Diagnosis of two distinct malignancies in a single sample is rare. Here we report a case of lung adenocarcinoma metastasized to a supraclavicular lymph node which was concomitantly diagnosed with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) using ultrasound-guided fine needle aspiration biopsy (US-FNA) sample.
A 62-year-old Caucasian male presented with cough and bloody sputum. US-FNA of a supraclavicular lymph node showed two distinct cell populations and, based on morphological examination and immunohistochemical staining of the FNA cell block slides, diagnosed with CLL/SLL and metastatic lung adenocarcinoma. Flow cytometric analysis of peripheral blood supported the diagnosis of CLL/SLL. To our knowledge, this is a rarely reported cytology case in which metastatic lung adenocarcinoma is concurrently diagnosed with CLL/SLL in a single lymph node and can be diagnosed based an FNA sample.
Backgrounds: Malignant melanoma (MM) of urethra is extremely rare; only 84 cases have been reported in PubMed search.
Case: An 84-year-old woman presented dysuria. Physical and endoscopic examination revealed a polypoid tumor in proximal urethra, and endoscopic tumorectomy was performed. The tumor could not be seen in outer genitalia. Grossly, the tumor is brownish soft tumor measuring 15 mm × 26 mm × 23 mm. Multiple sections were made and immunohistochemical procedures were performed. Microscopically, malignant epithelioid cells with brown pigment were seen to proliferate and invade. The size of tumor was circa 13 mm × 21 mm × 18 mm. The depth of invasion was 10 mm (pT4), but it was not clear whether the marginal tissue status is positive or negative. Lymphovascular permeation seen, yet no obvious vascular invasion was noted. The brown pigment was found to be melanin by Masson-Fontana stain. Immunohistochemical study showed tumor cells were positive for vimentin, S100 protein, HMB45, Melan A, p53, and Ki67 (labeling = 85%), KIT and PDGFRA, while they were negative for cytokeratins. Genetic analysis of paraffin-embedded tumor tissue identified no mutations in hot spots of KIT and PDGFRA genes. No apparent metastatic lesions were seen after the diagnosis. The outcome of the patient is unknown because the patient was referred to a large hospital specializing in cancer treatment.
Conclusions: The author presented a very rare case of MM of the proximal urethra. The MM showed typical histochemical and immunohistochemical features. No mutations of KIT and PDGFRA were seen.
Testicular cystadenoma is ranked the second commonest benign neoplasm. Other benign epididymal neoplasms include adenomatoid tumor (most common), leiomyoma, serous (nonpapillary) cystadenoma, cavernous hemangioma, and melanotic neuroectodermal tumor. Adenocarcinoma, mesothelioma, and metastatic renal cell carcinoma are malignant tumors that can affect the epididymis. A 24-year-old male undergraduate with a 3-month history of mildly tender right testicular swelling histologically diagnosed as papillary cystadenoma is presented. This case is presented from our locality as the first of its’ kind; and because it can be a possible manifestation of other diseases like von Hippel- Lindau (VHL) disease.
An adenomyoma of the uterus is a nodular tumor-like mass of benign endometrial glands, endometrioid stroma and smooth muscle tissue. Extra-uterine adenomyoma is an extremely rare tumor. The majority of the cases described was from ovary and located in the pelvis. We present a case of a 70 years old woman with clinical and radiological suspicious of disseminated malignancy. In the abdominal wall, a 5-cm nodule of larger dimension detected by computed tomography-scan was biopsied for accessibility reasons. The morphological and immunohistochemical features of the biopsy led us to propose the diagnosis of an extrauterine adenomyoma. This article reports the 22nd case of extrauterine adenomyoma, a rare and poorly understood tumor that could be imagiologically and clinically indistinguishable from a metastasis.
Introduction: Overall incidence of invasive fungal infections in solid organ transplant recipients is low with the more common infections being invasive candidiasis, aspergillosis and cryptococosis. Zygomycosis comprises of only 0.2%-1.2% of infections in renal transplant recipients with current recommendations advising against routine prophylaxis.
Case: The patient was a 60-year-old male with a history of renal transplant 25 years ago on immunosuppressants, chronic transplant glomerulopathy, squamous cell carcinoma post penectomy and bilateral orchiectomy 2 years ago, controlled diabetes and hypertension who presented with pain in the perineal region for 4 days. On exam he was discovered to be afebrile and had a scrotal skin fold with urethral opening from his previous surgery and 2.5 cm induration and tenderness in the left gluteal fold. He was treated with 5 days of Unasyn. A biopsy was taken to rule out recurrence of squamous cell carcinoma and he was discharged home. The patient returned with worsening perineal pain within 3 days. On exam he had progressive induration with erythema, swelling and tenderness in the perineum. An initial white blood cell count of 15.8 increased to 25.8 and blood cultures remained negative. The computed tomography scan showed diffuse edema in the perineum without any evidence of abscesses. Immunosuppression was held and broad spectrum antibiotics were started. His renal failure progressively worsened eventually requiring continuous renal replacement therapy, intensive care transfer and vasopressor support. The biopsy revealed intermingled fibrous tissue with focal necrosis and no evidence of malignant cells. A repeat incision and debridement (I&D) culture showed growth consistent with mucor. He was started on liposomal amphotericin B and taken to the OR for multiple debridements. Unfortunately he progressed to multisystem organ failure and died after transitioning to comfort care.
Conclusions: Invasive fungal infections remain one of the life threatening differentials for cellulitis like skin lesions, especially for patients not responding to antibiotics and those who are immunocompromised. Early cultures and histopathology of lesions should be done for diagnosis and to avoid delays in treatment.
Cellular angiofibromas (CAF) are rare, benign, soft tissue/stromal lesions first described by Nucci et al. in 1997. These masses are well circumscribed, typically small (＜ 6 cm), and occur mainly in the vulvar region in women and the inguinoscrotal region in men. We present a case of a 60-year-old male who was found to have a very large (20 cm × 13.5 cm × 6 cm) lesion occupying the deep pelvis bridging the pelvic outlet and involving the perineum. Because of diagnostic uncertainty and significant symptomatology, the mass was ultimately resected en bloc with the rectum and anus. Final pathology revealed a large multi-lobulated CAF. This tumor is the largest CAF reported in the literature to date. Furthermore, this mass involved the deep male pelvis with extension between two anatomic compartments which has not been previously described.
We present the case of a 56-year-old gentleman who presented with non specific malaise, myalgia and anorexia. Clinical examination revealed a large circumscribed palpable mass in the left iliac fossa. He underwent an intraabdominal pelvic biopsy, computed tomography (CT), magnetic resonance imaging (MRI) of abdominal wall and Positron Emmission Tomography (PET). Differential diagnoses included Gastro Intestinal Stromal Tumour (GIST) and sarcoma. He underwent a laparotomy and excision of the lesion. Histological analysis of the lesion demonstrated a dedifferentiated liposarcoma involving the colon and adjacent pericolic fat. Margins were clear and there was no nodal involvement. He declined adjuvant chemotherapy. He subsequently developed a local recurrence, which was deemed unresectable. He commenced chemotherapy but continued to deteriorate. He received palliative treatment and died 6 months following his initial surgery.