Keratoacanthoma of the Nasal Septum Secondary to Ranibizumab Use

Keratoacanthoma (KA) is a benign epithelial tumor that typically presents as a firm, cone-shaped, flesh-colored nodule with a central horn-filled crater. KA is considered to be a low-grade variant of squamous cell carcinoma (SCC). We report a rare case of a 72-year-old male who presented with a KA involving the nasal septum, possibly related to ranibizumab use. A flesh-colored lesion on the right anterior nasal septum lesion was visualized on examination. Histologic examination revealed a well-circumscribed, dome-shaped central crater filled with keratin, well-differentiated squamous epithelium with ground-glass cytoplasm with pushing margins, and intraepithelial microabscesses establishing the diagnosis of KA. KA of the nasal septum has only been reported once in the literature. This case is unusual because it normally presents on sun-exposed areas. Additionally, this patient was taking ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor for macular degeneration. Despite ranibizumab not being directly linked to precancerous and cancerous skin lesions, agents in this medication class have been. Although it is difficult to prove associations in this isolated case, the role of ranibizumab causing cutaneous lesions should be further investigated.

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Cutaneous Angiomatosis in a Young Dog

Veterinary Pathology ◽

10.1354/vp.42-3-378 ◽

2005 ◽

Vol 42 (3) ◽

pp. 378-381 ◽

Cited By ~ 18

Author(s):

Y. Kim ◽

S. Reinecke ◽

D. E. Malarkey

Keyword(s):

Blood Vessels ◽

Skin Lesions ◽

Punch Biopsy ◽

Cutaneous Lesions ◽

Mixed Breed ◽

Skin Punch Biopsy ◽

Surgical Preparation ◽

Well Differentiated ◽

The Right ◽

Extensive Involvement

A 1-year-old, spayed, female, mixed-breed dog had two reddish-purple cutaneous lesions, one on the right dorsal antebrachium and the other on the right shoulder. The lesions consisted of approximately 13 x 3 cm and 15 x 10 cm, irregular, patchy regions of 0.5-3.0 cm, circular, sometimes raised, reddish-purple swellings resembling ecchymoses. The lesion on the antebrachium had been noticed since the dog was adopted at 6 months of age and appeared to have increased in size over an 11-week period, at which time skin punch biopsy revealed an infiltrative pattern of well-differentiated blood vessels leading to an interpretation that the lesion was a well-differentiated hemangiosarcoma. The second lesion was revealed when the dog had its fur shaved in that area during surgical preparation to excise the antebrachial lesion. No other skin lesions were found on the dog. Microscopically, there was a widely disseminated and infiltrative-like pattern of benign-appearing small blood vessels, which were throughout the superficial and deep dermis and subcutis. Although the disseminated nature suggested malignancy, the histologic appearance of well-differentiated small blood vessels and nonprogressive clinical features indicate that the lesions were benign. The dog has been followed for 6 years and to date has no evidence of progression of the antebrachial lesion or shoulder lesion. To the authors' knowledge, this is the first report of a congenital angiomatosis-like lesion in a young dog, with extensive involvement of the forelimb.

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Treatment of Coates retinitis in both eyes in a 5-year-old girl

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-63-65 ◽

2021 ◽

pp. 63-65

Author(s):

A.O. Nazarenko ◽

◽

E.E. Sidorenko ◽

I.V. Suhanova ◽

A.R. Shavaleeva ◽

...

