Fiberoptic bronchoscopic removal of intratracheal pledgetted repair sutures

The intrascrotal localization of lymphangioma in children is uncommon, especially when the lymphangioma does not depend on testicular structures. We present the case of a 13-year-old male who started with a right intrascrotal mass unconnected with the testicle, clinically and ultrasonically compatible with cystic lymphangioma. The mass was excised because of progressive growth over the previous 5 months, and at surgery a scrotal lymphangioma was disclosed projecting towards the umbilical area through the subcutaneous cell tissue of the anterior abdominal wall. There have been no complications or recurrences to date, 6 months afterwards. Surgical removal is the only efficacious therapeutic approach and is the best way to achieve a definitive diagnosis in these patients.     

A case of progressive multiple focal nodular hyperplasia with alteration of imaging studies

Focal nodular hyperplasia (FNH) of the liver is a lesion characterized by a well circumscribed region of hyperplastic liver tissue with stellate fibrosis. The pathogenesis of the lesion is unknown but various authors consider that FNH may be a response to a preexisting vascular abnormality. We experienced a case of progressive multiple FNH, in which the hemodynamic change as shown by imaging modalities, may support this hypothesis. The patient, a 38-yr-old woman, was found by chance to have multiple portal venous shunts and multiple FNH in both lobes of her liver. Because of their benign characteristics, we followed the nodules periodically without any special treatment. After about 4 yr, the nodules increased both in size and number. In addition, digital subtraction angiography showed that the diameter of the artery had become larger. The hemodynamic change revealed by imaging studies in this case supports the hypothesis that one of the pathogens of FNH is a secondary hepatocellular response to arterial hyperperfusion caused by some vascular malformations.     

Potential advantages of treatment of transplanted saphenous vein aorto-coronary artery bypass grafts with beta irradiation to prevent graft occlusion

Intimal proliferation or Neointimal hyperplasia (NIH) is a vascular lesion that often arises in arteries after balloon angioplasty or other vessel wall injuries. FIH is a vascular lesion that develops in autologous saphenous vein grafts (SVG) after transplantation into the aorto-coronary circulation or the peripheral vascular circulation. FIH shares elements of smooth muscle migration, proliferation and fibrous tissue deposition in common with nibrointimal proliferation (NIH). Either NIH of a coronary artery or FIH of a SVG obstruct the vascular lumen and result in myocardial dysfunction. Local radiotherapy has been used for several decades to reduce the post-operative recurrence of the fibrovascular proliferations of pterygia and keloids. Similarly, in animal and human experiments, endovascular radiotherapy has been shown to reduce arterial smooth muscle proliferation. Consideration of the similarities of vascular smooth muscle cell proliferation in NIH and FIH leads one to suggest that endovascular beta irradiation can reduce FIH as well as it reduces NIH. The goal of such treatment is to achieve a clinically significant decrease in the morbidity and mortality resulting from SVG occlusions. The potential for large reduction of the consequences of SVG occlusion, the very large number of patients at risk, and the simplicity of the proposed intervention encourages prompt scientific evaluation of this technique.     

Masson's "vegetant intravascular hemangioendothelioma:" a lesion often mistaken for angiosarcoma: study of seventeen cases located in the skin and soft tissues

The occurrence of Masson's "hemangio-endotheliome vegetant intravasculaire" (Masson's pseudoangiosarcoma) in the skin and soft tissues is illustrated with 17 surgically excised specimens. Two forms are recognized; it may appear either as a pure lesion or as a focal condition in a pre-existing vascular process, such as pyogenic granuloma or hemangioma. The clinical appearance is not specific and the diagnosis can only be established by microscopic examination. It shows a predilection for the head and extremities. Its characteristic morphologic appearance makes possible its differentiation from a group of benign and malignant vascular proliferations. The key microscopic feature is the presence of a papillary growth composed of hyperplastic endothelial cells supported by delicate fibrous stalks entirely confined within the vascular lumen. The lesion should not be mistaken for angiosarcoma, since its clinical behavior is invariably benign.     

Ischemic fasciitis. Report of a case with fine needle aspiration findings

BACKGROUND: Ischemic fasciitis, also called atypical decubital fibroplasia, was recently described as a distinctive fibroblastic proliferation occurring predominantly in elderly, bed-ridden individuals. This entity can easily be misdiagnosed as a malignant process. CASE: A 70-year-old, white male presented with an enlarging right hip mass. Fine needle aspiration yielded spindled and ovoid cells with ample cytoplasm and occasional nuclear atypia. The histologic features of a subsequent biopsy and resection specimen included a zonal pattern of fibrinoid necrosis with surrounding reactive fibroblasts, histiocytes and vascular proliferation, which are characteristic of ischemic fasciitis. CONCLUSION: Ischemic fasciitis can be mistaken clinically, cytologically and histologically for sarcoma. The cytologic findings seen in this case, when combined with the clinical history, were sufficient to avoid misdiagnosis of malignancy in a benign, proliferative lesion.     

