Supraclavicular Mass Research Articles

Rare case of a cervical nodular adipose mass

Cervical and supraclavicular adipose tissue masses are relatively rare, being lipoma and hibernoma the most e less frequent forms. The present paper deals with a case of a 72-year-old patient with clinical history of right supraclavicular nodular lipomatous mass, with cytological diagnosis of probable hibernoma. The histology of the surgical specimen confirmed the cytological suspicion.

Carcinoid Tumor of Thymus: A Rare But Highly Recurrent and Metastatic Disease

SESSION TITLE: Disorders of the Mediastinum 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Primary carcinoid tumor arising in thymus is rare with very few cases reported. Recurrence and metastases are common. We present a case of carcinoid tumor of thymus that recurred 6 years post treatment. CASE PRESENTATION: 28 yo female presented with adrenocorticotrophic hormone( ACTH) secreting low-grade carcinoid tumor of thymus causing Cushing syndrome. She underwent trans-sternal thymectomy and adjuvant radiotherapy. Postoperative CT scan and ACTH levels were stable for 5 years with no evidence of disease. Several month prior to presentation to us she noted a left neck mass , her ACTH levels rose and she was admitted for pneumonia. CT and Positron Emission Tomography (PET) scans demonstrated PET-avid mass in the left neck just behind the sternocleidomastoid, and along the right internal jugular lymph node chain. Fine needle aspiration of the left supraclavicular mass demonstrated neuroendocrine carcinoma. She underwent successful resection of the mass along with extended left neck dissection with en-bloc resection of the internal jugular vein down to the left subclavian junction including thoracic duct resection and bilateral lymphadenectomy of jugular nodes. Post surgery her ACTH level declined from 81-19.7 pg./ml ( Normal:10-50 pg/ml) DISCUSSION: Carcinoid tumors are unusual tumors and account for less than 5 % of all anterior mediastinal tumors. It is incidentally found in over one third of patients. Others present with signs and symptoms of rapidly expanding mass such as cough, chest pain, superior vena cava syndrome. At least 20% have metastases at presentation with extra thoracic disease in 20-30%. Almost 50% are functionally active and associated with endocrinopathies such as Cushing syndrome as in our patient and multiple endocrine neoplasia. Invasion of adjacent structures such as in our patient occur in 30-50% and metastases to lung, bone and liver in about 30%. Surgical resection is the treatment of choice although recurrence is 67% and often after long intervals. Radiotherapy and chemotherapy is recommended but without clear-cut benefit. Survival varies and in one review 51% survived three years, 27% survived five years and 9% survived 10 years or more CONCLUSIONS: Thymic carcinoids are slow growing aggressive tumors, which commonly invade surrounding structures. Despite extensive resection late recurrence may occur. Reference #1: Carcinoid tumor of the thymus. Thorax 1994; Wang et al Reference #2: Primary Neuroendocrine carcinoma of thymus: Niger med J 2013 jan feb:Gaude et al DISCLOSURE: The following authors have nothing to disclose: Bikash Bhattarai, Kevin Kovitz, Benjamin Seides No Product/Research Disclosure Information

Schwannoma of Brachial Plexus Presenting as Supraclavicular Mass: A Rare Presentation, Evaluation and its Management is a Challenge to Surgeons

Schwannoma of Brachial Plexus Presenting as Supraclavicular Mass: A Rare Presentation, Evaluation and its Management is a Challenge to Surgeons

Etiologic and differential diagnostic significance of tumor location in the supraclavicular fossa.

