Multiple Trichoepitheliomas: A Disfiguring Lesion Successfully Treated with Excision and Skin Grafting.

BACKGROUND: Multiple trichoepitheliomas are rare benign adnexal tumours that present a unique challenge both to the patient and the managing physician. The multiple nature of the lesion and face being a common location often causes cosmetic concern and psychosocial challenges. Physicians on the other hand face the challenge of providing an ideal treatment with a satisfactory outcome. Dermabrasion and laser therapy have been used to treat this lesion successfully, though they require multiple sessions, and recurrence is common. These options are however either not available or unaffordable in low-resource countries such as Nigeria. Surgical excision though an option, has rarely been advocated due to scarring, leading some experts to offer no treatment at all in developing nations. We report a challenging case of sporadic multiple trichoepitheliomas successfully treated with surgical excision and full-thickness skin graft. METHOD: Following diagnosis, the patient was counselled on the procedure, the risks and benefits. She had en-bloc excision of the lesion, and full-thickness skin graft harvested from the right groin was transplanted and anchored with Monocryl 5-0. All wounds were dressed, and the graft site was reviewed on day 10. She was discharged for outpatient follow-up. RESULT: Graft take was 95%. Epidermolysis which was seen on postoperative day 10 resolved. Hypertrophic scar on the ala nasi is softening on scar massage, and the patient is very satisfied with the outcome. CONCLUSION: Surgical excision can be a valuable tool in low-resource settings for the management of multiple trichoepitheliomas.

CONTEXTE: Les trichoépithéliomes multiples sont des tumeurs annexielles bénignes rares qui présentent un défi unique à la fois pour le patient et le médecin traitant. La nature multiple de la lésion et le visage étant un site commun entraînent souvent des préoccupations esthétiques et des défis psychosociaux. Les médecins, de leur côté, sont confrontés au défi de fournir un traitement idéal avec un résultat satisfaisant. La dermabrasion et la thérapie au laser ont été utilisées avec succès pour traiter cette lésion, bien qu'elles nécessitent plusieurs séances et que la récidive soit fréquente. Ces options ne sont cependant pas disponibles ou abordables dans les pays à faibles ressources tel que le Nigeria. L'exérèse chirurgicale, bien qu'une option, a rarement été préconisée en raison des cicatrices, conduisant certains experts à ne proposer aucun traitement du tout dans les pays en dével oppement . Nous rappor tons un cas difficile de trichoépithéliomes multiples sporadiques traités avec succès par exérèse chirurgicale et greffe de peau totale. MÉTHODE: Après le diagnostic, la patiente a été informée de la procédure, des risques et des avantages. Elle a subi une exérèse en bloc de la lésion, et une greffe de peau totale prélevée dans l'aine droite a été transplantée et fixée avec du Monocryl 5-0. Toutes les plaies ont été habillées, et le site de la greffe a été examiné le 10e jour. Elle a été renvoyée pour un suivi en consultation externe. RÉSULTAT: La prise de greffe était de 95 %. L'épidermolyse observée le 10e jour postopératoire a disparu. La cicatrice hypertrophique sur l'aile du nez s'assouplit avec le massage de la cicatrice, et la patiente est très satisfaite du résultat. CONCLUSION: L'exérèse chirurgicale peut être un outil précieux dans les contextes à faibles ressources pour la prise en charge des trichoépithéliomes multiples. MOTS-CLÉS: Trichoépithéliomes multiples, Thérapie au laser, Électrocautérisation, Exérèse chirurgicale, Greffe de peau totale.

Juvenile Nasopharyngeal Angiofibroma: A Case Study on the Diagnostic and Surgical Challenges in an Adolescent Male.

A rare and locally aggressive vascular tumor, juvenile nasopharyngeal angiofibroma (JNA) mostly affects male teenagers. This paper describes a 14-year-old male patient who presented with lethargy and recurrent nasal bleeding, which are symptoms of JNA. CT and MRI scans confirmed a vascular mass with a significant local invasion originating from the sphenopalatine foramen. After a CT angiography, which revealed the tumor's large blood supply and helped with efficient excision, a focused surgical strategy was designed. Histopathology verified the benign nature of the tumor, and the operation was successful and the patient had a smooth recovery. This case adds to the little literature on JNA. It highlights the need for healthcare professionals to be aware of the requirement of early identification and careful presurgical preparation in managing the illness.

A Large Pilar Sheath Acanthoma of the Cheek Successfully Treated With Surgical Excision.

