Recurrent Clear Cell Hidradenoma of the Foot

BACKGROUND: Clear cell hidradenoma is an uncommon neoplasm without established optimal treatment. OBJECTIVE: Using Mohs micrographic surgery, a recurrent clear cell hidradenoma of the right foot was treated. METHODS: Case report and literature review. RESULTS: Two stages of Mohs micrographic surgery and subsequent repair successfully treated the recurrent clear cell hidradenoma. No recurrence of the neoplasm has been observed at 11 months follow-up. CONCLUSION: Optimal treatment of clear cell hidradenoma is unestablished. Adequate primary local excision is essential. Mohs micrographic surgery should be considered for treatment, especially on recurrent tumors in critical locations.     

Nodular hidradenoma of the breast: A case report with literature review

Nodular hidradenoma or clear cell hidradenoma is a rare skin adenexal tumor which arises from eccrine sweat glands. Skin adenexal tumors situated in the breast parenchyma are still very rare and is one of the differential diagnoses of breast tumors. Failure to identify its morphologic features may lead to a mistaken diagnosis and over treatment. We report a case of breast lump, in a 40-year-old lady, which was diagnosed clinically as a malignant breast lump. Final diagnosis of nodular hidradenoma was made only after excision biopsy as fi ne needle aspiration cytology was inconclusive.     

Malignant clear cell hidradenoma of the upper lip

Malignant clear cell hidradenoma is an uncommon tumor of eccrine sweat gland origin that has a predilection for the head and neck. It is characterized by an indolent growth pattern yet frequently recurs following surgical excision and has a high incidence of regional and distant metastases. A case of recurrent malignant clear cell hidradenoma of the upper lip is presented. The lesion was treated with surgical excision followed by radiotherapy. The literature on this rare lesion is reviewed and treatment strategies discussed.     

Clear Cell Hidradenoma of the Ankle

Clear cell hidradenoma is a relatively common, benign eccrine neoplasm with rare presentations in the foot and ankle. Variable clinical and histopathologic characteristics of the tumor warrant careful consideration over primary and recurrent malignancy, particularly eccrine carcinoma. The first known case of primary benign clear cell hidradenoma of the ankle is presented with imaging studies, surgical management, and clinicopathologic correlation, distinguishing the neoplasm from its malignant counterparts.     

Une localisation inhabituelle d’hidradénome à cellules claires

Clear cell hidradenoma is a rare benign eccrine tumor, mostly located in the trunk. We report a case of clear cell hidradenoma of the sole. A 52 year-old woman presented with a 3 cm soft tumor of the right sole. The lesion first appeared a year ago and developed slowly. Examination revealed a painless, fistulized lesion with clear serous fluid. The biopsy specimen showed a hidrocystoma. The patient underwent large excision of the tumor. Histopathologic investigation found a clear cell hidradenoma with safe excision margins. No cellular atypia or mitotic figures were present. Immunohistochemical studies showed positivity for Ki67, but less than 3%, reflecting a low growth activity. Clinical monitoring was elected. No signs of recurrence were found after two years of follow-up. Hidradenoma is a rare tumor of the skin, representing 1% of all skin tumors. In two of the biggest series with 32 and 38 cases, only two hidradenomas were located in the foot, and more than half in the trunk. The treatment is based on a large surgical excision with safe margins, because of high local recurrence rate and the potential of malignant transformation. Through this case, we would like to highlight the unusual location of this hidradenoma.     

Malignant nodular hidradenoma. A clinical case

Malignant clear cell hidradenoma is an uncommon tumor of eccrine sweat gland origin. In contrast to the benign form, malignant clear cell hidradenoma tends to invade the surrounding tissue and has a high incidence of distant metastases. For these reasons a wide surgical excision associated to a locoregional lymph node dissection should be performed alter the initial diagnosis. The case of a 17 year old female with this rare lesion is reported; the literature is reviewed and surgical treatment discussed.     