Patients presenting with a cervical mass are common for head and neck specialists and present a diagnostic challenge against the backdrop of a wide variety of etiologies. The objective of the present study was to evaluate the significance of a mass in the supraclavicular fossa for etiology, diagnostic procedure, and therapy. Individual retrospective cohort study. We reviewed the data of 211 consecutive cases (116 male, 95 female) with excisional biopsy or tumor removal of a supraclavicular mass. In 202 of 211 cases, a biopsy was taken from a lymph node. In 182 biopsies, a malignant lymphadenopathy was found (117 metastases, 65 malignant lymphoma). The histologic findings of metastatic diseases were adenocarcinoma (48), followed by squamous cell carcinoma (22). The majority of primary carcinomas were located below the clavicle (94), in the lung (32), in the breast (29), and in the head and neck region (18). In the left supraclavicular fossa, only metastases of the genitourinary tract were significantly more frequent (16 of 17). In nonmalignant tumors (29), tuberculosis (11) was most prevalent. In 79% of biopsies, the neck mass was the first manifestation of the disease. The location of a cervical mass in the supraclavicular fossa provides a strong indication of malignancy. A biopsy is mandatory in the majority of patients presenting with a supraclavicular mass. In cases of metastatic disease, the location of a cervical mass helps identify the primary site. Histologic findings are essential for further diagnostic steps, therapy, and prognosis. 4. Laryngoscope, 128:646-650, 2018.

Unusual Presentation of Differentiated Thyroid Cancer Metastasis.

Introduction The rates of thyroid cancers are on a rise, especially well-differentiated thyroid cancers. This could be partly due to newer diagnostic modalities, like high-resolution ultrasound, that can pick up smaller lesions. Differentiated thyroid cancers with distant metastases are not common, and even rarer is the initial presentation with complaints not related to the neck. Objectives The objective of this series was to study and report the unusual cases of patients with differentiated thyroid cancer with distant metastasis. There is a lack of data in the literature on these cases, and due to the rarity of such metastases, no definite treatment protocol has been defined. Methods A retrospective chart review of 1,200 cases of thyroid surgeries was performed. A total of 10 cases of well-differentiated thyroid cancer on the final histopathology exam that had initially presented with usual complaints to departments other than the Otolaryngology Department were identified. Results A total of 6 patients had papillary carcinoma, whereas 4 patients had follicular carcinoma on final the histopathology exam. Two patients presented with iliac crest lesions, 2 with vertebral lesions one each with parapharyngeal mass, supraclavicular mass, labia majora swelling and bleeding, lung, rib and neck of femur lesion. Conclusion There are still no specific guidelines on how to address these patients with differentiated thyroid cancer with distant metastasis (except for the cases of bone and lung lesions) and on which treatment should be offered in case of recurrence. More studies on the subject are required.

Supraclavicular Metastasis from Infraclavicular Organs: Retrospective Analysis of 18 Patients

Background: Supraclavicular fossa masses have usually been malignant lesions. When fine needle aspiration biopsy results have not been satisfactory excisional biopsy of supraclavicular lymphadenopathy would be mandatory. Methods: In this study we investigated 18 patients who had supraclavicular region metastasis from infraclavicular primary sites. Results: Distant metastatic sites were mostly lung in origin. Other sites were breast, prostate, pancreas, cervix, urothelial, gastric carcinoma and pleural mesothelioma. All of our patients except the one with mesothelioma have died within one year after diagnosis of supraclavicular metastasis due to disseminated disease. Conclusions: Supraclavicular neck masses should be evaluated carefully, since they were mostly malignant in origin. Lung has been the most common origin site. Early diagnosis would be critical because supraclavicular metastasis indicates poor prognosis with decreased survival. Excisional biopsy should be performed promptly when fine needle aspiration biopsy was not diagnostic.

Cervical pseudomeningocele-induced hydrocephalus following traumatic brachial plexus injury-–a case report