This case report describes an atypically large pilar sheath acanthoma (PSA) presenting on a patient's cheek. Due to the bothersome nature of the lesion, the patient underwent surgical excision, with subsequent histopathological analysis confirming the diagnosis of an unusually large PSA. In addition to a definitive diagnosis, surgical excision provided symptomatic relief for the patient.

Sinonasal Carcinoma Presenting with Proptosis and Visual Impairment: A Case Report.

Sinonasal carcinoma is a rare but aggressive malignancy arising from the nasal cavity and paranasal sinuses. We present a case of a 40-year-old female who presented with a three-month history of headache, diminution of vision, and proptosis. Imaging studies revealed soft tissue density with bony erosion and extraconal extension in the left orbit. Histopathological examination confirmed sinonasal carcinoma with anaplastic changes. The patient underwent surgical excision of the tumor and received post-operative care in the neuro-ICU. Her visual acuity improved post-surgery, and she was discharged with stable neurological status. This case highlights the challenges in the diagnosis and management of sinonasal carcinoma and underscores the importance of multidisciplinary care for optimal outcomes. Early diagnosis and intervention are crucial in preventing complications and achieving favorable outcomes in patients with this aggressive malignancy.

A rare case of hibernoma in the posterior thigh of an elderly patient: A surgical case report.

INTRODUCTION AND IMPORTANCE: Hibernoma is a rare benign adipose tumor that arises from brown fat. Often misdiagnosed as liposarcoma, hibernomas require biopsy and histopathological examination for accurate diagnosis. This case report presents an unusual instance of hibernoma located in the posterior thigh of an elderly patient, emphasizing the diagnostic challenges and surgical management involved. CASE PRESENTATION: We report the case of Mrs. F.D., a 70-year-old woman with a history of ovarian cyst surgery 17 years prior, who presented with a mass in the posterior left thigh. The mass had been developing over two years and was hard, painless, and measured 7 × 12 cm. Initial imaging suggested liposarcoma; however, an MRI revealed a 9 × 19 cm mass with heterogeneous tissue characteristics. A surgical biopsy confirmed the diagnosis of hibernoma. The tumor was excised completely, and histological examination showed typical features of hibernoma. CLINICAL DISCUSSION: Hibernomas, although rare, should be considered in the differential diagnosis of soft tissue masses. Imaging techniques such as MRI are essential, but definitive diagnosis relies on histopathology. Surgical excision is the treatment of choice, requiring meticulous technique to manage the hypervascular nature of the tumor. CONCLUSION: This case underscores the importance of considering hibernoma in differential diagnoses and highlights the role of biopsy for accurate diagnosis. Complete surgical excision is crucial to prevent recurrence. Further research is needed to better understand the pathogenesis and optimal management of hibernomas.

A Rare Case of a Pedunculated Lipoma in the Perianal Region: A 20-Year Journey.

Lipomas are common benign soft tissue tumors, typically presenting as painless, slow-growing masses of mature adipose tissue. However, their occurrence as pedunculated lesions in the perianal region is rare. We present a case of a 70-year-old male with a 20-year history of a painless, cosmetically concerning mass in the perianal region. Clinical examination and ultrasonographic findings were consistent with a pedunculated lipoma. Surgical excision was performed successfully, and histopathological examination confirmed the diagnosis of lipofibroma. This case highlights the importance of considering unusual presentations of lipomas in the differential diagnosis of perianal masses. It emphasizes the role of surgical excision for symptomatic or cosmetically concerning lesions. Long-term follow-up is essential to monitor for recurrence and ensure optimal patient outcomes.

Epidemiological Trends and Clinicopathological Characteristics of Oral Leukoplakia: A Retrospective Analysis From a Single Institution in Chennai, Tamil Nadu, India.

Background India has a high prevalence of oral potentially malignant disorders and malignant transformation. Cases of oral leukoplakia are not commonly encountered, and only a small cohort of patients undergo biopsies for the same. This study aims to assess the various etiological factors causing leukoplakia, the clinical features, histopathological findings, and treatment received by the patients who were histopathologically diagnosed with oral leukoplakia. Methodology Oral leukoplakia cases were included in this study from total biopsy samples received in the oral pathology department. Details were collected from the Dental Information Archival Software of our institution. The period analyzed was from January 1, 2021, to December 31, 2023. Relevant clinical and histopathological details were retrieved and tabulated. Statistical analysis (chi-square test) was used to assess the association between the clinicopathological parameters using SPSS software version 21.0 (IBM Corp., Armonk, NY, USA) with a significance level set at a p-value <0.05. Results A total of 76 oral leukoplakia cases were retrieved from 2,600 biopsy samples. The prevalence of oral leukoplakia was 3.1% to 3.4% for the three years. Leukoplakia was commonly observed in those aged 51 to 60 years (33%). Overall, 21% of the patients with leukoplakia showed severe epithelial dysplasia, 22% showed mild epithelial dysplasia, and 39% showed moderate epithelial dysplasia. Moreover, 30% of the patients presented with leukoplakia and oral submucous fibrosis and showed varying degrees of epithelial dysplasia. Finally, 45% of the patients were managed conservatively using pharmacotherapy. Conclusions Severe epithelial dysplasia was commonly associated with oral leukoplakia. Oral submucous fibrosis was also found to be associated with leukoplakia and showed epithelial dysplasia. None of our proliferative verrucous leukoplakia cases showed any association with oral submucous fibrosis. Surgical management was the preferred treatment.