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Retinal Detachment ◽

Clinical Case ◽

Vascular Endothelial ◽

Vegf Inhibitor ◽

Vascular Activity ◽

Factor Inhibitor ◽

The Right ◽

Endothelial Growth Factor

Purpose. To present a rare clinical case of bilateral Coates retinitis in a 5-year-old girl. Material and methods. A clinical case of a 5-year-old girl with rare Coat's retinitis in both eyes is described. The disease occurred abruptly: the child's parents noted the appearance of leukocoria in the right eye. After the examination Coates ' retinitis was diagnosed. At the time of examination in the clinic, there was a retinal detachment in the right eye, the surgical treatment was performed: lensvitrshvartectomy, plastic surgery of the anterior chamber, with the melting of the retina with perfluoroorganic compounds, drainage of subretinalfluid, endolaser coagulation on the right eye. A month after the first symptoms appeared in the right eye, the patient complained of decreased vision in the left eye. Examination on the pediatric retinal camera showed an increase in vascular activity in the left eye, and signs of Coats' retinitis were revealed. Results. As a therapy for this disease, the patient was twice injected intravitreally inhibitor of vascular endothelial growth factor (VEGF inhibitor) into the left eye with positive dynamics noted as a decrease in the activity of retinal vessels and leveling of the exudative component, as well as with an increase in visual acuity in the left eye. Conclusion. This clinical case demonstrates that intravitreal administration of inhibitor VEGF with traditional methods of treatment can be used as a treatment for patients with Coates retinitis. Key words: Coat's retinitis, Coats' disease, vascular endothelial growth factor inhibitor, aflibercept, intravitreal injection, anti-VEGF, retinal detachment.

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Paravertebral Well-Differentiated Liposarcoma with Low-Grade Osteosarcomatous Component: Case Report with 11-Year Follow-Up, Radiological, Pathological, and Genetic Data, and Literature Review

Case Reports in Pathology ◽

10.1155/2017/2346316 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Nicolas Macagno ◽

Stéphane Fuentes ◽

Gonzague de Pinieux ◽

André Maues de Paula ◽

Sébastien Salas ◽

...

Keyword(s):

Histopathological Examination ◽

Soft Tissue Sarcomas ◽

Fish Analysis ◽

Low Grade ◽

Central Mass ◽

Divergent Differentiation ◽

Paravertebral Muscles ◽

Well Differentiated ◽

The Right

Despite being one of the most frequent soft-tissue sarcomas, well-differentiated liposarcoma has never been reported near the spine. The authors present the case of a 67-year-old man with progressive history of back pain. Physical examination revealed a mass located within the right paravertebral muscles. MR and CT imaging showed a heavily ossified central mass surrounded by a peripheral fatty component. No connection with the underlying bone was detected on imagery and during surgery. After surgical resection, histopathological examination revealed a tumor harboring combined features of well-differentiated liposarcoma and low-grade osteosarcoma. Tumor cells displayed overexpression of MDM2, CDK4, and P16 by immunohistochemistry and CGH revealed amplification of 12q13-15 as the only genetic imbalance. MDM2 FISH analysis was performed but was inconclusive. The pathological, immunohistochemical, and genetic features, the differential diagnoses, and the therapeutic management of this unusual tumor are discussed. No complementary treatment was performed initially. Following first treatment, two recurrences occurred 6 and 9 years later, both displaying histological features similar to the first occurrence. Radiotherapy was started after the second recurrence. Follow-up shows no evidence of disease 11 years after initial diagnosis. This case was unusual due to the paravertebral location of the tumor and its divergent differentiation.

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Wide Excision of a Retroperitoneal Liposarcoma with En Bloc Ureterectomy and Renal Salvage by Autotransplantation

Case Reports in Transplantation ◽

10.1155/2019/9725169 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Siegfredo R. Paloyo ◽

Arjel D. Ramirez ◽

Ferri P. David-Paloyo ◽

Rodney B. Dofitas

Keyword(s):

The Philippines ◽

Wide Excision ◽

Low Grade ◽

En Bloc ◽

Excellent Outcome ◽

Mesenchymal Neoplasm ◽

Renal Autotransplantation ◽

Characteristic Features ◽

Well Differentiated ◽

The Right

Liposarcoma is a malignant mesenchymal neoplasm composed of adipose tissue with varying degrees of atypia. These tumors grow slowly and may reach an enormous size particularly if located in the retroperitoneum. We report a 40-year-old male with a 6-month history of gradual abdominal enlargement. Computed tomography (CT) of the abdomen showed a huge retroperitoneal mass with characteristic features consistent with liposarcoma. On laparotomy, the mass was noted to be encasing the right ureter for which a wide excision with en bloc ureterectomy and subsequent renal autotransplantation for organ preservation was done. Post-operative course was uneventful with excellent outcome after 6 months of follow-up. Final histopathologic diagnosis was low-grade, well differentiated liposarcoma, which has favorable prognosis following radical surgery. This was the first report of such a case in the Philippines.