Introduction: We report a case of a 49-year-old man who sustained a left brachial plexus injury and traumatic brain injury after a motor vehicle accident and subsequently developed a giant left cervical pseudomeningocele. The patient suffered multiple fractures in the cervical and thoracic ribs, transverse processes and the scapula. Physical examination revealed a giant left supraclavicular mass restricting his ability to turn his head ipsilaterally, with head tilted to the right, consistent with complete plexus avulsion. Neurological examination showed progressive muscular atrophy and a positive Tinel’s sign and paresthesias of the left hand. Methods: MRI and CT revealed a giant cervical pseudomeningocele. Left hemilaminectomy and partial medial facetectomy were performed for an extradural repair of the cyst. Three days later, the pseudomeningocele recurred; C6-T2 cervical laminectomy and a combined intra- and extradural repair of CSF leak with tensor fascia lata graft were performed. One day after the second surgery, the patient developed acute communicating hydrocephalus (CH) with progressive neurological decline. Results: Ventriculoperitoneal shunt placement successfully resolved neurological symptoms associated with CH. The patient continued receiving treatment for neuropathic pain and spams in the left upper arm at one-year follow up. Conclusion: We present one of the few documented cases of acute CH after a successful repair of a giant cervical pseudomeningocele. It is important for physicians to be aware of changes in CSF flow dynamics that occur in patients with traumatic brain injury. A repair of a large chronic pseudomeningocele can lead to acute CH in patients and cause rapid neurological decline. It is critical for clinicians to be mindful of the potential complication of acute hydrocephalus in patients who undergo repair of a large chronic pseudomeningocele secondary to trauma.

A Case Report of Complete Excision of Brachial Plexus Schwannoma: A Rare Entity

Brachial plexus schwannomas are rare benign nerve sheath tumors and only about 5% of schwannoma arise from the brachial plexus. They create a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present a case of 37 yrs female presented with a right supraclavicular mass with severe radiating pain in right hand. Further investigation was done with MRI and FNAC which turns out to be huge right brachial plexus schwannoma. Gross total resection was done without any neurological motor defi cits. Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 92-93

Adrenal malignant melanoma masquerading as a pheochromocytoma in a patient with a history of a multifocal papillary and medullary thyroid carcinoma

Adrenal masses usually represent benign and nonfunctional adrenal adenomas; however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. We present a rare case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. A 61-year-old male farmer was referred for evaluation of a mass in the right supraclavicular region and a left adrenal lesion. The patient had a history of a multifocal papillary and medullary thyroid carcinoma. Laboratory tests revealed increased 24hour urinary dopamine and also increased serum calcitonin and neuron specific enolase. A pathology report of the resected right supraclavicular mass and left adrenal showed a malignant melanoma. This is a case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. Although this case is very rare and there are rigid diagnostic criteria for the diagnosis of primary adrenal melanoma, it underlines the fact that the differential diagnosis of a dopamine secreting adrenal mass should include primary or metastatic malignant melanoma in order to determine the best diagnostic approach for the patient and select the most appropriate surgical management.

Neck metastasis of a juvenile granulosa cell tumour. A case report and literature review

Juvenile granulosa cell tumour (JGCT) is a rare tumour arising from the ovarian sex cord stroma (SCST) and comprising about 5 percent of all granulosa cell tumours. To our knowledge, a cervical metastasis has not been described before.We report a case of a 19-year-old female who had a left supraclavicular mass with a previous history of a JGCT in 2010 and an abdominal recurrence in 2011 followed by radiotherapy and chemotherapy after surgery.JGCT generally affects young women, can be hormonally active, and has malignant potential. The diagnosis is made by histopathology after surgical removal, although it should be suspected when there is a large adnexal tumour along with hyperestrogenism signs. Regional lymph nodes metastases are rare let alone extra-abdominal ones.

Aerococcus Viridians: Under-Recognized Cause of Pyomyositis

Introduction: Aerococcal infection is a rarely described pathogen in the literature. Aerococcus species may be isolated from urine, blood or other sources. Several sites of infection caused by aerococcal infection have been reported including arthritis, UTI, endocarditis and meningitis. However, to our knowledge there is not a single case of soft tissue infection caused by this germ. Case presentation: We report a case of middle aged patient with multiple comorbidities, presenting with right supraclavicular mass following chest trauma. Imaging study showed multilobulated collection involving thoracic and neck muscles and invading the clavicle. Intraoperative drainage of the pus grew exclusively Aerococcus viridens. Conclusion: Aerococcus viridans is unusual cause of soft tissue infection, but should be considered in the differential diagnosis when evaluating patients with suspected deep soft tissue infection. A. viridens infection is underestimated because of technical difficulties in the identification of this organism. The introduction of matrixassisted laser desorption ionization time-of-flight mass spectrometry carried great success in accurate identification, as early identification of the offending organism guides physicians to appropriate treatment.

