Mineral oil granulomatosis of scrotum

An unusual case of mineral oil granulomatosis of the scrotum in an elderly male patient is presented. Failure to consider the diagnosis of foreign-body granuloma in any nonulcerating lesion of the external genitalia may result in erroneous preoperative diagnosis and unnecessary surgical procedures.     

Dieulafoy's lesion of esophagus

Dieulafoy's lesion is a rare arterial malformation that can cause massive gastrointestinal hemorrhage. The lesion occurs most commonly in the proximal stomach. The esophagus is not a common location for this lesion. We present the case of a 25-year-old woman who was admitted to our emergency unit with the findings of hematemesis and melena. Early upper gastrointestinal endoscopic examination revealed a Dieulafoy's lesion, which was located in the distal esophagus. Endoscopic band ligation stopped the bleeding successfully. The patient was discharged 3 days after the band ligation without any complications. Dieulafoy's lesion may cause severe, life-threatening bleeding. Endoscopic diagnosis can be difficult because of the small size and obscure location of the lesion. An abnormally dilated artery that penetrates through the mucosa constitutes the etiology. Endoscopy plays an important role in the diagnosis and treatment of this pathology. Despite widespread awareness of this entity, it may present a real challenge for the endoscopist due to the small size and hidden location of the lesion. The endoscopic approach to occult gastrointestinal bleeding for the diagnosis of vascular malformations is accepted as a quick and safe diagnostic method.     

Intramedullary spinal cord metastases from a hypernephroma 11 years following the diagnosis and treatment of the primary lesion

Intramedullary spinal cord metastases are rare. An intramedullary spinal cord metastasis of renal origin, presenting 11 years after the diagnosis of the primary lesion, is reported.     

Inflammatory Pseudotumor of the Spleen: Report of a Case

We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions.     

Sialadenoma papilliferum in a young patient: a case report and review of the literature.

Sialadenoma papilliferum is a rare exophytic tumor of salivary gland origin, accounting for less than 1% of minor salivary gland tumors. It usually occurs in males older than 50 years as a painless papillary intraoral lesion. An 18-year-old male patient presented with an exophytic intraoral lesion present for approximately 12 years. The tumor was excised with a clinical diagnosis of infected hemangioma. However, histopathological diagnosis was consistent with sialadenoma papilliferum. The patient was followed up at regular intervals and no evidence of recurrence was noted. Our patient, aged 18 years, with tumor lasting for 12 years becomes the youngest case of intraoral sialadenoma papilliferum yet reported. This case highlights the importance of keeping sialadenoma papilliferum as a differential diagnosis of an intraoral exophytic proliferative lesion even in a young patient.     

Villous tumor of the appendix

An infrequently diagnosed lesion, villous tumor is extremely rare in its appendicular localization. Its diagnosis is then fortuitous and its secondary treatment is still debatable if surveillance is univocal. A further case of appendicular villous tumor is reported.     

Intraoperative consultation for the retroperitoneum and adrenal glands

An incidentally discovered mass lesion is the most frequent indication for intraoperative consultation involving the retroperitoneum or adrenal gland. The goal of the surgeon is to determine the nature and extent of the lesion and, for solid lesions, to obtain a biopsy adequate for histopathologic diagnosis. Benign lesions may be excised locally, whereas therapy for malignancies depends upon the individual circumstances of the patient, the histology of the lesion, and involvement of adjacent organs. Treatment of hematomas requires early vascular control. Adrenal tissue should be preserved whenever possible.     

Eosinophilic granuloma causing intussusception in a three year old child

An unusual case of intussusception of the midportion of the small bowel in a three year old child secondary to a rare eosinophilic granuloma is presented. The salient features of occurrence, diagnosis, and pathology of this unusual lesion are reviewed.     

Gouty Tophi: A Squamous Cell Carcinoma Mimicker?