Chordoma with cutaneous metastasis

Chordoma is a neoplasm arising from the primitive notochord. Even though many chordomas follow a progressive course with multiple recurrences and metastases and eventual death due to tumor, reports of skin metastases from chordoma are rare. This report describes a case of chordoma with metastasis to the scalp in a 67-year-old man with a primary lesion of the sacrococcygeal region.     

Coupled column chromatography in chiral separation of salmeterol

The neuromuscular hamartoma (also referred to as the neuromuscular choristoma or benign triton tumor) is a rare developmental lesion composed of mature elements of both striated muscle and nerve. To date, less than 20 cases have been reported in the English language literature. The majority of these have involved large nerves, such as the sciatic or brachial plexus, but cutaneous lesions have also been reported. We report 2 cases that involve the head and neck and that are among the few described in this location. The majority of cases have been described in infants and young children. However, 1 of our cases (and at least 1 previously reported case) occurred in an adult. While surgical excision has been the most widely used form of therapy, a few cases have been complicated by and/or associated with a second lesion, such as a fibromatosis or lymphangioma.     

Cystic lymphangioma of the spermatic cord. Report of a new case

We report a new case of spermatic cord lymphangioma in a young patient. It is a rare tumor of the lymphatic system. Only eleven cases have been reported in literature. This lesion tends to recur despite surgical ablation. The pathogenesis of this lesion is still controversial.     

Acute renal failure in idiopathic nephrotic syndrome

The authors report a huge lymphangioma of the tongue in a sixty-seven years old female patient. The remarkable progression in dimensions of this lesion, leading to the inevitable protrusion of the tongue, led to the realization of an extended glossectomy, with a functional objective in mind. This simple procedure showed an excellent five years follow-up results. From this case report, the authors stress up on the etiopathogenic, pathological, clinical as well as therapeutic aspects of lingual lymphangioma.     

Transcranial erosion of a benign dermal cylindroma

Dermal eccrine cylindroma is a benign adnexal tumor that commonly affects the scalp, neck, and face. Malignant transformation is rare and has resulted in several cases of intracranial invasion. There have been no previously reported cases of a benign lesion eroding through the skull vault. We report the development of such a lesion in a woman who had undergone total scalp excision and resurfacing with a split skin graft some 23 years earlier. Details of the case and its management are presented.     

Solitary metastasis of a clear cell renal cell carcinoma after a 20 year latency clinically simulating a vascular tumor

HISTORY AND CLINICAL FINDINGS: A 72-year-old woman was referred because of progressive skin discoloration with venectasia and swelling in the left lower leg, the possible diagnosis being atypical varicose veins. 20 years before she had a right nephrectomy for "clear-cell" renal adenocarcinoma with subsequent tele-cobalt radiotherapy. On examination a pulsating swelling was palpated over the hyperpigmented area of the skin with venectasia. INVESTIGATIONS: She had hypercholesterolaemia (254 mg/dl) and hyperuricaemia (uric acid 6.2 mg/dl). Duplex sonography, angiography and computed tomography of the lower leg revealed a vascular tumour with infiltration of the right head of the gastrocnemius. DIAGNOSIS, TREATMENT AND COURSE: Because an arteriovenous fistula within a vascular soft-tissue tumour of unknown histology was suspected, a wide resection was performed. Histopathological examination revealed a metastasis of a clear-cell adenocarcinoma. Postoperative diagnostic tests discovered no other findings suspicious of malignancy. It is therefore to be assumed that the resected tumour was a solitary metastasis of the renal adenocarcinoma removed 20 years previously. CONCLUSION: Even rare causes should be considered in the differential diagnosis of vascular tumour, as this case of a solitary metastasis after a latency of 20 years demonstrates.     

Eruptive epithelioid hemangioendothelioma with spindle cells

A 39-year-old white man presented with four discrete dermal nodules in his right upper arm. Biopsy revealed superficial dermal well-circumscribed nodules composed of solid areas and vascular spaces lined by epithelioid endothelial cells and a similar nodule composed of spindle and epithelioid cells. A moderate mitotic count of 3-4 mitoses/10 hpf was present. Multiple lesions erupted 1 month later distally and proximally to the original lesions. Magnetic resonance imaging of the right arm demonstrated a lesion in the humerus. Biopsy of the humerus showed a vascular tumor with similar histologic features to the overlying skin lesions. The differential diagnosis included epithelioid vascular tumors, bacillary angiomatosis, pyogenic granuloma, and Kaposi sarcoma. Vascular lesions containing epithelioid and spindle cells span a spectrum from benign to malignant. We believe these tumors belong in the category of hemangioendothelioma and propose the name eruptive epithelioid hemangioendothelioma with spindle cells. Our case emphasizes that eruptive cutaneous vascular lesions do not always suggest immunosuppression or malignancy. Additionally, it highlights the association between epithelioid vascular lesions of the skin and bone.     