Large Ulcerated Perianal Hidradenoma Papilliferum in a Young Female

BACKGROUND: Hidradenoma papilliferum is an uncommon benign tumor that is located almost exclusively in the vulvar and anal areas. It is usually very small and asymptomatic, and to make a correct diagnosis is clinically very difficult. Occasionally the tumor becomes elevated to form a reddish brown papillary mass, and the surface ulcerates, which may erroneously suggest malignancy. OBJECTIVE: We report a case of a large, perianal hidradenoma papilliferum with suspected malignancy in a young Japanese female. RESULTS: A 22-year-old female had been aware of a perianal nodule for approximately 1 year. Examination of the perianal area revealed a wide pedunculated, reddish nodule with several white maculae. It was ulcerated and bleeding, 2.0 x 1.2 x 0.8 cm in size, and located in the 3 o'clock position. The nodule was totally excised with a narrow margin. The histopathologic diagnosis was hidradenoma papilliferum. No recurrence was observed for 23 months. CONCLUSION: When dermatologists encounter tumors of the anogenital area of adult females, it is important to keep hidradenoma papilliferum in mind as the differential diagnosis. Dermatologists should recognize that the tumor is benign, eliminating the need for wide resection.     

Malignant clear-cell hidradenoma of the toe.

Malignant sweat gland tumors are rare tumors of the extremity. Their insidious growth patterns and often confusing pathological characteristics can cause confusion with more common benign tumors. However, these tumors cannot be neglected because they do have a propensity to metastasize. Presented is a 56-year-old woman with a malignant clear-cell hidradenoma of the foot actually presenting as a benign lesion.     

Giant apocrine hidradenoma of the breast

We report a case of a 26-year-old woman with an 8.0-cm tumor of the left breast. The tumor was clinically and radiologically suspicious for malignancy. The pathologic evaluation of the core biopsy and the subsequent excision specimen revealed a benign sclerosing, cystic, and papillary adnexal tumor with apocrine and clear cell morphology. The immunohistochemical staining for p63 was positive. Estrogen, progesterone, and Her-2 receptor immunohistochemical stains were negative. The cytogenetic analysis revealed 46, XX t(11:19) (q21;q13.1) balanced translocation. The final diagnosis was apocrine hidradenoma.     

Neurothekeoma.

OBJECTIVES: The purpose of this study was to investigate and share the experiences at The University of Texas M. D. Anderson Cancer Center in diagnosing, treating, and following patients with neurothekeoma. We report 13 cases. STUDY DESIGN: Case series. The clinical, surgical, and pathology records of the 7 patients with neurothekeoma treated at M. D. Anderson Cancer Center were retrospectively reviewed. In addition, the pathology records of 6 patients reviewed by the Department of Pathology for diagnosis only were retrospectively reviewed. RESULTS: Nine patients were women. Their mean age was 30 years (median, 24 years). Six of the lesions were on the head or neck, 4 were on extremities, and 2 were on the trunk, and the location of 1 was not recorded. Two lesions had been previously diagnosed, histologically, as leiomyosarcomas, 1 as a malignant nodular hidradenoma, and 1 as a clear cell hidradenoma. All the lesions had the characteristic nested pattern of growth, with various degrees of myxoid background. Mitotic figures and marked cellular pleomorphism were not common. Six cases were treated with wide local excision. A lesion of the nasal ala was excised by using Mohs micrographic surgery. Most cases were limited to the dermis, but 2 lesions infiltrated subcutaneous tissue and skeletal muscle. All patients were without evidence of disease at 8 months median follow-up range (0 to 35 months). CONCLUSION: Neurothekeoma is a benign neoplasm occurring usually in women and commonly in the head and neck. Because it may be locally invasive, treatment with wide local excision using frozen section control of margins is recommended. Care must be taken in the pathologic diagnosis of cutaneous neoplasms, and neurothekeoma should be considered in the differential diagnosis for spindle cell lesions. SIGNIFICANCE: Neurothekeoma is commonly misdiagnosed, pathologically and clinically, and it can be treated successfully with surgical excision. EBM rating: C.     

