Schwannoma septal, una causa infrecuente de obstrucción nasal / Septal schwannoma, an uncommon cause of nasal obstruction

Resumen Los schwannomas son neoplasias derivadas de las células de Schwann de la cubierta de los nervios periféricos. Su desarrollo en la región nasosinusal es poco frecuente, especialmente a nivel septal. Su diagnóstico diferencial es variado y debe establecerse con otras causas más habituales de masa nasal unilateral. Su tratamiento es quirúrgico. Describimos el caso de un varón de 47 años con una masa nasal derecha intervenida mediante cirugía endoscópica nasosinusal y con diagnóstico anatomopatológico de schwannoma septal.

Abstract Schwannomas are tumors that proceed from Schwann cells in the cover of peripheral nerves. It is uncommon in the sinonasal area, especially in the nasal septum. The differential diagnosis is extensive and requires contemplating other more frequent causes of unilateral nasal mass. The current treatment of septal schwannoma is surgical. We report a 47-year-old male with a right nasal mass operated by endoscopic sinonasal surgery with an anatomopathological diagnosis of a nasal septal schwannoma.

Nasal Mucoepidermoid Carcinoma after Radiotherapy: Case Report

Introduction Mucoepidermoid carcinoma (MEC) is a tumor originated from the epitheliumof the glandular excretory ducts and has highly variable biological potential. It is the most prevalent cancer of the salivary glands. The present report aims to describe a case of nasal mucoepidermoid carcinoma that developed after adjuvant radiotherapy (RT) treatment of a recurrent pituitary macroadenoma. Case Report Male patient, 62 years old, presented with recurrent nasal epistaxis on the right, associated with intense pulsatile headache, visual analogical scale (VAS) 10/10, with improvement only with the use of opioids andmorphine. After undergoing oncological screening and study by imaging exams, the presence of an expansive seal lesion with suprasellar extension was seen, involving the medial wall of the cavernous segment of the right carotid artery and the anterior cerebral artery, as well as the presence of a new expansive lesion in the right nasal cavity, with ethmoid bone invasion superiorly and medial orbit wall invasion laterally, compressing the ipsilateral optic nerve canal. Discussion Sinonasal neoplasms represent a small portion of all malignancies of the upper aerodigestive tract, accounting for<5% of these neoplasms. The development of MEC involves risk factors such as occupational issues, history of trauma and surgery involving the nasal area, and radiation exposure, as in previous RT. Conclusion Mucoepidermoid carcinoma is an uncommon neoplasia and can be associated with RT treatment, as used in cases of recurrent pituitary macroadenoma. In general, surgical resection to obtain free margins of neoplastic tissue is the aimed treatment, seeking better prognosis.

Extranodal NK/T-cell lymphoma, nasal type with extensive cardiopulmonary involvement

Extranodal NK/T-cell lymphoma, nasal type (ENKTL-NT) is a rare type of Non-Hodgkin's lymphoma, which usually presents with extranodal involvement and affects the nasal/upper aerodigestive tract in the classical presentation. Herein, we report the case of a 31-year-old, previously healthy, male patient diagnosed with ENKTL-NT with the involvement of the lung parenchyma and heart. Unfortunately, due to the rapid disease progression, the diagnosis was performed only at the autopsy. The authors highlight the rare clinical presentation of this type of lymphoma, as well as the challenging anatomopathological diagnosis in necrotic samples.

Sinonasal neoplasms in 49 dogs: clinical, macroscopic, and histopathological aspects / Neoplasmas nasossinusais em 49 cães: aspectos clínicos, macroscópicos e histopatológicos