Tumor after tumor in two years: A rare presentation of brain glioma, meningioma and supraclavicular meningiosarcoma

Introduction: Low-grade gliomas (LGG) and meningioma are common brain tumors but it is rare for both tumors to be diagnosed in a same patient. Furthermore, it is rare for the same patient to develop an extracranial primary or metastasis meningioma. Probably this is the first case report of a second primary with extracranial meningiosarcoma in literature. Case Report: We present a rare case of brain atypical meningioma which occurred shortly following craniotomy and radiotherapy after being diagnosed as brain glioma (diffused astrocytoma) in a 22-year-old Malay female. Tumors occurred at different sites of the brain namely the atypical meningioma at the temporal and the initial glioma at the frontal region. Subsequently, patient developed a right supraclavicular meningiosarcoma. We believe that the patient could have developed radiation-induced meningioma but the transformation period is very short. The patient's mother had history of brain tumor that added into the risk factors in this patient. However, we are unable to confirm whether the supraclavicular mass was a primary supraclavicular meningiosarcoma or metastatic meningiosarcoma progression from atypical meningioma. Conclusion: There are multiple variant revealed associations of glioma and meningioma. However, these variant could be coincidental. There is a possibility that one tumor acts locally as an irritating factor that induced another unrelated neoplasm. Relation of two or more types of cancers might lead to new therapies, provided target surveillance for cancer patients and risk factors or causal agent are identified.

Challenges of Preoperative Diagnosis and Management of Scalene Intramuscular Angioma

Intramuscular angioma of scalene muscle is rare with only five cases reported so far. Four of them have not been suspected before surgery; one was diagnosed preoperatively by core biopsy. Preoperative diagnosis is important for management. Awareness of cytologic features could help preoperative diagnosis when need of ruling out malignancy and coagulopathy make fine needle aspiration a choice. We herein demonstrate a new case of a 27 year old male with history of hepatocellular carcinoma, who presented with a 6 cm left supraclavicular mass. The fine needle aspiration was paucicellular; however, the bland ovoid to spindle cells with a whirling and luminal arrangement in the background of blood, fatty drops and degenerate muscle are suggestive of intramuscular angioma. The magnetic resonance imagines (MRI) demonstrate a T1 isointense and T2 hyperintense ill-defined lesion splaying anterior and mid scalene muscles with subtle vascular voids at periphery. These features in combination with cytology findings indicate intramuscular angioma. The pre-operative findings are correlated to the histologic picture of mixed capillaries and varying sized venues intervening with fatty tissue and atrophic muscle. Intraoperatively, the mass is adjacent to the brachial plexus rootlets, interdigitating with the scalene muscle and pushing the carotid sheath, left subclavicular artery and vein aside. Following embolization, the mass is resected with minimal bleeding. Our case suggests that scalene intramuscular angioma can be successfully managed by surgery after embolization; preoperative diagnosis rendered by cytologic features and imaging characters would aid the planning of surgery.

Pure embryonal carcinoma of testis presenting with extensive metastasis

Embryonal carcinoma is a type of non-seminomatous germ cell tumor. Pure embryonal carcinoma of testis occurs only in 3–4% cases. We present a case of 34-year-old man with aggressive clinical course. At the time of presentation, he had left testicular swelling along with supraclavicular mass with extensive metastasis to retroperitoneum, liver, and lung. On gross pathological examination, specimen showed tumor replacing entire testis with involvement of rete testis, epididymis, and spermatic cord. It is observed that many patients with a tumor composed predominantly of embryonal carcinoma have metastasis at the time of diagnosis. Embryonal carcinoma is an aggressive tumor due to its tendency to early hematogenous spread emphasizing its need for early detection and treatment. The estimation of serum tumor marker levels is not conclusive in these cases. We are presenting this case for its rarity, and advanced stage of disease with clinical and histomorphological features.