BACKGROUND: Digital lesions can have a broad differential diagnosis. Squamous cell carcinoma (SCC), the most common digital malignant neoplasm, must be excluded as the cause of persistent digital lesions causing nail dystrophy. OBJECTIVE: To describe a patient with a periungual hyperkeratotic lesion on the left fifth digit which, upon initial dermatopathologic examination, appeared to be a malignancy. However, on further biopsy, the lesion proved to be a gouty tophus. METHODS: Case report and literature review. RESULTS: An 84-year-old white man presented with a hyperkeratotic papule on the lateral proximal nail fold of the left fifth digit, which resulted in nail dystrophy for 1 year. Similar lesions were present on several other digits which did not affect the nail plate. Initial biopsy was consistent with actinic keratosis and was treated with cryotherapy. When the lesion persisted, repeat biopsy was performed, demonstrating fragments of squamous epithelium with focal atypia and an infiltrative growth pattern. SCC could not be excluded and the patient was referred for Mohs micrographic surgery (MMS) consultation. An excisional biopsy was performed and a white chalky material was observed at the base of the defect. Histopathology confirmed a gouty tophus. The patient was referred to his primary care physician and was treated with allopurinol. CONCLUSION: This is the first report of gouty tophus of the periungual region presenting as a hyperkeratotic lesion. Initial clinical diagnosis favored SCC and histologic evidence suggested a possible early SCC. This lesion can be confused with digital squamous cell carcinoma. The presence of pseu- docarcinomatous hyperplasia may complicate accurate diagnosis.     

Clinical, radiological and histological correlation in the diagnostic work-up of cemento-ossifying fibroma of the maxilla: case report

Cemento-ossifying fibroma is a relatively rare tumor classified between fibro-osseous lesions. This lesion appears within the bone although in some occasions it involves the gingivae soft tissues. It is a slow growing and well-defined tumorous lesion, because of this, it is considered as a benign lesion. We report a case of a young female presenting a mass in the right cheek. The evolution of the process was 4 years. She was treated with surgical resection via a Weber-Fergusson approach. The histology was that of a benign fibro-osseous proliferation composed of bony spicules and spherules admixed with a fibrous stroma. Clinical and radiological information was essential for the final diagnosis. The histologic findings alone may be similar to other pathologies such as osteoblastoma, low-grade osteosarcoma and particularly to fibrous dysplasia. An accurate diagnosis requires careful clinical, radiological and histological correlation in order to make an optimal treatment and an excellent outcome.     

Pseudomelanoma after laser therapy

An 18-year-old man had a melanocytic nevus on the chin that had been treated with three different lasers at a private clinic for 2.5 years. This lesion was excised and sent to a pathologist. The initial histological diagnosis was reported as compound nevus coexistent with changes suspicious of malignant melanoma. The reevaluation of histology together with the clinical information that the lesion had been pretreated with laser resulted in a revised diagnosis of pseudomelanoma. It is important to be aware of this benign pseudomelanoma, which can arise as a complication of laser therapy, to avoid subjecting patients to unnecessary surgical procedures or other forms of adjuvant treatment.     

Instrumental diagnosis in shoulder instability

The authors call attention to the pathology caused by glenohumeral instability and, in particular, to painful shoulders in athletes which so often cause problems in diagnosis. An instrumental protocol for diagnosis is suggested, based on several specific radiographic views, Ct scan and arthro-Ct scan, with double contrast medium, the latter having the task of determining lesion which would not otherwise be able to be studied.     

Usefulness of FDG-PET in monitoring effects of the modality therapy for central nervous system malignant lymphoma: report of three cases

We have reported three cases of central nervous system malignant lymphoma in which FDG-PET was useful in monitoring therapeutic effects. Case 1: A 53-year-old man complained of gait and memory disturbance. An MRI of the patient's brain showed enhanced mass lesions in the bifrontal lobe. An FDG-PET showed markedly high uptake of the tracer, which means a higher metabolism of glucose. The tumor was biopsied and the histological diagnosis was diffuse B cell lymphoma. The patient received chemotherapy and external irradiation therapy. Case 2: A 64-year-old woman suffered memory disturbance and left hemiparesis. An MRI showed a right frontal mass lesion, and FDG-PET showed high uptake of glucose. After the histological diagnosis was determined as diffuse large B cell lymphoma, the patient received the same therapy as case 1. Case 3: A 55-year-old woman suffered right hemianopsia. An MRI showed an enhanced lesion in the right basal ganglia and an FDG-PET showed high uptake of glucose. After the histological diagnosis was determined as diffuse large B cell lymphoma, the patient received the same therapy as case 1 and 2. In all cases, high uptake of glucose disappeared on the PET after initial chemotherapy, although an enhanced lesion continued on MRI even after radiation. FDG-PET was useful in monitoring the therapeutic effects of malignant lymphoma. These results indicate that we were able to confirm the effectiveness of the therapy in the early stage.     