This study aimed to quantify nasosinusal neoplasms diagnosed in dogs in 20 years (2000-2019) and characterize the main clinical, macroscopic, and histological aspects of these neoplasms. The sex, breed, age, skull conformation, the main clinical signs, and the anatomopathological characteristics (distribution, macroscopy, and histology) were computed. During this period, 49 dogs were affected by neoplasms in these regions, totaling 50 neoplasms (one dog had two neoplasms of different locations and histogenetic origins). Similar amounts of mixed-breed dogs (25/49) and purebred dogs (24/49) were affected, these distributed in 16 breeds. Among purebreds, it was noted that dogs with mesocephalic cranial conformation (12/24) were the most affected, followed by dolichocephalic (10/24) and brachycephalic (2/24). There were 22 cases in males and 27 in females, making a proportion of 1:1.23. There was an age variation from 11 months to 16 years old. The epithelial neoplasms have occurred in older dogs compared to those of other histogenic origins (mesenchymal and other origins/round cells). The main clinical signs were similar between the histogenetic categories, related to the involvement of the upper respiratory tract, sometimes accompanied by nervous signs (when there was brain invasion of nasal neoplasms or vice versa). The possible origin site was mostly in the nasal cavity concerning the paranasal sinuses (and other locations). Invasions occurred in different tissues adjacent to the nasal cavity and paranasal sinuses, resulting in cranial and facial deformities (21/49). The frequency was 48% of epithelial neoplasms, 32% of mesenchymal neoplasms, and 10% of neoplasms with other origins and round cells. The neoplasms most frequently observed, in decreasing order of frequency, were: adenocarcinoma (9/50), squamous cell carcinoma (9/50), transmissible venereal tumor (5/50), osteosarcoma (5/50), chondrosarcoma (4/50), and undifferentiated sarcoma (4/50). Through this study, it was possible to establish the frequency of these neoplasms in 20 years and their clinical, macroscopic, and histological characteristics.(AU)

Este estudo teve como objetivo quantificar os neoplasmas nasossinusais diagnosticados em cães em 20 anos (2000-2019) e caracterizar os principais aspectos clínicos, macroscópicos e histológicos desses neoplasmas. Foram computados sexo, raça, idade, conformação do crânio, principais sinais clínicos e características anatomopatológicas (distribuição, macroscopia e histologia). Nesse período, 49 cães foram acometidos por neoplasmas nessas regiões, totalizando 50 neoplasmas (um cão tinha dois neoplasmas de localização e origens histogenéticas distintas). Foram acometidas quantidades semelhantes de cães sem raça definida (25/49) e de cães com raça definida (24/49), estes distribuídos em 16 raças. Entre os cães com raça definida, notou-se que os cães com conformação craniana mesocefálica (12/24) foram os mais acometidos, seguidos pelos dolicocefálicos (10/24) e braquicefálicos (2/24). Foram observados 22 casos em machos e 27 em fêmeas, perfazendo a relação de 1:1,23. Ocorreu uma variação de idade de 11 meses a 16 anos; tendo os neoplasmas epiteliais ocorrido em cães mais velhos quando comparado aos de outras origens histogênicas (mesenquimais e outras origens/células redondas). Os principais sinais clínicos foram semelhantes entre as categorias histogenéticas, sendo relacionados ao comprometimento do trato respiratório superior, por vezes acompanhados de sinais nervosos (quando houve invasão encefálica de neoplasmas nasais ou vice-versa). O possível local de origem em sua maioria foi na cavidade nasal em relação aos seios nasais (e de outras localizações). Ocorreram invasões para diferentes tecidos adjacentes à cavidade nasal e seios paranasais, tendo como consequência deformidades cranianas e faciais (21/49). A frequência foi de 48% de neoplasmas epiteliais, 32% de neoplasmas mesenquimais e 10% de neoplasmas com outras origens e de células redondas. Os neoplasmas mais frequentemente observados, em ordem decrescente de frequência, foram: adenocarcinoma (9/50), carcinoma de células escamosas (9/50), tumor venéreo transmissível (5/50), osteossarcoma (5/50), condrossarcoma (4/50) e sarcoma indiferenciado (4/50). Com isso, pode-se estabelecer a frequência desses neoplasmas em 20 anos, bem como suas características clínicas, macroscópicas e histológicas.(AU)

Success in the use of oral propranolol in the treatment of infantile hemangioma in nasal tip - Report of two cases

Abstract Infantile hemangioma is the most common pediatric vascular tumor, with the following risk factors: low birth weight, prematurity, white skin, female gender, multiparity and advanced maternal age. The use of oral and topical beta-blockers, although recent, has emerged as the first line of treatment, with superior safety and efficacy to previously used therapies, such as corticosteroids and surgeries. This report describes two cases of nasal tip infantile hemangioma, treated with oral propranolol. Both presented excellent therapeutic responses.