Prenatal diagnosis of an extensive fetal lymphangioma using ultrasonography, magnetic resonance imaging and cytology

An unusual case of fetal lymphangioma diagnosed before delivery is reported in a second trimester pregnant woman. The lymphangioma was suspected at 28 weeks on the basis of the ultrasound appearances and progression of the lesions with advancing gestation. MRI was used to evaluate the extent and the tissue characteristics of the lesions. Cytology of the fluid aspirated from the cystic lesions showed abundant lymphocytes and macrophages, confirming the diagnosis of a lymphangioma. The parents opted for a pregnancy termination because of the rapid growth of the lesions and the poor prognosis. It is suggested that the combination of these tests could enable the early diagnosis of these tumours at a stage when the lesion is relatively limited and accessible to therapy in utero.     

Improving influenza immunization among healthcare workers

Infected cystic duplication of the duodenum is an unusual lesion. We report a case in which pre-operative MR imaging revealed a huge multicystic mass masquerading as a cystic lymphangioma or mesenteric cyst. The differential diagnosis of this unusual appearance is discussed.     

Urethroplasty for balanitis xerotica obliterans

PURPOSE: To report a 20-month-old child with a rapidly growing dome-shaped red nodule on the left lower eyelid. The lesion was diagnosed clinically as an hemangioma, but microscopy disclosed an epithelioid Spitz nevus. METHOD: Case report. RESULT: Histopathologic examination of the excised lesion disclosed a Spitz nevus (benign juvenile melanoma) of a chiefly epithelioid cell type. CONCLUSIONS: The differential diagnosis of eyelid skin nodules in children should include Spitz nevus. This uncommon nevus has many cytologic features in common with nodular malignant melanoma. Histologically, it may be difficult to distinguish between nodular malignant melanoma and Spitz nevus.     

Idiopathic solitary neuroma of skin with unusual histologic changes

We report herein a case of idiopathic solitary neuroma with vascular proliferation and neurofibroma-like features. Clinically, the skin lesion was a 0.7 cm nodule without tenderness on the forearm. Histologically, there was vascular proliferation in the upper dermis, some neural structures among the proliferative vasculature in the mid dermis and large bundles of neural structures extending in various directions in the mid and deep dermis (resembling neurofibroma). Special stains, such as Masson's trichrome and Luxol fast blue, and immunohistochemical studies, including S-100 protein, neuron-specific enolase (NSE), vimentin, desmin, factor-VIII related antigen and epithelial membrane antigen (EMA), were added for this very rare case.     

Intra-thoracic costal sites of osteogenic exostoses in the child

INTRODUCTION: The technologic improvement of surface coils in MRI has allowed better visualization of the skin and thus permitted the clinical use of this technique in dermatology. MRI allows to assess the depth and extent of skin tumors and to detect any malignant transformation. The MR differentiation between benign and malignant skin lesions relies on morphological criteria which however do not have an absolute diagnostic value. We investigated the role of paramagnetic contrast agents in the differentiation between benign and malignant skin lesions. MATERIAL AND METHODS: Forty-one patients, 33 with benign and 8 with malignant skin tumors, were submitted to MRI. All the examinations were performed with a 1.5 T superconductive unit, with a 2.5 cm surface coil. Axial T1- and T2-weighted SE images were acquired with 2 mm slice thickness. Paramagnetic contrast material was administered to all patients. The signal intensity of the skin lesions was calculated before and after paramagnetic contrast agent administration positioning a region of interest. A percentage ratio of contrast enhancement was calculated to quantify contrast agent uptake and the relative values were compared between benign and malignant lesions. A qualitative analysis was also performed rating the contrast enhancement of each lesion as high, intermediate, or absent. RESULTS: The quantitative analysis showed a statistically significant difference (p < .5) between the contrast enhancement values of benign and malignant lesions. In particular, malignancies had values ranging 117.3 (+/- 28.7) to 125 (+/- 32.4), while benign lesions had -20.6 to 99.8 (+/- 21.1). Conversely, no difference in contrast enhancement was found at qualitative analysis. CONCLUSIONS: MRI is a promising tool for characterizing skin tumors. Our preliminary results should be confirmed on larger series of patients with the use of high temporal resolution imaging sequences.     

Fine needle aspiration cytology of adenoma of the nipple. A case report

BACKGROUND: Adenoma (papillary adenoma, florid papillomatosis, subareolar duct papillomatosis, erosive adenomatosis) of the nipple is an uncommon lesion and can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma. CASE: A case of adenoma of the nipple was studied by cytology and histopathology. CONCLUSION: Recognition of this benign lesion on cytology will prevent unnecessary radical surgery. Local excision alone suffices.