Disseminated Mycobacterium genavense infection in a patient with immunosuppressive therapy and lymphoproliferative malignancy

We present the case of a 51-year-old woman who presented a right supraclavicular mass corresponding to lymphadenitis with atypical mycobacterium (Mycobacterium genavense). Later, she developed subcutaneous purulent small nodules containing the same germ. The presence of this mycobacterium was in the context of recurrent peripheral T-cell lymphoma and immunosuppressive therapy for seronegative inflammatory polyarthritis.

Advanced carcinoma of the prostate presenting as a supraclavicular mass: Case report

Advanced carcinoma of the prostate presenting initially with supraclavicular lymphadenopathy is uncommon. These are 2 cases of advanced prostate cancer that presented initially with persistent painless left supraclavicular mass. Both patients had elevated prostate specific antigen (PSA) level. This as well as histological finding of metastatic adenocarcinoma following biopsy of the neck masses necessitated referral to the urologists. Urological review revealed enlarged hard nodular prostate and transrectal prostate biopsy findings in keeping with high grade adenocarcinoma in both cases. The patients had initial clinical and biochemical response to androgen deprivation therapy with resolution of neck masses within 4-8 weeks of treatment. The authors advocate that men presenting with persistent supraclavicular masses should have a digital rectal examination (DRE) and a PSA test as part of their initial assessment.

Multiple symmetrical lipomatosis (Madelung’s disease) : Lipomatose simétrica múltipla (doença de Madelung)

A male patient, 47 years old, white, without comorbidi-ties, alcoholic for 20 years, presented to this unit with a complaint of bulging in the bilateral supraclavicular region, painless, which had been progressively growing for the past five years.At physical examination, he showed good overall status, with bilateral supraclavicular mass of soft consistency, pain -less, measuring 10 × 6 cm to the left and 12 × 8 cm to the right (Fig. 1A). The computed tomography (CT) confirmed the presence of a symmetrical supraclavicular mass, whose density was compatible with fat (Fig. 1C). The mass was sur-gically removed, and the anatomopathological analysis of the specimen evidenced the presence of lipomatosis (Figs. 1D, 1E, 1F). To date, the patient has progressed well with-out recurrence, and outpatient follow-up has been main-tained (Fig. 1B).

Management of intrathoracic benign schwannomas of the brachial plexus.

Primary tumours of the brachial plexus are rare entities. They usually present as extrathoracic masses located in the supraclavicular region. This report describes two cases of benign schwannomas arising from the brachial plexus with an intrathoracic growth. In the first case the tumour was completely intrathoracic and it was hardly removed through a standard posterolateral thoracotomy. In the second case the tumour presented as a cervicomediastinal lesion and it was resected through a one-stage combined supraclavicular incision followed by left video-assisted thoracoscopic surgery. A brachial plexus tumour should be suspected not only in patients with a supraclavicular or cervicomediastinal mass but also in those with intrathoracic apical lesions. A preoperative magnetic resonance imaging study of brachial plexus should be performed in such cases in order to plan the correct surgical approach.

Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass

A 58-year-old woman presented with a palpable mass at the base of the left neck which she had first noticed 12 years previously, shortly after abdominal surgery. The mass had...