Leiomiosarcoma primario de cornete nasal inferior: reporte de caso clínico y revisión de la literatura / Primary leiomyosarcoma of inferior nasal turbinate: clinical case report and literature review

Los leiomiosarcomas de la cavidad nasal y senos paranasales son neoplasias malignas de baja frecuencia, localmente agresivas. Presentan una alta tendencia a la recurrencia de aproximadamente 55% en nariz y senos paranasales. Están conformados por células musculares lisas. Según diversos autores, aproximadamente el 50% de los pacientes mueren antes del primer año y la supervivencia a los 5 años es del 20%. Anteriormente se pensaba que no poseían potencial metastásico, sin embargo, en series actuales se ha visto que presentan un alto poder metastásico de hasta el 50%. Las metástasis se presentan de forma tardía. El tratamiento recomendado consiste en la resección radical del tumor primario con un amplio margen de tejido normal y la radioterapia es de uso controversial en el manejo.

Leiomyosarcoma of the nasal cavity and paranasal sinuses are malignant, low frequency, locally aggressive neoplasm. They present a high tendency to recurrence of approximately 55% in the nose and paranasal sinuses. They are made up of smooth muscle cells. According to different authors, approximately 50% of patients die before the first year and survival at 5 years is 20%. Previously it was thought that they did not possess metastatic potential, however in current series it has been seen that they have a high metastatic power of up to 50%. Metastases present late. The recommended treatment consists of radical resection of the primary tumor with a wide margin of normal tissue.

Sinonasal organising haematoma - a little known entity / Hematoma nasossinusal em organização - uma entidade pouco conhecida

Abstract Introduction: Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation. Objective: To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used. Methods: A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed. Results: Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogeneous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease. Conclusion: Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.

Resumo Introdução: Hematoma nasossinusal em organização é uma condição inflamatória benigna rara, recentemente descrita, que se assemelha a lesões malignas em sua apresentação clínica. Objetivo: Descrever as características clínicas do hematoma em organização e analisar a evolução das opções cirúrgicas usadas com sucesso. Método: Foi feita a revisão retrospectiva dos prontuários de todos os pacientes com diagnóstico histopatológico de hematoma nasossinusal em organização. Resultados: Seis (60%) dos 10 pacientes eram do sexo masculino, com média de 47,4 anos. Todos os pacientes apresentavam doença unilateral com epistaxe recorrente como sintoma de apresentação. O seio maxilar era o mais comumente afetado. Não havia histórico de trauma em qualquer dos pacientes. Hipertensão (80%) foi a comorbidade mais comumente associada. A tomografia computadorizada dos seios paranasais com contraste mostrou opacificação heterogênea do seio com/sem erosão óssea. O exame histopatológico foi diagnóstico. A excisão endoscópica completa foi feita em todos os pacientes, resultou na resolução da doença. Conclusão: A conscientização a respeito dessa entidade clínica relativamente nova e sua avaliação e tratamento são importantes para os otorrinolaringologistas, cirurgiões buco-maxilo-faciais e patologistas. Apesar do quadro clínico de malignidade, as características histopatológicas da doença benigna podem descartar com segurança esse diagnóstico.

Melanoma mucoso nasal: una enfermedad impredecible / Mucosal melanoma of the nasal cavity: an unpredictable disease

RESUMEN El melanoma mucoso maligno es un tumor neuroectodérmico de menos del 5% de las neoplasias nasosinusales. Es un tumor de mal pronóstico clásicamente su promedio de supervivencia a cinco años es cercano al 28% y 17,5% a diez años, siendo aún peor cuando existe metástasis en cuello. Se presentan a continuación dos casos de melanoma mucoso en cavidad nasal y senos paranasales, el primero mujer 58 años con melanoma septal llevada a septotomía abierta más quimioterapia y radioterapia adyuvante, con recurrencia en cuello submaxilar derecho tratada con vaciamiento supraomohioideo actualmente sin recurrencia; el segundo hombre de 40 años con antecedente de resección melanoma septal quien presenta nuevo melanoma región etmoidal izquierda luego de su primera cirugía y es llevado a resección endoscópica transnasal sin tratamiento adyuvante por decisión del paciente.

