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Sinonasal malignant melanoma (SMM) is a rare malignant tumour among head and neck cancers predominantly found in adults 60 years and above. The commonly reported symptoms for sinonasal tumour lesions are nasal obstruction and recurrent, painless epistaxis as the symptoms are non-specific and can delay the diagnosis. Moreover, melanoma has a poor prognosis regardless of its location. We report an 86-year-old female patient presenting with recurrent, painless epistaxis from the nasal cavity. Anterior rhinoscopic examination revealed a bluish-black, bleeding mass completely obstructing the left nasal nare. Contrast-enhanced computed tomography of the nasal cavity and sinus region showed a polypoidal soft tissue attenuation with heterogeneous enhancement completely filling the left nasal cavity. The patient underwent endoscopic excision. Histopathology of the specimen showed a small, round and blue cell tumour which immunohistochemistry found to be positive for S100 and HMB 45. After surgical resection, the patient received chemotherapy and radiotherapy. Sinonasal malignant melanoma is a rare, aggressive tumour that has a very poor prognosis. Contrast-enhanced computed tomography of the nasal cavity and paranasal sinuses is the imaging modality of choice which reveals the enhancing mass. There is no optimal management strategy for SMM. Surgical resection is the first-line treatment but is limited due to the complex anatomy of the sinonasal region.

Langerhans cell histiocytosis (LCH) is a multi-faceted disease defined by the accumulation of dendritic cells in various organs with characteristics similar to the epidermal Langerhans cells and can affect any organ of the body. It is most commonly seen in young adults and children. Cholesteatoma is a congenital or acquired condition and is categorized into primary and secondary cholesteatomas. Only a few reported cases of primary or secondary cholesteatoma have been reported among patients treated for temporal bone LCH. We report a case of secondary acquired cholesteatoma in a six-year-old girl after five years of her LCH treatment. The patient initially presented with ear discharge and aural polyp which did not improve with medical management. A computed tomography scan of the mastoid showed a left middle ear cavity and temporal bone lesion with bony erosions and total obliteration of the left external auditory canal. The patient underwent multiple biopsies, and a histopathological evaluation confirmed the diagnosis of cholesteatoma. The diagnosis of LCH can be difficult due to variable clinical manifestations. Involvement of the ear as resemblance to other diseases such as mastoiditis and chronic otitis media are quite common. Computed tomography scan and biopsy are reliable tools for diagnosis. Cholesteatoma following LCH remains a rare entity, hence, critical examination at follow-up visits is needed. Surgery remains the treatment of choice for cholesteatoma patients.

Bifid epiglottis is a rare congenital laryngeal anomaly that is most commonly a syndromic rather than an isolated entity. It has been associated with specific syndromes, such as Pallister-Hall syndrome, Bardet-Biedl syndrome, and other related syndromes. Bardet-Biedl syndrome is a rare autosomal-recessive disorder characterized by hand and/or feet polydactyly, obesity, short stature, mental retardation, renal anomalies, and genital anomaly. Here we report a case involving a 25-year-old Saudi male patient who presented with hoarseness of voice since birth with no diurnal or diet association or other associated symptoms. On examination, he was noted to have craniofacial dysmorphism and polydactyly of the right hand and left foot. Fiberoptic nasopharyngolaryngoscopy (NPLS) revealed a laryngeal pedunculated rounded glottic mass and subglottic bulging with expiration and involuting with inspiration along with an abnormal-looking epiglottis having a separate cartilaginous framework with space in-between and bilateral mobile vocal cords. Computed tomography (CT) showed the vocal cord mass and a bifid epiglottis. Other investigations and labs were within normal range. The patient underwent vocal cord mass excision and soft tissue histopathology revealed a benign growth. On follow-up, the patient showed clinical improvement. In conclusion, this is a rare case of bifid epiglottis associated with Bardet-Biedl syndrome, which serves to highlight the significance of such anomalies in any syndromic patient presenting with airway symptoms. Our aim is to add more cases to the literature and to consider it as a differential diagnosis.

Diagnosis of tuberculosis was affected during the coronavirus disease 2019 (COVID-19) pandemic. Several studies have shown an association between tuberculosis reactivation and COVID-19, but disseminated tuberculosis was rare. We present a case of a 17-year-old male hospitalized due to a fever of unknown origin for two weeks. The patient recovered from COVID-19 five weeks ago, and his nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) was negative on current hospitalization. After investigations, diagnosis of disseminated tuberculosis was made by lymph node biopsy and radiological features. The patient was treated with four anti-tuberculosis medications and had a favorable outcome.

Introduction: Cutaneous metastases from RCC is an uncommon and poorly understood clinical phenomenon that frequently predicts a poor prognosis. Case presentation: A 69-year-old male with a history of type 2 diabetes and benign prostatic hyperplasia (BPH) was diagnosed with stage 4 renal cell carcinoma (RCC) and various cutaneous lesions. A dermatological checkup during his hospitalization revealed asymptomatic subcutaneous nodules and purpuric areas. Biopsy and immunohistochemistry (IHC) staining confirmed the presence of cutaneous metastatic carcinoma, which is consistent with renal cell origin. The immunohistochemistry profile was positive for pancytokeratin, CD10, and vimentin but negative for PAX8, indicating a distinct appearance in RCC patients. Conclusions: This case emphasizes the necessity of recognizing cutaneous metastases as an uncommon presentation of advanced RCC, as well as PAX8's potential role as a diagnostic marker.

Renal cell carcinoma (RCC) is a common renal malignancy that frequently metastasizes, though cutaneous metastasis, particularly to the scalp, is rare and generally indicates a poor prognosis. We report a case of scalp metastasis from RCC in a 69-year-old man who presented with unexplained weight loss and painless hematuria. Imaging revealed a 12-cm renal mass with adrenal, pulmonary, and scalp metastases. The patient's condition rapidly deteriorated, and he died one month after the presentation. Hematogenous spread through Batson's plexus might be the primary mechanism of RCC dissemination to the scalp. While targeted therapies have improved the management of metastatic RCC, the prognosis for patients with skin metastases remains poor.