Neurofibroma of facial nerve presenting as parotid mass

Mesenchymal Neoplasms of Salivary Glands: A Clinicopathologic Study of 68 Cases

Salivary gland neoplasms are uncommon, and most exhibit epithelial differentiation. Mesenchymal neoplasms of the salivary gland are rare, and the incidence ranges from 1.9% to 5%. The aim of this study is to identify the types and clinical-pathological features of mesenchymal salivary neoplasm and review their differential diagnosis. A retrospective search for mesenchymal neoplasms of salivary glands from our institution's pathology archives from the 2004-2021 period and consultation files of one of the authors (AER) was performed. The clinical data were obtained from available medical records, and the histological slides and ancillary studies were retrieved and reviewed. We identified a total of 68 cases that form the study cohort. Thirty-five patients were male, and thirty-three patients were female, with a mean age of 48 years (range, 7 months-79 years), and the male to female ratio was 1:.94. Sixty-three (92.6%) of sixty-eight tumors were benign and included: 38 (56%) lipomas, 9 (13%) hemangiomas, 7 (10.3%) schwannomas, 3 (4.4%) neurofibromas, 3 (4.4%) lymphangioma, 2 (3%) solitary fibrous tumors, 1 (1.5%) myofibroma. Five of sixty-eight (7.4%) were malignant and included: 3 (4.4%) Adamantinoma-like Ewing sarcomas, 1 (1.5%) malignant peripheral nerve sheath tumor (MPNST), and 1 (1.5%) malignant solitary fibrous tumor. The involved sites included: parotid (55), submandibular gland (5), parapharyngeal space (5), buccal mucosa minor salivary gland (2), and sublingual gland (1). Sixty-seven patients underwent surgical resection. One patient with lymphangioma manifested a recurrence/persistence a week post-surgery. One patient with a parotid hemangioma developed post-operative numbness, and another patient developed chronic postauricular pain after surgery. Two patients with MPNST and one patient with adamantinoma-like Ewing sarcoma underwent neoadjuvant chemoradiation and were disease-free after treatment. The remaining 37 patients with available follow-up ranging from 7 days to 96 months (mean, 18 months) had a favorable outcome and were disease-free after treatment. Mesenchymal neoplasms of salivary gland are rare; most are benign and demonstrate adipocytic, endothelial, and schwannian differentiation; awareness of their development is important for adequate diagnosis. The mainstay of treatment is surgical excision, with the extent determined by tumor type. Adjuvant therapy is reserved for high-grade sarcomas and may be given in a neoadjuvant or adjuvant setting.

Prevalence of oral neurofibroma in Central Indian population: A retrospective study of 20 years

CONTEXT

Neurofibroma is a benign peripheral nerve sheath tumor. Commonly found in the peripheral soft tissues, it can manifest as a solitary mass or as a component of neurofibromatosis.

AIMS

The purpose of the retrospective cross-sectional study was contributing to the literature by providing data about the prevalence of oral neurofibroma in Central Indian population.

SETTINGS AND DESIGN

Retrospective, cross-sectional study.

SUBJECTS AND METHODS

All histopathologically diagnosed cases of oral neurofibroma were retrieved from the archives of our department and were reviewed. All the cases that met the inclusion criteria were reviewed in terms of the year when the patient reported, patient's age, gender, location of the lesion, i.e., soft tissue or intraosseous, clinical appearance, i.e., growth or swelling, histopathologic diagnosis and immunohistochemistry results if available. The results were aggregated and described qualitatively using Microsoft Excel 2013.

RESULTS

In our retrospective analysis of 20 years (2000-2019), we came across 14 reported cases of oral neurofibroma, in five males and nine females. Two of these cases showed a recurrent nature and one case showed transformation into atypical neurofibroma. Two cases were encountered in the mandible as an intraosseous oral neurofibroma.

CONCLUSIONS

In our study, we found that oral neurofibroma was more common in the third decade with a female predilection. Gingiva was the most common site. Of the 14 cases that were encountered, two cases showed recurrence and one case showed malignant transformation. Hence, in spite of being a benign neoplasm, oral neurofibroma is locally aggressive and should be diagnosed accurately.

Computed tomography and magnetic resonance imaging in pediatric salivary gland diseases: a guide to the differential diagnosis

Salivary gland pathologies in children are frequent, particularly viral infections, but rarely need cross-sectional imaging. However, when a mass involves the salivary spaces (primarily or as a secondary invasion from other neck spaces) it may pose problems in the differential diagnosis and in immediate management. Infrequently, systemic autoimmune diseases can also involve the salivary parenchyma in children and correctly interpreting the constellation of findings in the whole body is critical for the diagnosis. Distinguishing between cystic and solid masses is the first step for radiologists in order to narrow down the diagnosis. Location and spatial extension are the most important elements differentiating cystic masses, while signal characteristics, internal structure and local invasion help in the differential diagnosis of solid masses.

Expansile Traumatic Neuroma of the Intratemporal Facial Nerve

Objectives  To present a rare case of traumatic facial neuroma involving the geniculate ganglion and review relevant literature.

Patient  Thirty-year-old man.

Intervention  Microsurgical resection via combined mastoid-middle fossa approach with great auricular nerve interpositional graft.

Main Outcome Measures  Patient demographics and pre- and postoperative facial nerve function.

Results  A 30-year-old man with a reported history of prior Bell's palsy developed progressive complete (House–Brackmann VI) right facial paralysis following blunt trauma. Imaging was strongly suggestive of a geniculate ganglion hemangioma. As the patient had no spontaneous improvement in his poor facial function over the course of 9 months, he underwent resection of the facial nerve lesion with great auricular nerve graft interposition via a combined mastoid-middle fossa approach. Histopathology demonstrated disorganized fascicles, with axonal clustering reminiscent of sprouting/regeneration following trauma. No cellular proliferation or vascular malformation was present.

Conclusion  Traumatic facial nerve neuromas can occur following temporal bone trauma and can closely mimic primary facial nerve tumors. Akin to the management of geniculate ganglion hemangioma and schwannoma, preoperative facial function largely dictates if and when surgery should be pursued.

Solitary neurofibroma of the face masquerading as a low-flow vascular malformation - case report and experience of management

This case report presents a 34-year-old woman who was referred to our regional plastic surgery unit following a 32-year history of a progressively enlarging mass overlying the left maxilla. The mass was initially diagnosed and treated as a low-flow vascular malformation. However, subsequent histopathological assessment confirmed the diagnosis of a cutaneous neurofibroma. To the best of our knowledge, there are only two other reported cases of a solitary neurofibroma arising from the soft tissue of the face, and this is the first reported case in the United Kingdom (UK). This article highlights difficulties in pre-operative diagnosis of solitary facial neurofibromas. We present our experience in managing this unusual case, discuss radiological clues to aid diagnosis and provide a review of the literature.

Large Solitary Neurofibroma of Face in a Paediatric Patient

Neurofibroma is a rare, benign, neurogenic tumour which may present as multiple lesions as a part of neurofibromatosis syndrome or as a solitary mass. This paper reports a case of large solitary neurofibroma of face in a young female patient. Clinical presentation, imaging characteristics and management of the pathology has been described in detail. The paper also reviews English literature for similar cases.