ABSTRACT Sinonasal mucosal melanoma is a neuroectodermic tumor account less 5% of nasosinusal tumors. It has a poor prognosis with a five-year average survival near 28% and 17.5% to 10 years; if neck metastasis is even worst. Here we present two clinical cases. First one a woman 58 years old with septal melanoma who receives an open septectomy with chemotherapy and radiotherapy with submaxillary recurrence treated with supraomohyoid neck dissection. The second case, a man 40 years old with previous septal melanoma surgery who has an ethmoid sinus recurrence and receives transnasal endoscopic surgery without adjuvant therapy by patient desire.

High-risk mucosal HPV types associated with squamous cell carcinoma on the nose tip in an immunocompetent young man

Abstract: The oncogenic role of high-risk HPV in anogenital, head and neck, and cervical cancer is well recognized, but not in skin cancer in the general population. Some authors have demonstrated their appearance mainly on the hands and feet, particularly in the area of the nail bed, which could be due to contamination with HPV types from anogenital regions. Here, we describe a case of genital HPV associated with SCC on the nose tip in an immunocompetent young man, which was confirmed by histopathological findings and in situ hybridization. The importance of this report is to highlight the potential role of HPV in the etiology of skin cancer in an immunocompetent individual.

Linfoma nasal de células T/NK (granuloma letal de la línea media), una neoplasia agresiva: reporte de un caso / Nasal T/NK-cell lymphoma (lethal midline granuloma), an aggressive neoplasia: report of a case

RESUMEN El linfoma nasal de células T/NK es una neoplasia agresiva, infrecuente, con predilección por el sexo masculino. Representa el 1,5% del total de linfomas no Hodgkin, el grupo etáreo más afectado es entre 40 a 80 años. Su etiología es desconocida, pero se ha asociado con el virus de Epstein Barr. Se presenta el caso de una paciente mujer de 40 años, con dolor e induración de fosa nasal derecha asociado a secreción fétida, seropurulenta de 3 meses de evolución. Estudio histopatológico, reporta linfoma nasal de células T/NK. La paciente recibe quimioterapia, con mejoría clínica sustancial. El linfoma T/NK es una neoplasia con sintomatologia inespecífica, predominio que afecta nasofaringe, amígdalas y base de la lengua. Entre las manifestaciones encontramos dolor de garganta, obstrucción nasal, rinorrea, epistaxis y cefalea. El diagnóstico se sospecha con imágenes, pero es necesaria la confirmación histológica con marcadores de inmunohistoquímica CD45Ro, CD43, CD3, CD2, CD45Ro entre otros. Muchos casos suelen detectarse en fase tardía, cuando ya son evidentes los signos radiológicos de destrucción ósea. El diagnóstico diferencial incluye lesiones infecciosas o inflamatorias, la bola fúngica fue el diagnóstico inicial realizado en esta paciente. El tratamiento suele realizarse con radioterapia y quimioterapia.

ABSTRACT Nasal T-cell / NK lymphoma is an uncommon aggressive neoplasm with male predilection. It represents 1.5% of the total number of non-Hodgkin's lymphomas, the most affected age group is 40-80 years. Its etiology is unknown but has been associated with the Epstein Barr virus. We present the case of a female patient of 40 years, with pain and induration of the right nostril associated with fetid secretion, seropurulent of 3 months of evolution. Histopathological study, reports T-cell / NK nasal lymphoma. The patient receives chemotherapy, with substantial clinical improvement. T / NK lymphoma is a neoplasm with predominant non-specific symptomatology, affecting the nasopharynx, tonsils and base of the tongue. Among the manifestations we find sore throat, nasal obstruction, rhinorrhea, epistaxis and headache. Diagnosis is suspected with imaging, but histological confirmation with immunohistochemical markers CD45Ro, CD43, CD3, CD2, CD45Ro, among others is required. Many cases are usually detected in the late phase, when radiological signs of bone destruction are already visible. The differential diagnosis includes infectious or inflammatory lesions, the fungal ball was the initial diagnosis made in this patient. Treatment is usually done with radiotherapy and chemotherapy.

