Concurrence of Marjolin’s Ulcer in the Lower Limb in a Patient with Idiopathic Multicentric Castleman Disease: A Case Report

Idiopathic multicentric Castleman disease (iMCD) is characterized by the benign proliferation of lymphoid cells in multiple regions. However, the co-occurrence of epithelial malignancy and idiopathic multicentric Castleman disease (iMCD) is rarely reported. Herein, we present a case of iMCD mimicking lymph nodal metastasis of Marjolin’s ulcer in the lower extremity. A 53-year-old male presented with an unhealed chronic ulcer on the left lower leg and foot accompanied by an enlarged mass in the left inguinal region. Intralesional biopsy was performed, and pathological examination showed squamous cell carcinoma (SCC). Imaged studies revealed left calcaneus bone invasion, and lymph nodal metastasis was suspected by the cancer TNM staging of T4N2M0 pre-operatively. The patient received below-knee amputation and lymph node dissection; intraoperative histological examination showed no lymphatic nodal malignancy and diagnosed the patient as having iMCD with lymphadenopathy. The patient recovered uneventfully and was referred to a hematologist for further treatment.

Pitfalls in pre-operative prediction of lymph node metastasis in early endometrial cancer

ObjectiveThe role of lymphadenectomy in early stage endometrial cancer is controversial as it is associated with intra-operative complications and its therapeutic benefit is not established. Prediction of lymph nodal metastasis so as to perform selective lymph node dissection is desirable. This study was conducted to study grade of the tumor obtained by endometrial biopsy specimen and depth of myometrial invasion assessed by imaging pre-operatively as predictors of lymph nodal metastasis in early endometrial cancers.MethodsOur study was a cross sectional study done in a tertiary care center in south India, where 100 patients were studied from August 2016 to May 2018. After Ethical Committee clearance, all patients who were diagnosed with early endometrial cancer and who underwent surgery in our hospital were included in the study after getting informed consent. Pre-operative tumor grade and depth of myometrial invasion were studied as predictors of lymph nodal metastasis. They were also correlated with post-operative grade and myometrial invasion.ResultsThe present study recruited 100 women of which 3 cases were excluded because of non-endometrioid histology. The incidence of positive lymph node metastasis in our study was 18.6%. Both pre-operative tumor grade and depth of myometrial invasion were not significantly associated with lymph node metastasis. There was significant variation between pre-operative and post-operative tumor grade and depth of myometrial invasion. Among post-operative histopathological factors, only lymphovascular space invasion was found to be significantly associated with lymph node metastasis.ConclusionIn our study, neither pre-operative nor post-operative grade of the tumor and depth of myometrial invasion were significantly associated with lymph node metastasis. There was considerable variation between pre-op and post-op grade of the tumor making pre-op grade an unreliable factor in predicting lymph node metastasis in endometrial cancer. Among post-operative histopathological factors, only lymphovascular space invasion was found to be significantly associated with lymph node metastasis.Key messageConsiderable variation between pre-op and post-op grade of the tumor makes pre-op grade an unreliable factor in predicting lymph node metastasis in endometrial cancer

A Case Report of a Solitary Pelvic Mass Proven to Be a Lymph Nodal Metastasis from Anal Cancer

A solitary pelvic-wall lymph nodal metastasis can be mistaken as a primary malignancy when a primary tumor has not been diagnosed. We report the case of a 72-year-old woman with a solitary left pelvic-wall mass that was finally proven to be a left internal iliac lymph nodal metastasis from anal cancer. No signs of the primary tumor had been initially found by general screening using computed tomography, colonoscopy, pelvic magnetic resonance imaging, and gynecological/urological examination; however, squamous cell carcinoma was detected by surgical biopsy of the left pelvic-wall mass. Additional 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) showed focal accumulations in the left pelvic mass and the anal canal. A biopsy of the induration in the anal canal led to the diagnosis of anal cancer, clinical T2N2M0, and stage IIIB (UICC-TNM 7th ed.), which was indicated for definitive chemoradiotherapy. Two months after completing a definitive chemoradiotherapy for anal cancer, a fixed induration developed under the surgical wound along with the surgical tract of the biopsy site. Physical examination and 18F-FDG-PET/computed tomography led to the clinical diagnosis of unresectable surgical tract recurrence of anal cancer. The patient underwent palliative treatment and died 14 months after the diagnosis of the surgical tract recurrence. In conclusion, anal cancer may present as a solitary pelvic mass without any anal symptoms. To evaluate the solitary pelvic mass, 18F-FDG-PET/computed tomography, along with digital examination, will probably help in establishing an accurate diagnosis. Anal cancer must be considered during the differential diagnosis of a solitary pelvic-wall mass for a correct diagnosis and to avoid unnecessary procedures.