolved postoperatively. Conclusion: Recognition of these atypical radiological features can help to avoid potential diagnosis and therapeutic pitfalls.

Clinical outcomes and challenges of surgical extirpation for carotid body paraganglioma in South Korea: a single-center retrospective study

BackgroundCarotid body paraganglioma (CBP) is a rare, highly vascularized, and slow-growing neuroendocrine tumor. Surgical resection is the definitive treatment for CBP, however, it remains challenging due to the tumor’s proximity to critical blood vessels and cervical cranial nerves. This study aimed to document the characteristics of CBP and examine the clinical outcomes of patients following surgical extirpation of CBP.MethodsThis is a single-center retrospective review analyzed patients who underwent CBP extirpation. We examined the patient demographics, preoperative clinical features, tumor characteristics, levels of catecholamines and their metabolites in the serum and urine. Surgeries were performed by one vascular surgeon with follow-ups at 1,3,6 months and yearly thereafter. Logistic regression analysis was conducted to identify risk factors associated with the occurrence of either permanent or temporary cervival cranial nerve palsy (CNP).ResultsFrom September 2020 to February 2023, this study examined 21 cases of CBP removal surgeries that were carried out in 19 patients. The mean age of the patients was 38.9 ± 10.9 years and the percentage of males was 57.1% (n = 12). The most common preoperative clinical feature was painless neck mass (n = 12; 57.1%). Complete resection was achieved in 20 cases; excluding one case with pathologically proven sclerosing paraganglioma. Vascular procedures were performed in four cases (ECA resection, n = 2; primary repair of ICA tear without carotid shunting, n = 1; and ICA patch angioplasty with carotid shunting, n = 1). Temporary cranial neurologic complications, specifically aspiration and hoarseness occurred in four (19.0%), and three (14.3%) cases, respectively. Hoarseness associated with permanent CNP persisted for more than 6 months in two cases (9.5%). No recurrence or mortality was observed during the follow-up period.ConclusionsSurgical resection is the primay treatment approach for CBP; however, it poses risks of vascular or cervical CNP. The intraoperative estimated blood loss was the only identified risk factor for CNP.

Chondrosarcoma of the Nasal Cavity and Paranasal Sinuses: A Rare Entity.

Background: Chondrosarcomas are slow-growing malignant tumors that originate in cartilaginous structures. They typically manifest in the head and neck region, with a preference for the maxillofacial skeleton, particularly the mandible and maxilla. However, chondrosarcoma of the sinonasal tract is exceptionally rare, and only few cases have been reported. Case Presentation: This report details the case of a 43-year-old woman who incidentally discovered chondrosarcoma in the maxillary and ethmoid sinuses with nasal extension. Subsequently, the patient underwent surgery via a paralatero-nasal approach with adjuvant radiotherapy. The aim of this study was to describe the clinical findings, management, and outcome of sinonasal tract chondrosarcoma. Conclusions: The primary treatment for chondrosarcomas remains surgery, with a transnasal endoscopic approach offering a viable option for complete resection in select cases.

Exceptional lymph node recurrence of an unusual ovarian tumor 16 years later: a case report

BackgroundSex cord-stromal tumors with annular tubules are a rare tumor accounting for less than 1% of all ovarian malignancies. However, they are characterized by very late recurrence, which can be as late as 30 years after diagnosis and treatment.Case presentationA 16-year-old female Caucasian patient was treated in our department for a stage IA ovarian sex cord-stromal tumors with annular tubules. She underwent a left salpingo-oophorectomy and ipsilateral pelvic node biopsy with no adjuvant treatment. She was seen for amenorrhea after being lost to follow up for 16 years. The diagnosis of recurrence was made by radiology and the elevation of serum inhibin B level. The patient underwent resection of the tumor, left segmental colectomy, and paraaortic lymphadenectomy because the mass was massively adherent to the left mesocolon. Histology confirmed the diagnosis with no metastatic lymph nodes. No adjuvant therapy was indicated. The patient was lost to follow-up again for 4 years and re-presented for amenorrhea. Serum inhibin B level was high. A second recurrence was suggested, and the patient underwent a laparoscopic surgery. We performed left pelvic and paraaortic lymphadenectomy, and 3 months after surgery the patient was pregnant.ConclusionSex cord-stromal tumors with annular tubules is a slow-growing ovarian tumor with a high potential for recurrence and metastasis. Surgery is the mainstay of treatment. Due to the rarity of these tumors, they are often unsuspected and thus incompletely staged before primary surgery; the diagnosis is made by histological examination. The prognosis of these patients is unknown, and they require long-term follow-up.