P3–010 - Testicular and Leptomeningeal Relapse as Myeloid Sarcoma in a Patient Initially Diagnosed with T Lymphoblastic Lymphoma

Background: T lymphoblastic lymphoma (T-LBL) is a neoplasm of lymphoblasts committed to the T-cell lineage. Although the tumor cells are usually TdT-positive, occasional cases of TdT-negative and CD99-positive T-LBL have been reported. Myeloid sarcoma (MS) is a rare subtype of acute myeloid leukemia involving extramedullary anatomic sites. It may be difficult to distinguish such a rare case of T-LBL from MS. Here we report a patient who was initially diagnosed as having T-LBL and later developed testicular and leptomeningeal recurrence as MS during intensive chemoradiotherapy including central nervous system (CNS) prophylaxis.Case reportA 48-year-old man was referred to our hospital because of a supraclavicular mass. FDG-PET/CT showed increased FDG uptake in the supraclavicular and axillary lymph nodes, and a bulky mediastinal tumor. Fine needle biopsy from the mediastinal tumor was performed. Histopathologically, diffuse infiltration of medium-sized tumor cells with scant cytoplasm and dense chromatin, which was accompanied by nuclear fragmentation, was observed. Immunohistochemistry demonstrated that the tumor cells were negative for CD1a, CD3, CD8, CD20 and TdT, and positive for CD4, CD43, CD56 and CD99. Bone marrow examination revealed no evidence of the infiltration of tumor cells. He was diagnosed as having T-LBL at clinical stage II and underwent an ALL-type chemotherapy regimen. After the induction chemotherapy, he achieved partial response, and received subsequent post-remission and CNS prophylaxis therapies according to the treatment schedule. Because he noticed painless right testicular swelling, right orchiectomy was performed for diagnosis. The flow cytometric analysis of cell suspensions of the biopsied specimen revealed positivities for CD13, CD33, CD34 and MPO, and the tumor was diagnosed as MS. Cerebrospinal fluid examination showed infiltration of myeloid blasts. We started high-dose cytarabine therapy.Conclusions: We report a rare case of testicular and leptomeningeal recurrence as MS during intensive chemoradiotherapy in a patient initially diagnosed as having T-LBL. We should take the possibility of MS into consideration in cases of T-LBL having atypical features, and we strongly recommend re-biopsy to obtain an accurate diagnosis upon relapse. Background: T lymphoblastic lymphoma (T-LBL) is a neoplasm of lymphoblasts committed to the T-cell lineage. Although the tumor cells are usually TdT-positive, occasional cases of TdT-negative and CD99-positive T-LBL have been reported. Myeloid sarcoma (MS) is a rare subtype of acute myeloid leukemia involving extramedullary anatomic sites. It may be difficult to distinguish such a rare case of T-LBL from MS. Here we report a patient who was initially diagnosed as having T-LBL and later developed testicular and leptomeningeal recurrence as MS during intensive chemoradiotherapy including central nervous system (CNS) prophylaxis. Case reportA 48-year-old man was referred to our hospital because of a supraclavicular mass. FDG-PET/CT showed increased FDG uptake in the supraclavicular and axillary lymph nodes, and a bulky mediastinal tumor. Fine needle biopsy from the mediastinal tumor was performed. Histopathologically, diffuse infiltration of medium-sized tumor cells with scant cytoplasm and dense chromatin, which was accompanied by nuclear fragmentation, was observed. Immunohistochemistry demonstrated that the tumor cells were negative for CD1a, CD3, CD8, CD20 and TdT, and positive for CD4, CD43, CD56 and CD99. Bone marrow examination revealed no evidence of the infiltration of tumor cells. He was diagnosed as having T-LBL at clinical stage II and underwent an ALL-type chemotherapy regimen. After the induction chemotherapy, he achieved partial response, and received subsequent post-remission and CNS prophylaxis therapies according to the treatment schedule. Because he noticed painless right testicular swelling, right orchiectomy was performed for diagnosis. The flow cytometric analysis of cell suspensions of the biopsied specimen revealed positivities for CD13, CD33, CD34 and MPO, and the tumor was diagnosed as MS. Cerebrospinal fluid examination showed infiltration of myeloid blasts. We started high-dose cytarabine therapy. Conclusions: We report a rare case of testicular and leptomeningeal recurrence as MS during intensive chemoradiotherapy in a patient initially diagnosed as having T-LBL. We should take the possibility of MS into consideration in cases of T-LBL having atypical features, and we strongly recommend re-biopsy to obtain an accurate diagnosis upon relapse.