Immunoreactivity for estrogen receptor protein in sweat gland tumors

The histologic and immunophenotypic similarities between sweat gland carcinoma and breast cancer are well known. Indeed, these likenesses often preclude the diagnostic separation of primary cutaneous glandular neoplasms from metastatic mammary carcinomas, based on light microscopic and immunohistochemical features alone. To assess whether the presence of estrogen receptor protein (ERP) in breast carcinoma might serve as a diagnostic marker in this context, we analyzed 33 eccrine carcinomas, 24 sebaceous carcinomas, 15 intraepidermal apocrine carcinomas (extramammary Paget's disease), and 42 benign sweat gland tumors for ERP content. The monoclonal anti-ERP H222 was used with a modified avidin-biotin-peroxidase complex (ABC) method and paraffin sections. For comparison, eight cutaneous metastases of mammary carcinomas were similarly studied. ERP was identified in six of eight secondary neoplasms. However, this steroid-binding protein also was detected in 10 of 33 eccrine carcinomas. In three of 10 eccrine hidradenomas, each of two examples of hidradenoma papilliferum, and two of three chondroid syringomas, ERP-reactivity was noted as well. The remaining eccrine, apocrine, and sebaceous neoplasms were nonreactive. Among immunoreactive eccrine neoplasms, eight of 10 carcinomas occurred in males, whereas most ERP-positive benign eccrine tumors arose in females. The potential expression of ERP by sudoriferous malignancies reinforces the biologic similarities between mammary and cutaneous adnexal neoplasms. Moreover, ERP reactivity in the latter lesions underscores the inability of immunohistochemistry to distinguish primary and secondary glandular tumors of the skin with certainty.     

Epidermoid Cyst Mimicry: Report of Seven Cases and Review of the Literature

Cysts are entities encountered frequently in dermatological clinics. Various types of cysts have been described and include trichilemmal cysts, epidermoid cysts, steatocystomas, and the myriad of developmental cysts (branchial cleft cyst, thyroglossal duct cysts, bronchogenic cysts). Moreover, not all lesions that appear clinically as cystic structures are, in fact, cysts. Increased awareness of these mimickers and a systematic approach to the evaluation of these cases is essential. The authors report seven cases, over the course of six years, presenting to their dermatology department, all of which were originally clinically diagnosed as “cysts” and referred to the authors for management. In this article, the authors review seven cyst mimickers and describe important aspects of these diagnoses to increase awareness of the importance of a preoperative biopsy and evaluation. It is important to have a thorough understanding of the wide differential diagnosis of cutaneous nodules and to consider other causes of lesions that appear to be cysts, particularly in the anatomical locations described.Cysts and cyst-like structures are frequently seen in dermatological practices. Histologically, a true cyst contains a closed cavity surrounded by a wall of true epidermis. The cyst cavity is filled with keratinaceous or fatty material arranged in layers.¹ In contrast, cyst-like structures, although lacking these histological markers, may be clinically identical to true cysts because of similar anatomical location and morphological appearance. It is important to differentiate between these cysts mimickers because true cysts are usually treated by simple surgical excision; whereas, other cyst-like masses may require further diagnostic workup and a more aggressive surgical approach.²It is necessary to have a clear understanding of the various cyst mimickers and to consider these entities when encountering patients with cutaneous nodules.Over the past six years, many interesting cases initially diagnosed as epidermal inclusion cysts were referred for excision to the authors’ dermatology clinic. Many had clinically changed in morphology, size, or color by the time they reached the authors’ clinic, while others remained benign-appearing. These patients were referred to the authors’ department for evaluation of a suspected cyst. This article presents seven cases of cyst mimickers: hidradenoma, cutaneous B-cell lymphoma, epithelioid sarcoma, Merkel cell carcinoma, metastatic adenocarcinoma of the lung, granular cell tumor, and cutaneous meningioma to increase awareness that other lesions can mimic cysts.     

Management of humeral fracture nonunion in severe osteoporosis by a combination of locking plating and intramedullary fibular grafting

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.     

Chaotic dynamics and convergence analysis of temporal difference algorithms with bang‐bang control

Reinforcement learning is a powerful tool used to obtain optimal control solutions for complex and difficult sequential decision making problems where only a minimal amount of a priori knowledge exists about the system dynamics. As such, it has also been used as a model of cognitive learning in humans and applied to systems, such as humanoid robots, to study embodied cognition. In this paper, a different approach is taken where a simple test problem is used to investigate issues associated with the value function's representation and parametric convergence. In particular, the terminal convergence problem is analyzed with a known optimal control policy where the aim is to accurately learn the value function. For certain initial conditions, the value function is explicitly calculated and it is shown to have a polynomial form. It is parameterized by terms that are functions of the unknown plant's parameters and the value function's discount factor, and their convergence properties are analyzed. It is shown that the temporal difference error introduces a null space associated with the finite horizon basis function during the experiment. The learning problem is only non‐singular when the experiment termination is handled correctly and a number of (equivalent) solutions are described. Finally, it is demonstrated that, in general, the test problem's dynamics are chaotic for random initial states and this causes digital offset in the value function learning. The offset is calculated, and a dead zone is defined to switch off learning in the chaotic region. Copyright © 2015 John Wiley & Sons, Ltd.     