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Hydroxyurea Associated Cutaneous Lesions: A Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.320 ◽

2018 ◽

Vol 6 (8) ◽

pp. 1458-1461 ◽

Cited By ~ 6

Author(s):

Viktor Simeonovski ◽

Hristina Breshkovska ◽

Silvija Duma ◽

Ivana Dohcheva-Karajovanov ◽

Katerina Damevska ◽

...

Keyword(s):

Side Effects ◽

Actinic Keratosis ◽

Myeloproliferative Disorders ◽

Skin Lesions ◽

Term Therapy ◽

Cutaneous Lesions ◽

Cutaneous Side Effects ◽

Dermatological Examination ◽

The Right ◽

Hands And Feet

BACKGROUND: Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas.CASE REPORT: We report a case of a 52-year-old man, on long-term therapy with HU for essential thrombocytosis, with several concurrent skin lesions. Despite the perennial use of HU, the cutaneous changes were neglected. The local dermatological examination revealed oval perimalleolar ulcer on the right leg, with dimensions 6 x 4 cm, clearly demarcated from the surroundings with regular margins, periulcerous erythema, with very deep and highly fibrinous bed of the ulcer, positive for bacterial infection. The ulcer was treated with topical wound therapy with alginate and parenteral antibiotics. The extended dermatological screening also showed two nummular lesions in the right brachial region, presenting as erythematous papules with sharp margins from the surrounding skin, gritty desquamation and dotted hyperpigmentations inside the lesion. Further dermoscopy and biopsy investigations confirmed a diagnosis of basal cell carcinoma. Nasal actinic keratosis was also noted. The patient was advised for discontinuing or substituting the HU therapy.CONCLUSION: We present this case to draw attention to the various cutaneous side effects that occur with perennial HU use and suggest an obligatory reference to a dermatological consult.

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Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

Serbian Journal of Dermatology and Venerology ◽

10.1515/sjdv-2016-0004 ◽

2016 ◽

Vol 8 (1) ◽

pp. 39-44 ◽

Cited By ~ 1

Author(s):

Lucija Kosi ◽

Jelena Perić ◽

Milica Pantović ◽

Gorana Bijelić ◽

Jelica Vukićević Sretenović ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Knee Arthroplasty ◽

Skin Lesions ◽

Direct Immunofluorescence ◽

Topical Steroids ◽

Cutaneous Lesions ◽

Predisposing Factor ◽

Dermatological Examination ◽

The Right ◽

Split Skin

Abstract Localized bullous pemphigoid is a rare variant of bullous pemphigoid, and its exact etiopathogenesis is yet to be elucidated. We present a case of a 74-year-old Caucasian male with a 3-month history of skin lesions that appeared 9 months after he underwent a knee arthroplasty. Dermatological examination showed several pruritic tense bullae on the right knee, localized around the surgical scar, as well as erosions covered with crusts. The diagnosis of localized bullous pemphigoid was confirmed by direct immunofluorescence test (conventional and split-skin). The patient was treated with potent topical steroids, which led to complete resolution of cutaneous lesions. We suppose that the occurrence of localized bullous pemphigoid in our patient may be explained by the concept of “immunocompromised district” in which one disease (surgery) caused an immunological alteration which is a predisposing factor for the development of secondary disease such as localized bullous pemphigoid.

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Lymphomatoid Papulosis in a Case of Atypical Secondary Syphilis

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v14i4.335 ◽

2019 ◽

Vol 14 (4) ◽

pp. e32-e33

Author(s):

Xin (Peter) Mu ◽

Ian Mazzetti

Keyword(s):