Intraluminal extension of papillary thyroid carcinoma into the Internal Jugular Vein; a case report

BackgroundPapillary thyroid carcinoma (PTC), being the most common thyroid malignancy, is a slow-growing tumor and is usually limited to the thyroid. Extra thyroid extension is uncommon; besides, invasion to the vasculature seems to be extremely rare and usually indicates aggressive nature of the disease.Case presentationWe present a case of a 40-year-old lady who referred with a palpable neck mass a month after total thyroidectomy which its histopathologic examination revealed follicular variant of PTC; the same variant as prior thyroidectomy. Preoperative ultrasonography failed to comment on the intravascular component of the mass. Surgical procedure confirmed a mass attaching and infiltrating to the internal jugular vein, which turned out to be persistent disease.ConclusionsAwareness of this entity is important for surgeons, oncologists and radiologist as it can influence patient management.

Genomic and Pathologic Profiling of Very Well-Differentiated Gastric Adenocarcinoma of Intestinal Type: A Study With Emphasis on Diffuse-Type Transformation.

Very well-differentiated adenocarcinoma of intestinal type is a distinct subtype of gastric cancer characterized by anastomosing glands with a hand-in-hand pattern and low-grade cytologic atypia resembling intestinal metaplasia. This is a slow-growing neoplasm with an indolent clinical course; however, a subset demonstrates transformation into adenocarcinoma with higher-grade histology, typically diffuse-type carcinoma, and behaves aggressively. This study aimed to better characterize the genomic and pathologic features, with a focus on factors associated with diffuse-type transformation. A total of 58 cases with (n=31) and without (n=27) diffuse-type transformation were analyzed for molecular and pathologic features. First, comprehensive deep DNA sequencing was conducted in 18 cases (discovery cohort), followed by a digital droplet polymerase chain reaction of hot spot RHOA mutations in 40 cases (validation cohort). In total, RHOA mutations were the most common alteration (34%), followed by loss of ARID1A (12%), p53 alterations (10%), and CLDN18 :: ARHGAP26/6 fusions (3.4%). FGFR2 amplification was identified in an advanced case with a p53 alteration. Altered p53 expression was recognized only in higher-grade components and was significantly associated with advanced disease ( P =0.0015) and diffuse-type transformation ( P =0.026). A mixed mucin phenotype was also strongly correlated with advanced disease ( P <0.001) and diffuse-type transformation ( P <0.001). Decreased E-cadherin expression was frequently observed (74%) in poorly cohesive components. This study demonstrated that a subset of RHOA -mutant diffuse-type gastric cancers develops through the transformation of very well-differentiated adenocarcinoma of intestinal type. Our observations suggest a mixed mucin phenotype as a risk factor and alterations in p53 and E-cadherin as drivers of diffuse-type transformation.

Management of ossifying fibroma of the bone of the maxilla: a case report and review of the literature

Abstract Ossifying fibroma (OF) is a slow-growing benign fibro-osseous neoplasm. It is mostly odontogenic in origin, and it arises in the jaws, particularly the mandible. OF is characterized by the production of bone and cementum-like calcifications in a fibrous stroma. OF reports of the bone of the maxilla are uncommon. Diagnosing OF can be challenging due to the considerable overlap of clinico-pathological characteristics with those of other neoplasms. Herein, the authors describe a case report OF in a 26-year-old male who presented with a huge fibro-osseous tumor of the maxilla. Histopathology established the diagnosis of maxillary OF. The tumor was surgically removed via a Weber–erguson approach with satisfactory functional and cosmetic results. No recurrence has been found after one year of follow-up. Clinical, radiological, and pathological characteristics, as well as surgical treatment approaches, are further discussed. This is one of a few documented cases of maxillary OF in our setting.

Meningioma Prognostic Tool Based on Correlation of Histopathological Grading and Immunohistochemistry.

