Distant metastasis in advanced breast cancer is not uncommon; however, spread to the paranasal sinuses is extremely rare. We present a case of a woman who presented to our ophthalmology colleagues with worsening unilateral proptosis secondary to a tumour mass within her ethmoid sinuses. Biopsy of the ethmoid tumour showed adenocarcinoma of unknown origin. Whole-body positron emission computed tomography demonstrated a breast primary lesion. The patient was treated with palliative chemotherapy, and the patient remains well at this point. The importance of specialist head and neck radiological interpretation of imaging cannot be underestimated. Early tissue diagnosis is essential before ascribing patients with orbital symptoms to non-malignant process.
We present a case of a man with a background of myasthenia gravis who presented with a neck lump, which was diagnosed as thyrolipomatosis in continuity with a very large thymolipoma. Following removal of these lesions, the patient’s myaesthenic symptoms improved. While thymolipomas are often seen in the context of myasthenia gravis, thyrolipomatosis is a rare entity and to our knowledge the concurrent finding of both lesions with myasthenia gravis has never been reported. We highlight the important imaging features of both entities and the clinical importance of recognising them.
Neurofibromatosis (NF) of the female genitalia is an uncommon manifestation. Selective involvement of the labium majus is quite rare. We describe a rare manifestation of a vulval plexiform neurofibroma without clitoral involvement in a post-pubertal girl. The patient had multiple café-au-lait spots over the neck, back, buttocks and thighs, a patch of pigmentation over the pelvis and inguinal region, axillary freckling, and a large hanging left vulval mass. On ultrasound, it showed hypoechoic nodules on a hyperechoic background with significant vascularity. Magnetic resonance imaging revealed T1-weighted (T1W) hypointense and T2-weighted (T2W) hyperintense, diffuse infiltrating lesion with few T2W hyperintense tubular and nodular areas, presence of “target sign,” and intense post-contrast enhancement. A biopsy confirmed it to be neurofibroma. The patient was diagnosed with NF type 1 and underwent surgical resection.
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