A rare case of extracranial schwannoma of the hypoglossal nerve located in the parapharyngeal space mimicking a deep neck abscess

Schwannomas are neurogenic benign tumors originating from the myelin sheath of peripheral nerves, and hypoglossal Schwannomas account for 5% of nonvestibular ones. Extracranial localizations are substantially rare, especially those affecting exclusively the parapharyngeal space; for this reason, the retrostyloid neoformations could initially masquerade as a carotid tumor or deep organized neck abscess. The purpose of this report is to highlight the importance of a multidisciplinary approach in the correct management of differential diagnosis

The impact of the COVID-19 pandemic on the prognosis of laryngeal adenoid cystic carcinoma: a case report and a literature review

Laryngeal adenoid cystic carcinoma (LACC) is a sporadic neoplasm, especially if supraglottic. The COVID-19 pandemic worsened the presenting stage of many cancers and impacted their prognosis negatively. Here, a case of a patient with adenoid cystic carcinoma (ACC) with delayed diagnosis and a rapid deterioration with distant metastasis due to the COVID-19 pandemic is illustrated. Next, we present a literature review of this rare glottic ACC. The COVID-19 pandemic worsened the stage of presentation of many cancers and adversely affected their prognosis. The present case had a rapidly lethal course, undoubtedly due to the diagnosis delay caused by the COVID-19 pandemic, which impacted the prognosis of this rare glottic ACC. Strict follow-up is recommended for any suspicious clinical findings, as an early diagnosis will improve the disease prognosis, and to consider the influence of the COVID-19 pandemic, especially on the timing of common diagnostic and therapeutic procedures for oncological diseases. In the post-COVID-19 era, it is important to generate new diagnostic scenarios to achieve an increasingly rapid diagnosis of oncological diseases, especially the rare ones, through screening or similar procedures

A rare case of low-grade mucoepidermoid carcinoma of the retromolar trigone

Mucoepidermoid carcinoma is a malignant salivary gland tumor that very rarely involves the retromolar trigone. We report the case of a 31-year-old woman who referred to the emergency department of our university hospital with a 12-month history of a slow-growing parapharyngeal mass and recent onset of dyspnea in the supine position and dysphagia for solids. CT showed a hyperdense formation of about 4 x 2.5 cm involving the right mandibular region up to the palatine tonsil and the superior constrictor muscle of the right pharynx, with obliteration of the right portion of the nasopharynx and oropharynx. Based on clinical evaluation and radiological evidence, the patient underwent surgical excision of the mass, performing a right radical tonsillectomy extended to the ipsilateral retromolar area, with unerupted right third molar extraction. In this case, we describe a rare condition in a rare localization with unusual symptoms and should be always considered in the differential diagnosis with other similar conditions. However, the prompt diagnosis and treatment allowed a conservative surgical management of the case with good long-term prognosis

The impact of the COVID-19 pandemic on the prognosis of laryngeal adenoid-cystic carcinoma

Objectives Laryngeal adenoid-cystic carcinoma (LACC) is sporadic, especially if supraglottic. This study aimed to show a rare case of supraglottic LACC with a late diagnosis due to COVID-19 era. Materials and methods This study followed the Institutional Review Board standards from Sapienza University of Rome. Patient’s relatives signed informed consent to share anonymous data in the article. Results In 2021 a 70 years old no smoker female patient went to the emergency room with stridor, dyspnea, and hoarseness with bilateral vocal folds paralysis. Tracheostomy and laryngeal biopsies were performed that confirmed a LACC. During hospitalization a pneumonia began. Despite the treatments, pulmonary condition deteriorated resulting in death. A total body CT scan with contrast showed a glottic mass and the cervical nodes volume increase. Partial laryngectomy (OPHL II B), bilateral selective neck dissection and radiotherapy were considered. Those therapies have not been carried out because of the bad general condition.3 Three months later CT scans showed earliest lung metastasis. In 2019 patient hoarseness arose. No abnormalities were found by laryngoscopy and laryngeal biopsies. A strictly follow-up was suggested but she did not follow recommendations due to COVID-19 pandemic. Conclusions COVID-19 pandemic worsened the presenting stage of many cancers and impacted their prognosis badly.4 The presenting case had a rapidly deadly course, surely due to COVID-19 that impacted the prognosis of this rare glottic ACC

Smell and Taste in Children with Covid-19

Objectives To assess the frequency of loss of smell and taste in children during Covid-19 infection and their prevalence along with other symptoms, as well as the recovery of chemosensory function once healed. Methods To evaluate symptoms during infection, we adapted the Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire and the modified Monel-Jefferson questionnaire. For smell analysis we used Odor Identification (OI) and two variants of the Odor Discrimination (OD) test, and we compared the results with those of a control group. Results We enrolled nine patients in our experimental group and nine in our control group. Fever was the most frequent symptom (55% of cases), followed by anosmia and ageusia (44% of cases), muscle pain and asthenia (22% of cases) and diarrhea, abdominal pain, cough, and headache (11% of cases). In 11% of cases, olfactory symptoms were the only manifestation of the disease. There was no statistically significant difference in OI test and OD tests between the two groups (Children healed from Covid-19 and Control Group). Conclusion Loss of smell and taste are the second most common symptoms of pediatric Covid-19, and they should always be tested because they can be the only manifestations of infection. Olfactory function in Covid-19 children decreases with increasing age and improves with the passage of time after illness

The neutrophil/lymphocyte ratio as a prognostic factor in COVID-19 patients: a case-control study

OBJECTIVE: SARS-CoV-2 (Se- vere Acute Respiratory Syndrome Coronavirus 2) has been identified in China as responsible for viral pneumonia, now called COVID-19 (Coro- navirus Disease 2019). Patients infected can de- velop common symptoms like cough and sore throat, and, in severe cases, acute respiratory syndrome and even death. To optimize the avail- able resources, it is necessary to identify in ad- vance the subjects that will develop a more se- rious illness, therefore requiring intensive care. The neutrophil / lymphocyte ratio (NLR) param- eter, resulting from the blood count, could be a significant marker for the diagnosis and man- agement of risk stratification. PATIENTS AND METHODS: A retrospective, single-center case-control observational study was conducted. The differential cell count of leu- kocytes, the NLR and the clinical course of pa- tients hospitalized in intensive care with COVID-19 were analyzed, comparing them with other pa- tients (COVID-19 and non-COVID-19) and healthy individuals selected among workers of the Teach- ing Hospital Policlinico Umberto I in Rome. RESULTS: 370 patients (145 cases and 225 controls) were included in the case-control study, 211 males (57%) and 159 females (43%). The average age of the population was 63 years (SD 16.35). In the group of cases, out of 145 pa- tients, 57 deaths and 88 survivors were record- ed, with a lethality rate of 39.3%. The group of cases has an NLR of 7.83 (SD = 8.07), a much higher value than the control group where an NLR of 2.58 was recorded (SD = 1.93) (p <0.001). The Neutrophils / Lymphocytes ratio may prove to be a diagnostic factor for COVID-19, an NLR> 3.68 revealed an OR 10.84 (95% CI = 6.47 - 18.13) (p <0.005). CONCLUSIONS: The value of NLR considered together with the age variable allows a risk strat- ification and allows the development of diagnos- tic and treatment protocols for patients affect- ed by COVID-19. A high neutrophil to lymphocyte ratio suggests worse survival. Risk stratification and management help alleviate the shortage of medical resources and reduce the mortality of critically ill patients