An Optimal control approach to marketing-production planning

The problem of finding an optimal advertising and production policy in a firm is analysed using a recently proposed model of a marketing-production system. First, it is shown that the optimal control problem underlying the proposed model is a partially singular control problem. Then, a reverse-time parametric solution procedure is designed to determine the optimal advertising and production policy for the proposed model. Finally, it is shown that the results derived from the new model are applicable to problems of capacity expansion in a firm.     

Cystic lymphatic malformation of bladder presenting as a pelvic mass

We report a 5-year-old boy with a cystic lymphatic malformation (LM) of bladder, and the imaging characteristics of the lesion are reported. Cystic LM of the urinary system is rare, and a location in the bladder is extremely rare. The exact mechanism of the lesion that occurs in bladder is unknown. This case is different from the 3 cases reported before, for it is only presented with a palpable pelvic mass and the lesion did not penetrate full thickness of bladder. Although imaging examinations are helpful in the definition of cystic LMs, no characteristic findings are available to diagnose a cystic LM of the bladder before surgery. The diagnosis is always made after surgical intervention. Surgical excision is ideal, and an extensive operation is not warranted because the lesion is benign. Once excised completely, the prognosis of the disease is good.     

Actinomycosis of the sigmoid colon: A case report

Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. The infection has a tendency to infiltrate adjacent tissues and is therefore rarely confined to a single organ. Presentation may vary from non specific symptoms and signs to an acute abdomen. A computed tomography scan is helpful in identifying the inflammatory process and the organs involved. It also allows visual guidance for percutaneous drainage of abscesses, thus aiding diagnosis. Culture is difficult because of the anaerobic character and slow growth of actinomycetes. Colonoscopy is usually normal, but may shows signs of external compression. Preoperative diagnosis is rare and is established only in less than 10% of cases. In uncomplicated disease, high dose antibiotic therapy is the mainstay of treatment. Surgery is often performed because of a difficulty in diagnosis. Surgery and antibiotics are required in the case of complicated disease. Combined medical and surgical treatment achieves a cure in about 90% of cases. The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology, and a review of the literature is presented.     

腹股沟疝与精索脂肪瘤

精索脂肪瘤是腹膜外脂肪经腹股沟内环突出形成的真性脂肪瘤.发生率一般在20%～30%.常由腹膜外脂肪从深环中脱出延续而造成,分叶状的后腹膜脂肪进入深环使其扩张,从而导致腹股沟疝与精索脂肪瘤的形成.BMI越高精索脂肪瘤越容易发生.同时也发现精索脂肪瘤在Ny-bus Type Ⅱ及Ⅲb型的患者存在更高的发生率,说明了精索脂肪瘤的发生与疝的类型有关系,疝越大越容易发生.精索脂肪瘤的术前诊断不易,其临床表现与腹股沟疝及其相似.超声检查是一种安全而有效的方法,对诊断腹股沟疝和脂肪瘤的确诊率高达92%.只要腹膜外脂肪组织疝入腹股沟管,在手术中尽可能的将脂肪瘤切除,并按腹股沟疝行修复手术.     

A pursuit–evasion game with one curvature constraint

In this paper, a pursuit–evasion game, in which the pursuer moves with simple motion whereas the evader moves at a fixed speed but with a curvature constraint, is investigated. The game is the inverse of the usual homicidal chauffeur game. Square of the distance between the pursuer and the evader when the game is terminated is selected as the cost function. To solve such a zero‐sum game, a Hamiltonian approach is applied. An algorithm is proposed to determine a saddle point and the value of the game under consideration. Copyright © 2000 John Wiley & Sons, Ltd.