Excision of a Giant Cell Tumor With Bone Grafting and Bone Cementing of the Proximal Humerus: A Case Report.

Giant cell tumors (GCTs) of the bone are uncommon neoplasms that predominantly affect the metaphysis of long bones, with proximal humerus involvement being less frequent. We present the case of a 58-year-old male who presented with a two-month history of progressive right shoulder pain and difficulty in raising his arm. Clinical examination revealed a palpable swelling on the lateral aspect of the right arm. Radiological investigations, including X-ray and magnetic resonance imaging (MRI), confirmed the presence of a primary osseous neoplasm involving the proximal humerus, suggestive of a GCT. The patient underwent surgical excision of the tumor with bone grafting and bone cementing of the proximal humerus. Post-operative care included prescribed medications and physiotherapy. This case highlights the successful management of GCTs of the proximal humerus through a multidisciplinary approach, emphasizing the importance of meticulous surgical technique, appropriate reconstruction, and comprehensive post-operative care for optimal patient outcomes.

Multiple cutaneous granular cell tumors involving the shoulder and foot in a child; a rare case report.

Granular cell tumors are rare soft tissue neoplasms derived from Schwann cells and are characterized by their infiltrative, non-encapsulated nests and sheets of polygonal cells with fine eosinophilic cytoplasmic granules on histology. Herin, we report a case of a 10-year-old Saudi female who presented to the hospital with multiple asymptomatic skin lesions, the largest located on the right shoulder and left foot. Preoperative workup revealed the absence of liver metastasis, and the patient underwent complete surgical excision successfully. Histopathology revealed ill-defined proliferation of large bland cells with prominent eosinophilic granular cytoplasm and mild epithelial hyperplasia consistent with granular cell tumors. Granular cell tumors are a rare entity that represent only 0.5% of all soft tissue tumors. They have characteristic histological features and can present with both malignant and being features. Due to the rarity of this disease, further research is needed to enhance our understanding and improve recognition in future practice.

De-escalating indications for excision when breast core needle biopsy returns fibroepithelial lesion-not further characterized.

PURPOSE: Surgical excision is often performed to exclude phyllodes tumor (PT) when Core Needle Biopsy (CNB) of the breast returns fibroepithelial lesion-not further characterized (FEL-NFC). If imaging or CNB pathology features can be identified that predict a very low probability of borderline/malignant PT, thousands of women could be spared the expense and morbidity of surgical excisions. METHODS: This retrospective cohort study includes 180 FEL-NFC from 164 patients who underwent surgical excisional biopsy. RESULTS: The upgrade rate from FEL-NFC to benign PT was 15%, and to borderline/malignant PT 7%. Imaging features predicting upgrade to borderline/malignant PT included greater size (p = 0.0002) and heterogeneous echo pattern on sonography (p = 0.117). Histologic features of CNB predicting upgrade to borderline/malignant PT included "pathologist favors PT" (p = 0.012), mitoses (p = 0.014), stromal overgrowth (p = 0.006), increased cellularity (p = 0.0001) and leaf-like architecture (p = 0.077). A three-component score including size > 4.5 cm (Size), heterogeneous echo pattern on sonography (Heterogeneity), and stromal overgrowth on CNB (Overgrowth) maximized the product of sensitivity x specificity for the prediction of borderline/malignant PT. When the SHO score was 0 (72% of FEL-NFC) the probability of borderline/malignant PT on excision was only 1%. CONCLUSION: The combination of size ≤ 4.5 cm, homogeneous echo pattern, and absence of stromal overgrowth is highly predictive of a benign excision potentially sparing most patients diagnosed with FEL-NFC the expense and morbidity of a surgical excision.

