Interesting Pathology Images

[HeadNeckPA]

I think that pictures are a really interactive way of learning. I am going to frequently post some interesting images with a little clinical information and we'll see how many people come up with the right answer.

All of these images are my own, just for the record.

Case #1

23 yr-old female college student who presents with a 6 week h/o dysphagia and a foreign body sensation in her throat (globus). Denies F, chills or wt loss. ROS unremarkable with the exception of the dysphagia and globus sensation. PMH is non-contributory, non-smoker / non-drinker and no f/h of head or neck cancer.

PE remarkable only for a bulging of the Left lateral pharyngeal wall w/o evidence of ulceration or mucosal lesion. Remainder of exam was unremarkable, including flexible laryngoscopy.

Image #1 is a CT showing a lesion in the Left parapharyngeal space w/ a small amount of central fluid accumulation. Lesion is well circumscribed w/o evidence of invasion. Notice the airway obstruction on the L side.



Image #2 is an intra-op pic of the lesion. Well encapsulated w/o evidence of invasion and appeared to be arising from the sympathetic chain. Permanent path was c/w benign tumor of neural origin.



Image #3 is a condition that resulted from the patient's surgery and not the tumor itself, per se. (Image taken from A.D.A.M. library to illustrate the point)






What is this tumor and what is the resulting condition called?

[Febrifuge]

That's ptosis, and since it seems to be a sequella of the surgery, I think it can be properly called blepharoptosis.

Since the tumor was in the patient's neck, I need to figure out how the frontal nerve, which innervates the levator palpibrae muscle, could have been affected; this is a branch from the opthalmic nerve, which is from the first part of the Trigeminal.

The tumor in the neck region might have been involved with other cranial nerves, but I don't see how the motor part of V could have been affected.

Any clues?

[HeadNeckPA]

That's ptosis, and since it seems to be a sequella of the surgery, I think it can be properly called blepharoptosis.

Since the tumor was in the patient's neck, I need to figure out how the frontal nerve, which innervates the levator palpibrae muscle, could have been affected; this is a branch from the opthalmic nerve, which is from the first part of the Trigeminal.

The tumor in the neck region might have been involved with other cranial nerves, but I don't see how the motor part of V could have been affected.

Any clues?

You are right about the ptosis part, but the droopy eyelid is only part of the problem created. Image #3 also shows miosis, although the image isn't all that great. So ptosis combined with miosis would be called.................?

Also, Image #2 stated that the tumor appeared to be arising from the sympathetic chain.

Last clue, this benign tumor arises from the covering around the nerve............

[caldje]

schwanomma, horner syndrome

nice images.. thanks for posting these.

[HeadNeckPA]

Very Good! This was a tough one.

Schwannomas are benign tumors of nerve tissue arising from, obviously, Schwann cells. They are the most common involving the 8th cranial nerve where they are termed acoustic neuromas (Tumors of the CNS - Burger and Scheithauer 1994), even though the tend to occur on the vestibular portion of the nerve, rather than the acoustic portion.

Horner's syndrome results from sympathetic interrupution and can occur anywhere along the symp chain, as the fibers ascend into the neck and subsequently the head.

Symp fibers innervate the pupil and Mueller's muscle of the eyelid, hence the ptosis and miosis.

More to come

[Febrifuge]

Cool case. Can't speak for anyone else, but stuff like this is exactly what helps me learn.

[BlocDoc]

Nicely done HeadNeckPA- You handled posting the graphics better than I can!
Bring by any others that you like

[whoRyou]

Too bad this post is not current