Nasal-type extranodal T-cell/NK lymphoma in association with hemophagocytic syndrome

Abstract: Extranodal NK/T-cell lymphoma nasal type is a rare disease that mainly affects the nasal cavity and paranasal sinuses of males in the fifth decade of life. It has aggressive and locally destructive behaviour, and can be complicated by the hemophagocytic syndrome, conferring high lethality to the disease. This article describes a case of NK/T-cell lymphoma nasal type in a previously healthy patient, exemplifying its rapid and fulminant course.

Tumores nasales congénitos de la linea media / Congenital nasal tumors of the midline in ENT

Las masas nasales congénitas de la línea media se presentan con una frecuencia muy baja ­1/20.000 a 1/40.000 nacidos vivos­. Se trata de hallazgos asintomáticos en el recién nacido y son resultado de anomalías congénitas del desarrollo embrionario, que suelen aparecer como masas en la línea media nasal en un punto cualquiera entre glabela y columela. Estas tumoraciones presentan un riesgo elevado de extensión al sistema nervioso central, lo que es especialmente importante tener en cuenta para prevenir consecuencias tales como la fístula de líquido cefalorraquídeo y/o la aparición de meningitis recidivante. Existen gran cantidad de tumores nasales de la línea media que aparecen en el recién nacido o en el lactante y que constituyen diagnósticos diferenciales de las lesiones congénitas antes descriptas. Describiremos brevemente los más frecuentes según nuestra experiencia. AU

Congenital nasal masses of the midline are very rare ­ 1/20,000 to 1/40,000 live births ­. Nasal tumors are asymptomatic findings in the neonate and are caused by congenital abnormalities during fetal development, usually appearing at the nasal midline between the glabella and columella. These tumors are associated with a high risk of extension to the central nervous system; therefore, it is especially important to prevent the development of a cerebrospinal fluid fistula and/or recurrent meningitis. There is a large number of nasal tumors of the midline in neonates or infants in the differential diagnosis of the above-described congenital lesion. Here we briefly describe the most common nasal tumors seen at our department. AU

What does the 4th edition of the World Health Organization Classification of Head and Neck Tumors (2017) bring new about mucosal melanomas?

Abstract: The recently published 4th Edition of the World Health Organization Classification of Head and Neck Tumors addresses the most relevant and updated aspects of tumor biology, including clinical presentation, histopathology, immunohistochemistry, and prognosis of head and neck tumors. The objective of the present study is to compare these updates to the 3rd edition of that book with regard to mucosal melanomas and to highlight the potential factors that differ those tumors from cutaneous melanomas. We observed progress in the understanding of oral and sinonasal mucosal melanomas, which also present themselves, in the molecular scope, differently form cutaneous melanomas.

Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

Linfoma T/NK extraganglionar tipo nasal: caso clínico / Extranodal T/NK-Cell lymphoma nasal type: clinical case

El linfoma T/NK extraganglionar tipo nasal es un linfoma extraganglionar, habitualmente expresa el fenotipo NK y VEB positivo. Cursa ocasionando necrosis y angioinvasión afectando de manera preferente estructuras mediofaciales. Característicamente es muy agresivo. Presentamos un caso con una sobrevida de siete meses a partir de los primeros síntomas y realizamos revisión de la literatura.

Extranodal NK/T-cell lymphoma nasal type, is an extranodal lymphoma, usually with an NK-cell phenotype and EBV possitive. It causes necrosis and angioinvasion, and it is most commonly presenting in the midfacial area. Characteristically it is very aggressive. A case with survival of seven months from the first symptoms is reported and a review of the literature is made.