Surgical Triumph Over Huge Nontraumatic Myositis Ossificans of the Gluteal Region in an Epileptic Patient With History of Stroke: A Case Report.

Myositis ossificans (MO) is a benign condition where bone forms within muscles due to increased activity of the periarticular tissues. Trauma is the most common cause. Nontraumatic MO is exceedingly rare. We present a rare instance of nontraumatic MO affecting the hip in a 32-year-old patient. The patient had a known case of seizure disorder and also had a history of a cerebrovascular accident (CVA). Despite the absence of trauma or known predisposing factors, the patient developed a sizable mass in the left hip, causing pain and restricted range of motion (ROM). Surgical excision of the mass was successful, resulting in complete removal and subsequent improvement in hip function and pain relief during postoperative recovery. Histopathological examination confirmed the diagnosis of MO. The patient's ROM normalized, and there were no signs of recurrence at the one-year follow-up. This case highlights the importance of recognizing MO in hip pain cases without trauma. Timely surgery through the approach described effectively removes the mass, preventing recurrence without compromising vital structures. It showcases a successful multidisciplinary approach for rare musculoskeletal conditions, offering valuable insights into similar cases.

A Child Plexiform Neurofibroma of the Temple Region: A Case Report.

Plexiform neurofibroma is a rare variant of neurofibromatosis type 1. Diagnosis is challenging due to the highly variable clinical presentation. Early diagnosis is essential for appropriate treatment and prevention of complications. This report describes a sporadic solitary plexiform neurofibroma in the temporal region of a seven-year-old girl. The growth of the mass began at birth and grew steadily over five years. Subsequently, the mass began to expand rapidly. The patient underwent complete surgical resection under general anesthesia. Histopathological examination revealed a plexiform neurofibroma. In conclusion, surgical excision is the gold standard for cases with symptomatic, visible, large superficial lesions.

Atypical Giant Lipoma in the Left Lower Abdomen: A Case Study.

In the present case report, we discuss a case of an uncommon giant lipoma in the left lower abdomen of a 55-year-old female. The case is presented to highlight the need to consider lipoma as one of the possibilities in cases with subcutaneous masses. Despite its abnormal location and considerable magnitude, surgical excision under short general anesthesia resulted in successful outcomes without immediate complications. Finally, by comparing with similar circumstances, it is possible to recognize that individualized management strategies based on patient characteristics can benefit surgical considerations. The significant message is that timely intervention, comprehensive assessment, and teamwork are essential in achieving satisfactory outcomes among patients with rare cases of lipomas, such as this one.

A Rare Case of Rhabdosarcoma on the Upper Pole of the Kidney.

Rhabdomyosarcoma arising from the upper pole of the kidney is an exceedingly rare occurrence, with only a few documented cases reported in the literature. Here, we present a case of a one-year-old Indian male child diagnosed with rhabdomyosarcoma localized to the upper pole of the kidney. The patient presented with abdominal distension persisting for three days, and imaging studies revealed a mass consistent with renal sarcoma. Surgical excision was performed, followed by histopathological examination confirming the diagnosis of rhabdomyosarcoma. Despite aggressive management, the patient's prognosis remains guarded due to the disease's aggressive nature. This case highlights the importance of considering rhabdomyosarcoma in the differential diagnosis of renal masses, particularly in atypical locations. Early diagnosis and a multimodal treatment approach are crucial for optimizing outcomes in such rare cases.

Reconstructive surgery for mycetoma: Preliminary algorithm and a systematic review.

Background: Surgical treatments of mycetoma are a cornerstone in management. However, while doing a wide surgical excision of mycetoma lesion, surgeons think about how to close the skin defect, which can be closed primarily, left to heal by secondary intension, by skin grafts or local flaps. In this review, we demonstrate the various applications and changes of mycetoma reconstruction after surgical excision. Methods: This is a systematic literature search and review conducted to determine articles presenting mycetoma reconstruction options. Articles were identified, and the time of publication, type of study, time of study, and country of study were checked. Additionally, all patients in those articles were included. Patients' names, sex, clinical presentation, and management were identified. Results: A total number of 9 articles fulfilled our inclusion criteria; 8 of them are case reports, and 1 is a case series. The first mycetoma reconstruction case was published in 1959. The country of publication varies from tropical and non-tropical countries. The total number of patients found in those articles is 34 patients, most of whom are male. The causative organism is mainly eumycetoma. The site of mycetoma lesions is varied with variable sizes. The reconstruction options used were skin graft and local or regional flaps, where only 1 case underwent a free flap for reconstruction. Conclusion: Reconstruction of mycetoma should be considered following mycetoma surgery in small or large size defects if skin closure is not feasible and there is no indication for amputation.

