Spindle cell sarcomatoid tumour of the trachea: a rare primary malignant tumour.

Spindle cell carcinoma is a subtype of sarcomatoid carcinoma, which has previously been described in various anatomical locations, though rarely in the trachea.We present the case of a woman in her 70s who presented with a sore throat and stridor. Fibreoptic nasendoscopy demonstrated a tracheal mass occupying 80% of the airway from the cricoid cartilage to the third tracheal ring, infiltrating the thyroid gland. Subsequent CT demonstrated pulmonary emboli and vertebral metastasis. Biopsy of the infiltrated thyroid confirmed the diagnosis of spindle cell carcinoma. The length of the tumour and metastasis at presentation made this surgically unresectable, and she was referred for a palliative stent but died after an acute deterioration.This pathology has been reported only five times previously in the literature, with management strategies varying greatly between patients. Primary tracheal tumours are difficult to manage as, due to their rarity, there are no clear guidelines.

Cisplatin induced acute mesenteric ischaemia: A case report and review of the literature.

INTRODUCTION: Cisplatin is a platinum-based chemotherapeutic agent, widely used in cancer therapies for numerous solid tumours. It is becoming more recognised that a potentially life-threatening complication of cisplatin is accelerated arterial and venous thrombosis. PRESENTATION OF CASE: We describe a case of a 62year-old with no risk factors for vascular disease who presented with thromboembolic acute mesenteric ischaemia of the small bowel during treatment with cisplatin for head and neck cancer. DISCUSSION: We review the literature on the incidence and pathogenesis of cisplatin induced arterial thrombosis and discuss current treatment options of acute mesenteric ischaemia detailing our management of this case. CONCLUSION: Cisplatin increases the risk of arterial thrombosis and this case report details acute mesenteric ischaemia secondary to its use. We hope to raise clinician awareness of this sequelae which can occur even in patients in the absence of other identifiable risk factors.

Bilateral otoneurological pathology: To operate or not?

OBJECTIVE: To illustrate our experience when managing a complex patient with potentially life-threatening bilateral otological disease facing multisensory compromise including complete loss of audiovestibular function and visual disturbance Clinical presentation: A 67 year old lady, presented with a large left vestibular schwannoma and extensive right cholesteatoma encircling the otic capsule. She underwent translabyrinthine resection of the vestibular schwannoma, resulting in profound sensorineural hearing loss, vestibular hypofunction and corneal scarring following an initial temporary facial palsy. Due to the extent of the disease and good right-sided bone conduction thresholds, the cholesteatoma was managed conservatively utilising a bone-anchored-hearing-aid with regular review by the Skull-Base team. However, following acute deterioration in hearing and disease extension threatening right facial nerve function, the decision was taken for surgical intervention with a view to staged cochlear implantation (CI). INTERVENTION: Our patient underwent right lateral petrousectomy, total osseous labyrinthectomy, and implantation of an intracochlear 'dummy' with blind sac closure of the external auditory canal. Recovery was excellent with no further deterioration in balance and no loss of facial nerve function. CI occurred 3 months post-operatively with good functional outcome. CONCLUSION: We present the management of bilateral complex otoneurological disease with significant risk of multisensory compromise. Size of the left vestibular schwannoma necessitated surgical resection with resultant loss of ipsilateral audiovestibular function. Due to residual right audiovestibular function and the risks of surgery, the extensive right cholesteatoma was managed conservatively until disease progression necessitated surgical intervention. Subsequently it was possible to restore access to open-set speech with a right CI.