In A Rare Feat Musk Melon Sized Tumour Removed From Neck Of 27 Yr Old Woman

In an intricate case, a 27-year-old woman from Nigeria who developed an enormous neck tumour the size of a musk melon, was successfully operated upon by a team of specialists at Amrita Hospital, Faridabad. The patient had gone through two surgeries in her home country prior to flying to India and being admitted to Amrita. 

The tumour, which obstructed the patient’s ability to breathe, speak, and swallow, was removed over the course of two separate surgeries. Split between two days, the surgeries were performed by multidisciplinary teams on the 12th and 13th of June giving relief to the patient.

The first surgery was carried out by a team of 14 doctors lasting 11 hours whereas the second surgery was performed by a team of 12 doctors lasting 8 hours. 

While highlighting the rarity of the case Dr Subramania Iyer, HOD, Head and Neck Surgery, Amrita Hospital said that in his 30 years of experience, this case is one of a kind and it's possible that he will not encounter a similar case again in his lifetime. 

Dr Sanjeev K Singh, Medical Director, Amrita Hospital stated the whole cost of the procedure amounted to Rs 18 lakhs of which the patient was only charged 50 per cent due to the family’s unaffordability and the case being very rare and big for Amrita. 

The woman was suffering from a rare genetic disorder called plexiform neurofibromas which is characterised by the development of tumours along the nerves in various parts of the body. These tumours, known as neurofibromas, can occur on or under the skin, as well as inside the body. Though noncancerous, they are at significant risk of turning cancerous if left untreated.

The occurrence of this condition in the neck is rare, and tumours of this nature usually grow to a size of only 5-6 cm. The woman’s tumour, however, was a whopping 16 cm in size. The tumour had begun to compress her windpipe, necessitating the insertion of a breathing tube into her throat. As a result, she was unable to speak. 

Dr Subramania Iyer, HOD, Head & Neck Surgery, Amrita Hospital, Faridabad, said, "She was diagnosed with neurofibromatosis type 1, a rare disorder that occurs in approximately 1 in 4,000 live births. It is uncommon to find this kind of tumour of such significant dimensions. Its growth pattern was also unusual, as it extended behind the food pipe, creating a separation from the spine and crossing from one side of the neck to the other. 

Dr Iyer said that the tumour was not only pressing on the food pipe, making eating progressively more challenging and limiting the patient to a liquid diet, but was also encroaching upon the critical blood vessel supplying the left side of her brain and beginning to affect the right side as well. 

The Multidisciplinary Approach

Speaking to BW Healthcare World Dr Iyer said that there were three risks associated with removing the tumour; damage to the food pipe and the windpipe, damage to the main blood vessels (carotid artery) which carry the blood to the brain and third being damage to the spinal cord. And in this case, the vertebrae were invaded by the tumour causing a bit of damage already so any quick moment could have caused a fracture of the spine or could have led to the blood vessels being pressed or ruptured leading to paralysis, Dr Iyer said. 

Performed in two stages the surgery involved removing the tumour from the neck and spine and stabilising the spine. The use of special techniques to monitor the nerves and the involvement of different medical specialities ensured that important structures were protected during the surgery. 

Dr Iyer explaining the process of the surgery told BW Healthcare World that the first thing his team did was handle the carotid artery by the balloon occlusion test which tells whether one artery can be temporarily or permanently blocked without significantly affecting the level of blood in your brain. 

“By doing that we had assurance that the patient will survive if there is an unfortunate event during the surgery. And the second hurdle was whether we should remove the neck part first or the spine part and then we went ahead with removing the tumour surrounding the windpipe because it created space for us to effectively remove the tumour around the spine ,” Dr Iyer said.  

The treating team also frequently monitored the whole body’s nerve activity through neuromonitoring. The patient was sedated and was on a ventilator during the whole course of the surgery for two days. 

The patient’s recovery has been fast and she has transitioned to oral feeding, needing minimal assistance from the feeding tube. While still breathing through a tube presently, the doctors are hopeful of removing it in the coming couple of weeks. 

Speaking to the media the patient revealed that she had lost all hope after undergoing two unsuccessful surgeries in Nigeria, as the tumour kept growing. "I am extremely relieved and happy with the outcome of the procedure, as I now resemble my former self once again. I eagerly anticipate resuming a normal life," the patient said.  

The surgery was performed by a team which included Dr Subramania Iyer, Dr. Anandh Balasubramanian, Dr. Tejal Patel, Dr. Neha Suri, Dr. Pradeep Sharma, Dr. Mukul Chandra Kapoor, Dr. J.S Rahul along with supportive expertise from Dr Sanjay Pandey, Dr Puneet Dhar, Dr Neha Chaudhary, Dr. Heena Parihar and Mr Kaustubh Talukdar.