Clinical History ◽

Skin Lesions ◽

Secondary Syphilis ◽

Low Grade ◽

Cutaneous Lesions ◽

Syphilis Infection ◽

Lymphomatoid Papulosis ◽

History Of ◽

Skin Biopsies ◽

Syphilis Serology

AbstractLymphomatoid papulosis is an indolent cutaneous lymphoproliferative disorder that presents as recurrent self-resolving papulonodular skin lesions. Currently, there are no known causes for lymphomatoid papulosis and definitive diagnosis is only made histologically. A 64-year-old man presented with a 6-week history of bilateral leg pains, low-grade fevers, and a widespread eruption of painless erythematic papules. Despite testing positive for syphilis serology, he lacked the typical clinical history for classic syphilis and therefore, skin biopsies were performed to confirm the diagnosis. Unexpectedly, the skin biopsies revealed lymphomatoid papulosis which resolved with antibiotic treatments for syphilis. Considering the synchronous resolution of the patient’s syphilis infection and his cutaneous lesions, this is the first report of findings to suggest syphilis as a possible cause for lymphomatoid papulosis. Clinicians should appreciate the possibility of alternative diagnosis for cutaneous presentations in settings of confirmed syphilis infections. RESUMELa papulose lympho-matoïde est un trouble lymphoprolifératif cutané indolent qui se présente sous la forme de lésions cutanées papulonodulaires auto-résolutives récurrentes. Actuellement, il n’y a pas de causes connues de la papulose lymphomatoïde et le diagnostic définitif n’est posé que sur le plan histologique. Un homme de 64 ans a présenté une histoire de 6 semaines de douleurs bilatérales aux jambes, de fièvres de bas grade et d’éruptions généralisées de papules érythémateuses indolores. Malgré un test sérologique positif pour la syphilis, il n’avait pas les antécédents cliniques typiques de la syphilis classique et des biopsies cutanées ont donc été effectuées pour confirmer le diagnostic. De façon inattendue, les biopsies cutanées ont révélé une papulose lymphomatoïde qui s’est résorbée grâce à des traitements antibiotiques contre la syphilis. Compte tenu de la résolution synchrone de l’infection syphilitique du patient et de ses lésions cutanées, il s’agit du premier rapport de résultats suggérant que la syphilis est une cause possible de papulose lymphomatoïde. Les cliniciens devraient apprécier la possibilité d’un diagnostic alternatif pour les présentations cutanées dans les contextes d’infections syphilitiques confirmées.

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A Case of Glomangiopericytoma at the Nasal Septum

Head and Neck Pathology ◽

10.1007/s12105-017-0870-6 ◽

2017 ◽

Vol 12 (4) ◽

pp. 572-575 ◽

Cited By ~ 4

Author(s):

Takashi Anzai ◽

Tsuyoshi Saito ◽

Sho Tsuyama ◽

Miri Toh ◽

Katsuhisa Ikeda ◽

...

Keyword(s):

Tumor Cells ◽

Nasal Septum ◽

Low Grade ◽

Beta Catenin ◽

Mesenchymal Neoplasm ◽

Resected Tumor ◽

Vascular Structures ◽

Borderline Malignancy ◽

Fibrous Tumor ◽

The Right

Abstract Glomangiopericytoma (GPC) is a rare sinonasal perivascular tumor that accounts for < 0.5–1% of all sinonasal tumors. GPC is categorized as a low-grade neoplasm with borderline malignancy and a tendency of local recurrence. GPC is a rare mesenchymal neoplasm characterized by the perivascular proliferation of tumor cells, and it requires being distinguished from solitary fibrous tumors. Here, we report a case of GPC in a 68-year-old male patient who presented at the emergency room of our hospital with a complaint of sudden epistaxis. A small, reddish, protruding tumor was observed on the right nasal septum. A biopsy revealed a possible perivascular tumor such as a GPC or solitary fibrous tumor. Thus, we performed complete resection with endoscopic surgery. The size of the resected tumor was 12 × 5 mm, and it showed a uniform proliferation of oval-to-short spindle-shaped cells with slightly branching vascular structures. The tumor cells showed minimal cytologic atypia and there were an average of 3 mitoses in 10 high power fields. Necrosis was not observed. The tumor cells showed strong and diffuse nuclear immunostaining with beta catenin and were negative with STAT6, CD34 and bcl-2. The MIB-1 labeling index was approximately 5%. Genetic testing revealed CTNNB1 mutation (p.S33C). Thus, a diagnosis of low grade GPC was made on the biopsy and the patient could be successfully treated with endoscopic resection.

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Olfactory Preservation in Craniofacial Resection of Tumor Invading Hemianterior Skull Base: Operative Video

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1727123 ◽

2021 ◽

Author(s):

Kenya Kobayashi ◽

Yasuji Miyakita ◽

Fumihiko Matsumoto ◽

Go Omura ◽

Satoko Matsumura ◽

...

