Silent Killer in the Nose: Two Cases of Nasal Alveolar Rhabdomyosarcoma in Adults.

We report two cases of nasal alveolar rhabdomyosarcoma (ARMS) in adult patients from our center who presented with local mass effect and systemic involvement. Our first patient had spontaneous unilateral epistaxis. Her blood investigation showed severe thrombocytopenia, and the bone marrow biopsy result showed bone marrow infiltration by non-hematopoietic malignant cells. Nasal endoscopy showed a mass arising medial to the left middle turbinate. Our second patient presented with right eye proptosis, associated with blurring of vision. Nasal endoscopy showed a right whitish nasal mass arising lateral to the middle turbinate. Both patients were diagnosed by immunohistochemical analysis showing ARMS, a soft tissue malignancy uncommon in adults. RMS in adults has a worse prognosis. Hence, the management is challenging. Early diagnostic workup is essential for the commencement of early treatment for better oncological outcomes.

Primary Nasal Tuberculosis Masquerading as Granulomatosis With Polyangiitis: A Case Report of Diagnostic Dilemma.

Primary nasal tuberculosis (TB) is a rare disease even in areas with high TB burden, possibly attributed to the protective mechanism of sinonasal mucosa. Its symptoms are subtle and can be mistaken for other granulomatous inflammatory conditions. We would like to report a case of a 70-year-old Indian lady who underwent a successful left endoscopic dacryocystorhinostomy three years ago and presented with recurrent left epiphora. During nasal endoscopy, multiple ulcerative masses with crusting were detected over the left nasal vestibule, anterior nasal septum, left inferior, and middle turbinate. Biopsy of the nasal mass revealed granulomatous inflammation without caseating necrosis. Initially, all TB-related tests were negative. As the patient had granulomatous nasal lesions with microscopic haematuria, granulomatosis with polyangiitis (GPA) was suspected. Regrettably, the patient did not respond to treatment. A repeated tissue culture at a later stage finally detected mycobacterium tuberculosis without the presence of pulmonary tuberculosis. Considering the current TB prevalence in the Southeast Asian region, it is crucial for otorhinolaryngologists to be aware of primary nasal TB when encountering unusual head and neck lesions, even in the absence of pulmonary TB.

Concurrent Anaplastic and Papillary Thyroid Carcinoma Manifesting as a Thyrocutaneous Fistula.

Anaplastic thyroid carcinoma (ATC) is a highly aggressive form of thyroid cancer with poor prognosis. Differentiated thyroid carcinoma (DTC) including papillary thyroid carcinoma (PTC) is more common and known to have a favorable outcome after treatment. Here, we report a case of a 59-year-old lady with a long-standing goiter presenting with a discharging anterior neck mass. Fine-needle aspiration cytology (FTAC) of the mass resulted with malignant cells. She underwent surgery, and histopathological examination revealed both ATC and PTC features. Mutation analysis was also performed, and results were positive for BRAF 600VE mutation. She received radiotherapy and also chemotherapy post-surgery. Treatment was well tolerated. The relatively favorable survival of this patient may suggest that synchronous ATC and DTC may have better prognosis than ATC alone. The objective of this article is to report the unique clinical presentation and favorable prognosis with combined treatment modalities.