Meningiomas are slow-growing brain neoplasms classified into three grades based on morphological criteria. While these grades are simple, they do not always correlate with patient outcomes. This study aimed to evaluate the status of estrogen receptor (ER), progesterone receptor (PR), and proliferation marker Ki-67/molecular immunology borstel-1 (MIB-1) in the three grades of meningioma. We evaluated the data of meningioma patients who were seen in our tertiary center over 10 years-8.5 years retrospectively and 1.5 years prospectively. Their archival hematoxylin and eosin stained slides were reviewed and re-graded according to the World Health Organization 2021 criteria. Immunohistochemical analysis for ER, PR, and Ki-67 was performed on all grade 2 and grade 3 meningiomas and 30 cases of grade 1 formalin-fixed, paraffin-embedded samples. Of the 276 cases included in the study, there were 231 (83.7%) cases of grade 1 meningioma, 34 (12.3%) cases of grade 2, and 11 (4.0%) cases of grade 3. ER was positive in 26.0% of grade 1 tumors, 5.8% of grade 2, and 0.0% of grade 3. PR was positive in 70.0% of grade 1 tumors, 20.0% of grade 2, and 18.0% of grade 3. The Ki-67/MIB-1 labeling index (LI) was 2.1 in grade 1, 6.3 in grade 2, and 13.4 in grade 3 tumors. For both PR and Ki-67, the differences between grades 1, 2, and 3 tumors were significant (p < 0.001). There was a significant inverse relationship between mean Ki-67 LI and PR status, with increasing grade of tumor. Ki-67/MIB-1 LI has significant positive correlations with meningioma grade and its recurrence, which makes it a useful auxiliary method for the routine assessment of meningiomas, especially in patients with borderline atypia. The expression of PR, on the other hand, is a positive prognostic indicator and has a substantial correlation with histological grade. In cases of subtotal resection, high proliferative/recurrence rates, and borderline histopathology, the PR status in combination with the MIB-1 LI can offer insights into the behavior and the recurrence probability of a meningioma.

Calcified Planum Sphenoidale Meningioma Mimicking Stroke in A 64-Year-Old Known Hypertensive: A Case Report

Background: Planum sphenoidale meningiomas are benign, slow-growing intracranial tumours with varied manifestations at any age group. Although it is rare, they usually present late when the size of the tumour is 4cm or more with headache, cognitive impairment, seizure, anosmia, nasal congestion and discharge, and visual disturbances. This type of meningioma constitutes a clinical diagnostic chal-lenge due to the non-specific nature of the subtle signs associated with it. Radiological investigations such as magnetic resonance imaging and computed tomography (CT scan) represent an imaging mo-dality used in the assessment of patients suspected of anterior cranial fossa meningioma and stroke. Case Presentation: We present a 64-year-old retired civil servant who presented to the Emergency Unit of the National Hospital, Abuja, with a history of sudden onset of seizure and loss of conscious-ness that lasted for over 6 hours. The patient had been having a history of recurrent nasal discharge for ten (10) years and one episode of seizure one month before presentation. There is also prior history of nasal discharge that was usually scanty, yellowish, and sometimes purulent. There was an associated feeling of nasal congestion. A clinical diagnosis of transient ischaemic stroke in a known hypertensive was made. However, the further radiological evaluation revealed a tumour mass with histological fea-tures consistent with planum sphenoidale psammomatous grade I meningioma. Conclusion: The clinical presentation of this tumour could mimic other cerebrovascular diseases. Thus, physicians need a high index of suspicion of other possible differential diagnoses, and appropri-ate radiological assessment is crucial with histopathologic examination.

SCHWANNOMA OF THE HEAD AND NECK REGION: A CASE SERIES IN A TERTIARY HEALTH CENTRE IN WESTERN ODISHA

Objective: Schwannoma is a benign peripheral nerve sheath tumour. Previously referred to as Neurilemmomas. It is a slow-growing tumour. The commonest site is the limb with a predilection to the upper limb. But, it has a 25–48% predilection for nerves of the head and neck. In the oral cavity, the commonest site is said to be the tongue. Methods: We report three cases of histopathologically diagnosed Schwannoma at unusual sites. The first case was a 52 y old lady with a palpable, firm, painless swelling in the occipital region of the scalp of size 2.0 x 1.0 x 1.0 cm. The second case was a 29 y old woman with a painless scalp swelling of 1 cm by 1 cm. The third case was a 23 y old boy who presented with a slow-growing and painless pedunculated swelling in the posterior pharyngeal wall for a year. All cases showed classical histopathologic pictures on microscopy. Results: All the patients were evaluated pre-operatively and subjected to an excisional biopsy. The post-operative period was uneventful and everything went according to plan for a full year. Conclusion: Schwannomas exhibit a slow growth rate, are present in all age groups, and are not specific to one gender. Extremities are the most common locations to occur, but some rare sites like the scalp, oral cavity, retroperitoneum, and internal viscera also exist. Magnetic resonance imaging (MRI) is helpful in those lesions, providing useful information about the location and nature of the lesion, eliminating differential diagnosis, and thus providing correct management plans.

