Background - Intramuscular hemangiomas are benign vascular tumours that most frequently occur in the trunk and extremities.They constitute about <1% of all hemangiomas, only 10%–20% have been found to arise in the head and neck region, and 36% of cases involving masseter muscle.They usually present as gradually enlarging soft-tissue mass with or without pain. They are located deep within the muscle, hence rarely exhibit clinical signs or symptoms such as bruits, thrills, pulsation which are suggestive of vascular origin. Due to their rare occurrence, unique location they are often confused with other soft-tissue pathologies such as parotid swelling or other muscular lesions. Case report - 21 year old male came with complaints of swelling and pain over the left cheek for past 6 months which was insidious in onset and non progressive.Patient did not have any history of trauma or increased salivation.On examination swelling of about 2*2 cm over the left cheek,well defined,non tender,soft in consistency.There was no pulsation,bruits or palpable thrill.There was no compressibility and the overlying skin was normal.There was no facial nerve involvement and parotid duct orifice was normal. Conclusion - The possibility of an Intramuscular hemangioma of the masseter muscle should be included in the differential diagnosis of any intra-masseteric lesion. Appropriate radiologic examinations, especially MRI, can enhance accurate preoperative diagnosis; the treatment of choice should be individualized in view of the clinical status of the patient.
Breast carcinoma in men represents approximately 1% of all breast cancers and 1% of all malignancies in men. The incidence of male breast cancer appears to be increasing. The risk increases with age, and the median age of diagnosis for men is later than that for women. There are several known risk factors for male breast carcinoma, including genetic predisposition, prior radiation exposure, alterations of the estrogen- testosterone ratio, and occupational hazards. 62 year old male came with chief complaints of papulonodular lesion over both breast which is progressive for the past one year associated with pain, itching and bloody discharge. Bilateral axilla on palpation had mobile, non tender, hard, multiple nodes in the anterior axillary and central group. FNAC from the node revealed metastatic carcinomatous deposits. Edge biopsy taken from the lesion revealed invasive breast carcinoma-no special type. Cutaneous metastasis is a phenomenon that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The primary malignant tumor that most commonly metastasizes to the skin is breast cancer, which can be manifested through papulonodular lesions, satellite nodules, erysipeloid or sclerodermiform infiltration, en cuirasse.
Pheochromocytoma are rare tumours originating from the chromaffin tissue. The clinical manifestations are variable and are not specific as pheochromocytoma and often imitate other diseases. The diagnosis is established by measurement of catecholamines and their metabolites in urine or plasma and by radiographic studies for localisation. Surgical removal of the tumour is the preferred treatment. 45 years old female presented with adrenal incidentaloma of about 6.1×6.2×5.4 cm well defined heterogenous lesion with internal cystic areas seen in right adrenal region abutting upper pole of right kidney. Biochemical investigations for adrenal hormones including plasma aldosterones, cortisols, plasma metanephrines, 24 hrs urinary metanephrines and VMA were found to be normal. Proceeded with adrenelectomy and histopathology of the specimen revealed pheochromocytoma as diagnosis. Pheochromocytoma leads to high mortality and morbidity rates if untreated. Fractionised metanephrines and catecholamines in a 24 hrs urine analysis is the preferred biochemical test. In a biochemically silent pheochromocytoma imaging modalities are used to identify and locate the tumour. Adequete alpha and beta blockade should be ensured before tumour removal. Surgery is recommenced irrespective of size and normal biochemical study to prevent complications.
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