Keyword(s):

Skull Base ◽

Nasal Septum ◽

Cribriform Plate ◽

Cerebrospinal Fluid Leakage ◽

Low Grade ◽

High Grade ◽

Craniofacial Resection ◽

Grade Malignancy ◽

The Right ◽

High Grade Malignancy

AbstractIn traditional craniofacial resection of tumors invading the anterior skull base, the bilateral olfactory apparatus is resected. Recently, transnasal endoscopy has been used for olfactory preservation in resections of unilateral low-grade malignancies. However, for tumors that invade the orbita or for high-grade malignancies, the transnasal endoscopic skull base surgery has been controversial. This video demonstrates the surgical techniques of olfactory preservation during craniofacial resection of a high-grade malignancy invading the hemianterior skull base and orbita.We present the case of a 32-year-old woman with osteosarcoma in the right ethmoid sinus. The tumor invaded the ipsilateral cribriform plate, dura menta, and orbital periosteum; however, the nasal septum and crista galli were intact (Fig. 1A, B). Because the tumor was a high-grade malignancy and the orbita had been invaded, we performed craniofacial resection instead of endoscopic resection (Fig. C2A). We drilled into the right side of the crista galli, midline of the cribriform plate, and perpendicular plate of the ethmoid bone via craniotomy. As a result, we accessed the nasal cavity directly (Fig. 2B). To preserve the nasal septum, we detached the remaining right septal mucosa through the transfacial approach (Fig. 2C). Because of the high risk of cerebrospinal fluid leakage as a result of previous irradiation, we performed vascularized free flap reconstruction of the skull base instead of pericranial flap.Postoperative computed tomography revealed no evidence of tumor (Fig. 1C, D). The patient's sense of smell returned after 1 postoperative day, and she was discharged on the postoperative day 14.The link to the video can be found at: https://youtu.be/XzPABYwzkjs.

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Endobronchial Mucus Gland Adenoma: A Case Report

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.096 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S45-S45

Author(s):

A D Sandhu ◽

Y Liu

Keyword(s):

Frozen Section ◽

Case Reports ◽

Bronchial Epithelium ◽

Benign Tumors ◽

Low Grade ◽

Sleeve Resection ◽

Diagnostic Challenge ◽

Epithelial Tumor ◽

Mucus Gland ◽

The Right

Abstract Introduction/Objective Mucus Gland Adenoma (MGA) is a rare benign epithelial tumor with few case reports. They arise from submucosal glands and ducts of large proximal airways, but have been reported peripherally and within lung parenchyma. MGAs form an exophytic mass that causes obstructive symptoms, occurring in all ages without gender predilection. MGAs have low to no malignant potential, but may be confused with more aggressive entities. Thus, MGA may present a diagnostic challenge on frozen section. Methods We present the case of a 66-year-old male with recurrent right pneumonia and empyema. Bronchoscopy revealed an obstructing mass in the right bronchus intermedius. Biopsies and cytology were insufficient showing only benign bronchial epithelium. Therefore, the patient underwent surgical sleeve resection of the right bronchus intermedius for diagnosis and treatment. It was received in two pieces measuring 1.0 x 0.6 x 0.5 and 2.0 x 1.5 x 0.9 cm - a well-circumscribed, firm white nodule with a smooth exterior and pushing borders. Cut surfaces were mucoid, homogenous and rubbery, with cysts measuring up to 2 mm. Histology showed crowded mucus-filled acini and tubules lined by bland cuboidal to columnar cells without atypia or mitosis. The stroma showed smooth muscle bundles and lymphocytic infiltrate. Benign bronchial epithelium lined the surface. A preliminary diagnosis of “adenoma” was made, with final classification pending permanent section. Results It showed positivity for s100, CK5/6, and CAM5.2. DOG1 showed a luminal staining pattern. NapsinA was negative and TTF-1 was patchy. P63, P40, CK5/6 and calponin highlighted myoepithelial cells, underlining the benign nature of the process. Conclusion MGA may resemble adenocarcinoma, low-grade mucoepidermoid carcinoma, and other benign adenomas. It presents a diagnostic challenge on frozen section as its malignant differentials are more common. Thus, it is important to recognize and be aware of these rare, benign tumors.

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