Schwannoma nasal / Nasal Schwannoma

Introdução: O Schwannoma é uma neoplasia benigna com origem nas células de Schwann presentes na bainha de nervos autossômicos periféricos. Localiza-se cranial ou extracranial. Na cabeça e pescoço constitui 30 a 45% dos casos extracraniais, sendo que 4% deles estão localizados no nariz e seios paranasais. Relato do caso: Paciente feminina, 37 anos, realizou tomografia de crânio após queda para investigar trauma cranioencefálico. Esta identificou velamento de seios paranasais à esquerda. O achado motivou a investigação da hiposmia e obstrução nasal à esquerda de longa data. À rinoscopia anterior, observou-se lesão expansiva polipoide ocupando a fossa nasal, não permitindo a passagem do nasofibroscópio. Tomografia computadorizada evidenciou lesão ocupando totalmente a fossa nasal esquerda, velamento do seio maxilar e células etmoidais anteriores e posteriores à esquerda. Realizou-se exérese endoscópica da lesão, que tinha provável origem no recesso esfenoetmoidal. A biópsia transoperatória com congelação observou lesão inflamatória. A confirmação do diagnóstico de Schwannoma foi feita pelo anatomopatológico e imuno-histoquímica, que evidenciou alta reatividade à proteína S-100. Discussão: As lesões intranasais unilaterais apresentam inúmeras possibilidades diagnósticas. Os sintomas são inespecíficos e os exames de imagem pouco esclarecedores. Neste relato, a tomografia sugeriu pólipo de Killian ou papiloma invertido pela unilateralidade da lesão. Porém, as características histopatológicas e a imunorreatividade à proteína S-100 auxiliaram na confirmação diagnóstica. Conclusão: O Schwannoma intranasal faz parte do diagnóstico diferencial das lesões intranasais. O exame histopatológico e a imunohistoquímica são de extrema importância para confirmação diagnóstica frente à inespecificidade dos sintomas e achados radiológicos (AU)

Introduction: Schwannoma is a benign neoplasm originating in the Schwann cells present in the sheath of peripheral autosomal nerves. It is located cranially or extracranially. In the head and neck it comprises 30 to 45% of extracranial cases, 4% of which located in the nose and paranasal sinuses. Case report: A 37-year-old female patient underwent skull tomography after a fall to investigate cranioencephalic trauma. This identified veiling of paranasal sinuses on the left. The finding motivated the investigation of long-standing hyposmia and nasal obstruction on the left. At anterior rhinoscopy, an expansive polypoid lesion occupying the nasal fossa was observed, not allowing the nasofibroscope to pass. Computed tomography revealed a lesion totally occupying the left nasal fossa, maxillary sinus veil, and anterior and posterior ethmoid cells on the left. Endoscopic excision of the lesion that was likely to originate in the sphenoethmoidal recess was performed. Intraoperative biopsy with freezing showed an inflammatory lesion. Confirmation of the Schwannoma diagnosis was made by pathology and immunohistochemistry that showed high reactivity to S-100 protein. Discussion: Unilateral intranasal lesions present numerous diagnostic possibilities. The symptoms are nonspecific and imaging exams are not very elucidating. In this report, CT scan suggested a Killian polyp or inverted papilloma due to the unilaterality of the lesion. However, the histopathological characteristics and immunoreactivity to the S-100 protein aided in the diagnostic confirmation. Conclusion: Intranasal Schwannoma is part of the differential diagnosis of intranasal lesions. Histopathological examination and immunohistochemistry are extremely important for diagnostic confirmation in the face of the non-specificity of symptoms and radiological findings (AU)

Malignant melanoma with synchronous thyroid metastases: case report and literature review

SUMMARY Thyroid metastases are rare in clinical practice. We describe the case of an 85-year-old woman who was referred to our department due to a multinodular goiter with compressive symptoms and subclinical hyperthyroidism. The patient was also undergoing evaluation for a polyp in her left nasal cavity, which was then diagnosed as a malignant melanoma of the nasal mucosa. A thoracoabdominal magnetic resonance imaging obtained for cancer staging revealed a > 50% tracheal obstruction caused by the goiter. The patient underwent simultaneous total thyroidectomy and melanoma excision. Histological analysis of the thyroid showed the presence of multiple metastatic foci from the melanoma. Due to the patient’s age, a decision was made to maintain her under surveillance and administer palliative treatment if necessary. Although metastases to the thyroid are rare, they should be considered in the differential diagnosis of thyroid lesions in patients with a known primary tumor. The thyroidectomy, performed in this patient’s case, allowed the diagnosis of the metastases and relief of compressive symptoms caused by the goiter.