Posttransplant lymphoproliferative disorder presenting as an isolated skin lesion.

A case of posttransplant lymphoproliferative disorder (PTLD) presenting as an isolated skin lesion is reported. An initial superficial biopsy of the lesion was diagnosed as squamous cell carcinoma. After pathologic review of the biopsy and staining for immunoglobulins and Epstein-Barr virus (EBV) DNA, the correct diagnosis of PTLD was made. The patient had no systemic manifestations of lymphoma and the skin lesion was successfully treated with excision. Isolated skin lesions should be included among the potential sites for PTLD and histologic skin specimens from posttransplant immunosuppressed patients should be examined carefully for PTLD.     

Subcutaneous basal cell carcinoma: A case report

An unusual case of a patient who presented with a subcutaneous soft tissue lesion of the back is described. The patient had no preceding history of cutaneous malignancy or local trauma. Excision of the lesion revealed a diagnosis consistent with basal cell carcinoma with deep infiltration. The site was re-excised with a generous margin to ensure complete removal. There has been no recurrence for 18 months. This case is presented to underscore the rarity and importance of its existence.     

Inflammatory pseudo-tumour of the appendix and acute appendicitis: a case report

Inflammatory myofibroblastic tumour (IMT) is a rare benign lesion of unknown aetiology. It mimics, clinically and radiologically, malignant tumours (especially sarcoma). It was initially described in the lung, but it was subsequently recognised that virtually any anatomic location can be involved. IMTs of the gastro-intestinal tract are rare and there have been only nine confirmed cases involving the appendix to date. We presented a 20-year-old male patient with a diagnosis of IMT that caused acute appendicitis. An appendectomy is the most efficient treatment in cases where the lesion is limited to the appendix. Being aware of such an entity and being careful in the differential diagnosis of the appendiceal masses, especially the large masses, may prevent overtreatment.     

Ultrasonic diagnosis of urethral diverticulum

A urethral diverticulum was diagnosed on pelvic ultrasonography. Its ultrasonic features and differential diagnosis are discussed. An awareness of the ultrasonic appearance should result in more frequent recognition of this lesion.     

A 71-year-old woman with a pigmented nail bed, which persisted after trauma

A 71-year-old woman presented in our out-patients department with pigmentation of the nail bed of her left large toe, which had persisted after a trauma two years earlier. An inconclusive biopsy showed melanoma in situ. The lesion was excised with amputation of the big toe at the IP-joint and closed primarily. The pathological diagnosis was melanoma in situ and lentigo maligna. The lesion had been radically excised.     

A 71-Year-Old Woman with a Pigmented Nail Bed,which Persisted after Trauma

A 71-year-old woman presented in our out-patients department with pigmentation of the nail bed of her left large toe, which had persisted after a trauma two years earlier. An inconclusive biopsy showed melanoma in situ. The lesion was excised with amputation of the big toe at the IP-joint and closed primarily. The pathological diagnosis was melanoma in situ and lentigo maligna. The lesion had been radically excised.     

Postoperative pyoderma gangrenosum. Apropos of 2 cases

The typical lesion of pyoderma gangrenosum is a rapidly extending necrotic ulceration, often associated with a system affection, inflammatory colitis, hematologic affections, rheumatic disorders. In about 30% of cases it develops on the site of a sometimes minimal injury. In the two cases reported one developed in the region of a graft after excision of a basal cell epithelioma, the other in a peritoneal drainage scar after colon resection. In patients with pyoderma gangrenosum, initial discussion must involve possible causes of the cutaneous necrosis, but in the cases reported the clinical appearance and rapid progression of the lesion, and negative results of serial bacteriologic and mycologic examinations were in favor of this diagnosis. An accurate diagnosis is essential since general corticotherapy is usually necessary.