Superficial malignant schwannoma of the scalp

Scalp ulcers - differential diagnoses that should be sought!

BACKGROUND

Ulceration of the scalp is an uncommon clinical presentation, and it may be caused by myriads of cutaneous etiologies such as infections, inflammatory disorders, and malignancies. We sought to reveal the underlying etiology of scalp ulcers referred to our tertiary wound healing clinic; we would also like to propose a classification for scalp ulcerations.

METHODS

A retrospective study was conducted in an academic tertiary wound healing clinic between January 2015 and June 2018. The study was approved by the Women's College Hospital Institutional Research Ethics Board. We have also conducted a review of the literature to recognize the major causes of scalp ulceration reported in the literature.

RESULTS

We have identified a total number of 15 patients with scalp ulceration. Twelve patients with atypical scalp ulcers underwent a skin biopsy. A malignancy rate of 73% (11/15) was diagnosed histologically. The review of the literature showed 237 articles. After screening the title and the abstracts, we have selected 41 case reports for the full text review.

CONCLUSION

Scalp ulcers are uncommon but important. Our sample study indicates the high frequency of malignant etiologies presenting as scalp ulcers. These results emphasize not only the need for clinicians to be on the watch for the possibility of this option but rather highlights the need for early biopsy to prevent further complications. We hope that our paper helps to shed some light on this topic and guide clinicians on how to approach scalp ulceration.

Malignant peripheral nerve sheath tumors of the head and neck: a case series and literature review

Background. Malignant peripheral nerve sheath tumors (MPNSTs) of the head and neck are rare aggressive neoplasms with a poor prognosis. This study describes the management and outcomes of 3 of our patients with MPNSTs of the head and neck. Methods. We identified 3 patients presenting with MPNST of the head and neck and treated at the University of North Carolina. We compared our results to the literature from 1963 to 2014. Results. Mean follow-up was 31 months. Average age at diagnosis was 44.7 years of age. All patients received wide-local excision and adjuvant radiotherapy. No patients recurred during the series. Recurrence-free survival time for the patients was 45, 37, and 3 months, respectively. Conclusions. Our data series confirms that a combined-modality approach with complete surgical resection and adjuvant radiotherapy leads to improved outcomes in MPNSTs of the head and neck. Nonetheless, due to historically poor outcomes, continued research into newer therapies needs to be explored.

Microsurgical management of giant malignant peripheral nerve sheath tumor of the scalp: two case reports and a literature review

Malignant peripheral nerve sheath tumors of the scalp are rare lesions of the nervous system. Only 14 cases have been reported to date. The field of neurosurgery has struggled with diagnosing and treating these tumors. In this report, we present two cases of giant malignant peripheral nerve sheath tumors of the scalp and retrospectively analyze the clinical features, imaging findings, pathological features, and prognoses of these two patients. Each underwent microsurgery and radiotherapy. In addition, based on a literature review, we discuss the diagnostic and therapeutic strategies used to treat these unusual lesions.

Cutaneous schwannoma masquerading as trichilemmal cyst over scalp in a young male

Schwannomas are benign tumors derived from Schwann cells. They are comparatively rare on scalp and easily mistaken for tumors of hair. Trichilemmal cysts are common over scalp and present as dermal or subcutaneous growths over scalp. We present a solitary schwannoma of scalp clinically mimicking trichilemmal cyst. The tumor was surgically excised and the same was confirmed by histopathology.

Diffuse scalp malignant peripheral nerve sheath tumor with intracranial extension in a patient with neurofibromatosis type 1

We describe a rare scalp malignant peripheral nerve sheath tumor (MPNST) with cranial destruction and intracranial extension in a 52-year-old male with neurofibromatosis type 1 (NF1). The scalp tumor measured 22cm×18cm, with local surface ulceration. Skin examination revealed many café-au-lait spots and small, hard dermal nodules on the trunk. CT scans revealed the scalp tumor to have heterogeneous density with partial destruction of the right parietal cranium; on T1-weighted MRI the scalp tumor displayed heterogeneous hypointensity, whereas on T2-weighted and fluid-attenuated inversion recovery MRI it was hyperintense. The tumor was excised totally and the scalp reconstructed using a skin flap isolated from the lateral aspect of the left thigh. Histological examination confirmed that the tumor was an MPNST. The patient recovered uneventfully and was well at the 6-month follow-up, with no local or other tumor recurrence noted.

Primary malignant peripheral nerve sheath tumour in the temporalis muscle

INTRODUCTION

Primary malignant neoplasms of nerve sheath origin are rare, highly aggressive tumours that account for no more than 5% of all soft tissue sarcomas. In the head and neck where the great majority of peripheral nerve neoplasms are benign, as in the rest of the body, malignant peripheral nerve sheath tumours (MPNSTs) are unusual lesions.

PATIENT

A case of a large MPNST is reported, which originated in the left temporalis muscle of a 74-year-old man who did not suffer from von Recklinghausen's disease. It had been treated as an abscess for a long time.

DISCUSSION

The clinicopathologic properties of this neoplasm have been widely discussed and the emphasis is on the need for its early identification since the tumour's non-specific symptoms may result in delayed diagnosis and treatment.

CONCLUSION

To date, to our knowledge, no case of MPNST located in the temporalis muscle has been described. The rarity of the tumour along with its clinical appearance and the vague symptoms may result in delayed referral and thus the tumour being quite large when diagnosed.