Characteristics and surgical management of spinal meningiomas in the Himalayan region

Background: Spinal meningiomas, originating from arachnoid cap cells, primarily manifest in the intradural extramedullary region, commonly favouring the thoracic area, albeit occurrences in the cervical, lumbar, and exceptionally rare sacral regions have been noted. Among tumours in this location, meningiomas, neurofibromas, and schwannomas prevail. MRI serves as the preferred imaging modality due to its ability to often reveal the distinctive dural origin of meningiomas. Microdissection and resection stand as the established gold standard for treating spinal meningiomas. Materials and methods: This study, conducted at the Sheri-Kashmir Institute of Medical Sciences Soura Srinagar in Jammu and Kashmir, India, spanned approximately 10 years from August 2009 to July 2017 retrospectively and August 2017 to July 2019 prospectively. It encompassed patients diagnosed with spinal meningiomas, evaluated through comprehensive history-taking, clinical examinations, biochemical assessments, and radiological studies. Surgical interventions predominantly involved laminectomy, aiming for gross total or subtotal tumour resection using a posterior approach. Postoperative complications, such as CSF leaks and wound infections, were monitored, and the duration of hospitalization was recorded from the surgery date to discharge. Results: The results showed a mean patient age of 44 years, with the youngest being 16 years old and the eldest 70 years old. Most patients (40.90%) fell within the 41-50 age group, with 22.72% in the 51-60 age bracket. Among the 22 patients, females comprised 68.18%, resulting in a female-to-male ratio of 2.1:1. The most prevalent symptoms were pain (77%) and weakness (63%), followed by bladder dysfunction (27%). Tumors were primarily located in the thoracic region (68%), with other occurrences in the cervicothoracic (18%), thoracolumbar (9%), and cervical (4.54%) areas. Posterior surgical approaches were utilized in 91% of cases, with the remaining 9% employing an anterior approach. Tumour sizes varied, with 22.72% smaller than 2 cm and 77.27% larger, having a mean greatest diameter of 2.9 cm. Postoperative complications were observed in 9.09% of patients, with CSF leaks and wound infections being the major concerns, while 91% experienced no complications. Conclusions: In conclusion, this study illustrates spinal meningiomas as slow-growing tumors with a subtle onset, typically appearing in the 4th to 5th decade, and exhibiting a female predominance with a 2:1 ratio. Pain emerges as the most prevalent presenting symptom. Surgery stands as the primary treatment, albeit accompanied by potential postoperative complications such as wound infections, CSF leaks, or bowel and bladder dysfunctions. Adjuvant radiotherapy might be considered for recurrent or advanced disease to offer palliative relief.

Intraosseous cavernous hemangioma of parietal bone: A case report and literature review

Introduction and background: Intraosseous Hemangiomas or Primary Intraosseous Hemangiomas (PIH) are slow-growing innocuous blood vessel tumors that make up less than 1% of all bone malignancies [1]. These lesions are estimated to account for 0.2 percent of all benign skull tumors [4], with a clear female predisposition (3:1) [2]. Prior trauma to the region is thought to be the most prevalent cause of intraosseous hemangiomas. They bleed profusely when removed or biopsied; therefore, preoperative diagnosis of the lesion’s vascular character is critical [8]. They are most frequently seen in the vertebral skeleton, although they can also be found in the calvarium and facial bones. The temporal bone is the most prevalent place in the head after the vertebral skeleton, followed by the parietal, mandible, malar, and zygomatic areas [8]. In this case report, we discuss the case of a 9-year-old male who presented with a large soft mass in his right parietal region.

Endoscopic endonasal approach for skull base chordoma

BackgroundChordoma is a rare slow-growing malignant bone tumor that arises from embryonic notochordal remnants in the axial skeleton. Clival chordomas have a high propensity for extension through the skull base and a high proclivity for recurrence. Recently, resection of skull base chordomas through the endoscopic transnasal approach has become the standard way of managing these lesions with the new advancements in neuronavigation and reconstructive techniques in skull base surgery.MethodsIt is a retrospective study of all patients with clival chordoma that were operated upon using endoscopic endonasal resection at the Main Alexandria University Hospital during the period from March 2008 to April 2013. The extent of surgical resection was assessed intraoperatively and confirmed by the postoperative MRI study performed 8–12 weeks, 6 months, and yearly after the surgery.ResultsTwelve patients with clival chordoma were managed by endoscopic transnasal resection. Gross total resection confirmed by postoperative MRI was achieved in four cases, subtotal resection in six cases, and partial resection in two cases of clival chordoma. In cases where gross total resection was not achieved, residual tumors were adherent to vital neurovascular structures as confirmed with the utilization of an intraoperative imaging navigation device. A study of postoperative complications and possible recurrence was done for all cases.ConclusionsThe findings of this study highlight the significance of gross total resection as a major determinant for preventing the recurrence of chordoma. Our findings also support the validity of the endoscopic approach for the management of clival chordoma especially when the approach is tailored based on the site and extent of the tumor.

