Malignant peripheral nerve sheath tumor of the parapharyngeal space arising from cervical sympathetic chain: A rare entity

A Giant Scrotal Neurofibroma in a Child Masquerading as Filariasis: Uncommon Presentation of a Common Disease

Neurofibroma of the scrotum is a very uncommon benign neoplasm, specifically when it affects teenagers and is not associated with neurofibromatosis type I. To the best of our knowledge, only a couple of cases of neurofibroma in children have been documented. Here, we report a case study of a 17-year-old boy who had a giant scrotal lump for ten years masquerading clinically as filariasis. A provisional diagnosis of benign nerve sheath neoplasm was made based on cytology findings. The lump was surgically removed from the patient, and a histopathological and immunohistochemistry examination established the diagnosis of neurofibroma. The combined clinical, preoperative cytological, histological, and immunohistochemistry findings were not presented in the literature in any of the formerly documented cases of scrotal neurofibroma. The current case expands the spectrum of differential diagnoses for scrotal tumours that clinicians have previously observed.

Quantification of vessel separation using the carotid-jugular angle to predict the nerve origin of neck peripheral nerve sheath tumours: a pooled analysis of cases from the literature and a single-center cohort

BACKGROUND

Postoperative nerve palsy is a major complication following resection of neck peripheral nerve sheath tumours (PNSTs). Accurate preoperative identification of the nerve origin (NO) can improve surgical outcomes and patient counselling.

MATERIAL AND METHODS

This study was a retrospective cohort and quantitative analysis of the literature. The authors introduced a parameter, the carotid-jugular angle (CJA), to differentiate the NO. A literature review of neck PNST cases from 2010 to 2022 was conducted. The CJA was measured from eligible imaging data, and quantitative analysis was performed to evaluate the ability of the CJA to predict the NO. External validation was performed using a single-centre cohort from 2008 to 2021.

RESULTS

In total, 17 patients from our single-centre cohort and 88 patients from the literature were analyzed. Among them, 53, 45, and 7 patients had sympathetic, vagus, and cervical nerve PNSTs, respectively. Vagus nerve tumours had the largest CJA, followed by sympathetic tumours, whereas cervical nerve tumours had the smallest CJA ( P <0.001). Multivariate logistic regression identified a larger CJA as a predictor of vagus NO ( P <0.001), and receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.907 (0.831-0.951) for the CJA to predict vagus NO ( P <0.001). External validation showed an AUC of 0.928 (0.727-0.988) ( P <0.001). Compared with the AUC of the previously proposed qualitative method (AUC=0.764, 0.673-0.839), that of the CJA was greater ( P =0.011). The cut-off value identified to predict vagus NO was greater than or equal to 100°. Receiver operating characteristic analysis showed an AUC of 0.909 (0.837-0.956) for the CJA to predict cervical NO ( P <0.001), with a cut-off value less than 38.5°.

CONCLUSIONS

A CJA greater than or equal to 100° predicted a vagus NO and a CJA less than 100° predicted a non-vagus NO. Moreover, a CJA less than 38.5 was associated with an increased likelihood of cervical NO.

A Retrospective Analysis on the Effects and Complications of Endoscope-Assisted Transoral Approach and Lateral Cervical Approach in the Resection of Parapharyngeal Space Tumors

Objective

To observe and compare the effects and complications of endoscope-assisted transoral approach and lateral cervical approach in the resection of parapharyngeal space (PSS) tumors.

Methods

From January 2013 to September 2021, 69 patients with parapharyngeal space tumors in the Affiliated Hospital of Jiangnan University were divided into the control group (n = 37) and the observation group (n = 32) according to the mode of operation. The tumors in the parapharyngeal space were resected by the lateral cervical approach in the control group, and the tumors in the parapharyngeal space were removed by endoscopy-assisted transoral approach in the observation group. The general clinical data and operation conditions of the two groups, including operative blood loss, operation time, drainage volume and drainage time, hospital stay, perioperative pain degree, and tumor resection rate were collected and analyzed statistically. The patients were followed up for 6 months, and the complications of the two groups were recorded.

Results

Compared with the control group, the operation time in the observation group was significantly shorter, and the amount of intraoperative bleeding in the observation group was significantly less than that in the control group, and the difference was statistically significant (P < 0.05). The postoperative drainage was less and the hospital stay in the observation group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in tumor resection rate between the two groups. The visual analog scale (VAS) score on the 1st and 3rd day after operation in the observation group was lower than that in the control group. After treatment, some patients in the two groups had complications such as nerve injury, dysphagia, difficulty in mouth opening, massive hemorrhage, and parotid fistula. The total incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05).

Conclusions

The effect of the endoscope-assisted transoral approach is similar to that of the lateral cervical approach in the resection of tumors in parapharyngeal space, but the endoscope-assisted transoral approach has shorter operation time, less intraoperative bleeding, and less postoperative drainage. The indwelling time and hospital stay of the drainage device were shorter than those of the patients with transcervical approach, and the perioperative stress response of patients with endoscope-assisted transoral approach is mild, which is beneficial to the physical and mental recovery of the patients.