Lingual osteoma presenting as a solitary painless lesion: Report of a rare case with review of the literature.

Lingual osteoma, a rare, benign bone tumor that primarily affects the posterior tongue, can be difficult to diagnose. This study aims to report a case of osteoma affecting the tongue in a 17-year-old female. The patient had a foreign body sensation and a progressively growing lesion for 3 years and underwent clinical examination and diagnostic procedures. A well-defined, smooth-surfaced, white mass was discovered in the posterior third of the tongue. The 1.5 × 1 × 0.4 cm mass was completely excised under local anesthesia and histopathologically confirmed as a benign lingual osteoma. The 2-month post-operative outcome was uneventful. The rarity of lingual osteoma, as well as the fact that it is often asymptomatic, makes diagnosis difficult. The diagnosis entails a proper clinical examination, imaging studies, and histopathological analysis. Surgical intervention, primarily aimed at complete excision while preserving tongue function, remains the primary treatment option. Successful excision entails educating healthcare professionals about this rare benign bony tumor to ensure the best possible patient outcomes.

Assessment of Knowledge and Awareness Levels of Lipoma and Simple Surgical Excision Among Adults in Makkah Region, Saudi Arabia.

Background Lipoma is a soft tissue tumor primarily composed of fat cells. These slow-growing, painless, subcutaneous nodules can occur in any place in the body where fat is present. Our study aims to assess the awareness, knowledge, and attitudes of Makkah region inhabitants regarding lipomas and the surgical excision method. Methodology This study used a cross-sectional methodology to evaluate the general public's knowledge regarding lipomas and the surgical excision method using a self-administered questionnaire in the Makkah region from January to April 2024. Results A total of 367 participants were included, with the majority (56.10%) aged between 18 and 29 years. The survey revealed that 48.50% had heard about lipomas, 42.80% lacked any knowledge about them, and 26.70% acquired their information via social media. Furthermore, 31.60% believed it to affect both genders equally, 46.60% admitted uncertainty, 20.40% correctly identified that lipomas can occur at any age, and 39.80% were uncertain. Overall, 57.20% correctly identified lipomas as benign tumors composed of fat cells. Opinions diverged on whether lipomas cause pain, with 46.90% being uncertain. Moreover, 25.90% of respondents thought that surgery was the sole option for removing a lipoma, while 38.10% recognized the risk of lipoma recurrence after surgical removal. Overall, 85.60% reported never being diagnosed with a lipoma, while 4.10% had been diagnosed, predominantly with single lipomas 6.00%. There were significant differences in the participants' marital status, with widowed people exhibiting the greatest awareness level, followed by single people. Conclusions Our study findings indicate a moderate level of awareness about lipomas among residents of the Makkah region. However, there are significant gaps in understanding various aspects of lipomas, including their characteristics, treatment options, and demographic distribution.

Peripheral Ossifying Fibroma: A Case Report.

Peripheral ossifying fibroma (POF) is a reactive overgrowth that most commonly occurs on the gingiva. It is a benign oral soft tissue tumour. It is most commonly found on the anterior maxilla and has a female predilection. Most commonly found to occur in the second decade of life. This type of lesion originates from the cells of the periodontal ligament. It is often associated with trauma or local irritants, such as subgingival plaque and calculus, dental appliances and poor-quality dental restorations. This entity requires a proper treatment protocol and a regular follow-up. It can cause significant discomfort and irritation in the oral health if left untreated. The recurrence rate of the lesion varies according to the authors. This case report describes a case of POF in an adult female patient which was treated using surgical excision resulting in an uneventful healing during the post-operative period.

Mucoepidermoid carcinoma of the hard palate mimicking a dental abscess: Case report.

Mucoepidermoid carcinoma is a malignant tumor that arises from the salivary glands. The recommended treatment strategy typically involves surgical intervention, sometimes complemented by radiotherapy, depending on the histological grade of the tumor. A case of a 22-year-old female patient without medical history was described. The clinical examination revealed a bluish lesion located on the hard palate. The histological examination confirmed the diagnosis of a low-grade mucoepidermoid carcinoma. Resection of the lesion was performed and oro-nasal communication was immediately closed by a prosthetic obturator and later on by a rotational palate flap. The patient was followed up for 12 months, and there was no evidence of any recurrence. This article highlights the importance of prompt clinical diagnosis of such lesions and provides an opportunity to review these cancer therapeutic measures to reduce postoperative morbidity.