Prostate cancer risk stratification via eNose urine odor analysis: a preliminary report.

Prostate cancer (PCa) is known for its highly diverse clinical behavior, ranging from low-risk, slow-growing tumors to aggressive and life-threatening forms. To avoid over-treatment of low-risk PCa patients, it would be very important prior to any therapeutic intervention to appropriately classify subjects based on tumor aggressiveness. Unfortunately, there is currently no reliable test available for this purpose. The aim of the present study was to evaluate the ability of risk stratification of PCa subjects using an electronic nose (eNose) detecting PCa-specific volatile organic compounds (VOCs) in urine samples. The study involved 120 participants who underwent diagnostic prostate biopsy followed by robot assisted radical prostatectomy (RARP). PCa risk was categorized as low, intermediate, or high based on the D'Amico risk classification and the pathological grade (PG) assessed after RARP. The eNose's ability to categorize subjects for PCa risk stratification was evaluated based on accuracy and recall metrics. The study population comprised 120 participants. When comparing eNose predictions with PG an accuracy of 79.2% (95%CI 70.8 - 86%) was found, while an accuracy of 74.2% (95%CI 65.4 - 81.7%) was found when compared to D'Amico risk classification system. Additionally, if compared low- versus -intermediate-/high-risk PCa, the eNose achieved an accuracy of 87.5% (95%CI 80.2-92.8%) based on PG or 90.8% (95%CI 84.2-95.3%) based on D'Amico risk classification. However, when using low-/-intermediate versus -high-risk PCa for PG, the accuracy was found to be 91.7% (95%CI 85.2-95.9%). Finally, an accuracy of 80.8% (95%CI72.6-87.4%) was found when compared with D'Amico risk classification. The findings of this study indicate that eNose may represent a valid alternative not only for early and non-invasive diagnosis of PCa, but also to categorize patients based on tumor aggressiveness. Further studies including a wider sample population will be necessary to confirm the potential clinical impact of this new technology.

Adenoid Cystic Carcinoma of Maxillary Sinus

ABSTRACT Adenoid cystic carcinoma is a rare, slow-growing tumor that develops from the mucous glands’ epithelium. Most commonly, it develops in salivary glands and is rare in the nose and paranasal sinuses. It is common in the fourth to sixth decade of life, with a female preponderance. We present a case of a 40-year-old male who came with complaints of right-sided nasal obstruction, which was clinically and radiologically diagnosed as a mucocele. He underwent endoscopic excision of the mass. Histopathology was suggestive of adenoid cystic carcinoma. Later, the patient underwent right orbital floor-sparing total maxillectomy, followed by adjuvant radiotherapy.

Dissecting the mystery: A case report of a parapharyngeal ganglioneuroma

Introduction: Ganglioneuromas, slow-growing non-neoplastic tumors from neural crest cells, are typically asymptomatic but may manifest clinically when reaching a significant size. While rare in the parapharynx, imaging assists in preoperative planning and assessing features of more sinister pathologies. Case Report: A 45-year-old woman presented with persistent unilateral neck pain and sore throat, computed tomography (CT) imaging parapharyngeal space, ultimately diagnosed as a parapharyngeal ganglioneuroma on tissue biopsy. Surgical excision was performed with an uneventful postoperative course. Conclusion: Parapharyngeal ganglioneuromas pose diagnostic challenges due to their rarity and diverse presentations. This case underscores the diagnostic challenges posed by rare parapharyngeal lesions and highlights the successful management of ganglioneuromas through appropriate imaging and surgical intervention.

Spinal calcifying pseudoneoplasms of the neuraxis: A case report and review of the literature

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare, non-neoplastic, slow-growing tumors that can present anywhere throughout the central nervous system. While the etiology of these lesions remains unknown, the mainstay of treatment is surgical excision. We describe a case of CAPNON at our institution in a 66 year-old female patient who presented with 5 months of pain and burning sensation in her thigh. On MRI, an intradural extramedullary lesion was identified at the level of T11-T12. The mass was surgically excised and the patient reported resolution of her symptoms by her six week follow-up appointment. We reviewed 79 spinal CAPNON cases, covering all cases reported in the literature thus far. In summary, we find that spinal CAPNON are most commonly lumbar and extradural in location, with pain as the most common presenting symptom. Lesions are well-defined and hypointense on T1 and T2 MRI sequence. The majority of cases had favorable surgical outcomes with near complete resolution of pain and associated symptoms.