Xanthogranuloma of nose in an adult: an uncommon presentation

<p class="abstract">Xanthogranuloma is a relatively rare histiocytic cutaneous disorder that typically affects the pediatric age group. Its occurrence in adulthood is still rarer with only a handful of cases on the record. The present case report describes a case of adult-onset xanthogranuloma in a 49 years old lady who presented to the otorhinolaryngology clinic with a 6 months history of a nodule on the left side of the columella. There was no history of associated pain or bleeding from the site. Local examination revealed a 0.6×0.6 cm, non-tender, soft-to-firm, pinkish dome-shaped lesion with rounded edges. No similar lesions were found elsewhere. Excisional biopsy of the lesion was performed and microscopy showed a dermal lesion comprising of sheets of histiocytes admixed with lymphoplasmacytic infiltrate, touton giant cells and few spindle cells. A diagnosis of xanthogranuloma was rendered. A number of lympho-histiocytic lesions comes in the differential diagnosis of xanthogranuloma and hence it is important to be aware of such unusual presentations in order to make correct histological diagnosis.</p>

Possible IgG4-related respiratory disease (IgG4-RRD) - a rare presentation as a Pancoast tumour-like

IgG4-related respiratory disease (IgG4-RRD) is a recently recognized disease that can have multiple presentations. In many cases, the exclusion of malignancy is essential. We present a case of a male patient with right omalgia and supraclavicular swelling. Radiologic exams showed a lung mass suggestive of a Pancoast tumour in the right upper lobe. Patient underwent transthoracic biopsies that revealed fibromuscular tissue with fibrosis, lymphoplasmacytic infiltrate and a significant increase in IgG4 cells with 15% IgG4/IgG ratio. He started on prednisolone with clinical and radiologic improvement. As it is a heterogeneous disease it is important that clinicians are aware of the possible presentations.

Peritoneal Chlamydia trachomatis Infection as a Cause of Ascites: A Diagnosis Not to Be Missed

Ascites is a common complication of several conditions, but it is rare in cases of <i>Chlamydia trachomatis</i> infection. We report a 36-year-old patient presenting with abdominal swelling for a week prior to hospitalization. An extensive workup excluded liver or heart disease and malignancy. A computed tomography scan demonstrated massive ascites and severe thickening of peritoneal reflections. Laboratory tests showed low serum-ascites albumin gradient, high total protein, and low adenosine. Diagnostic laparoscopy revealed inflammatory signs of both fallopian tubes. The histopathological results from peritoneal biopsy were consistent with lymphoid proliferation with reactive lymphoplasmacytic infiltrate. A gynecological investigation showed a positive DNA for <i>C. trachomatis</i> in the cervical swab. After treatment with doxycycline, there was a complete resolution of ascites.

An aggressive case of Warthin-like variant of papillary thyroid carcinoma (PTC)

Introduction/Objective Warthin-like variant of PTC is a rare subtype of PTC, characterized by papillary growth lined with oncocytic neoplastic cells and lymphocytic rich stroma in the stalks of the papillae. It is frequently associated with Hashimoto thyroiditis and has good prognosis due to lower risk of metastasis. An association with BRAF V600E mutation has been reported. Here we report an aggressive case of Warthin-like variant of PTC. Methods/Case Report A 33-year-old Hispanic female presented with a progressively expanding neck mass, difficulty swallowing, voice hoarseness, and neck pain. Ultrasound showed a 3.8 cm left thyroid nodule which on biopsy was positive for PTC. Laboratory tests were positive for anti-peroxidase and anti-thyroglobulin antibodies. A total thyroidectomy was performed. Grossly, the left thyroid lobe nodule was well-circumscribed, unencapsulated, and firm with solid homogenous gray-tan cut surface. Microscopically, the nodule consisted of large eosinophilic cells demonstrating characteristic PTC nuclear features, arranged in papillary structures with the cores packed with prominent lymphoplasmacytic infiltrate consistent with Warthin-like variant of PTC (figure). Separate sub-centimeter foci of PTC with similar features were identified in a background of chronic lymphocytic thyroiditis. Central and left neck dissection showed extensive lymph node metastasis which had features similar to the primary tumor but with less pronounced lymphoplasmacytic cores. The patient is currently 6-month post operation and is receiving iodine ablative therapy. Results (if a Case Study enter NA) NA Conclusion Molecular analysis of the tumor may aid in identifying molecular aberrations responsible for the aggressive nature in this case and potentially guide treatment.

Lymphoepithelial Carcinoma of the Palatine Tonsil

Lymphoepithelial carcinoma is an undifferentiated carcinoma with nonneoplastic lymphoplasmacytic infiltrate, mostly located in the nasopharynx, while it is extremely rare in the oropharynx. We present a rare case of lymphoepithelial carcinoma arising from palatine tonsil. A 81-year old male patient complained of dysphagia, hypersalivation and bloody sputum. Clinical examination revealed hypertrophy of the right palatine tonsil and ipsilateral cervical lymphadenopathy. Biopsy and histopathological analysis confirmed the diagnosis of lymphoepithelial carcinoma. Multi-slice computed tomography showed a 33x31x38 mm heterodense mass in the region of the right palatine tonsil, and 37x30 mm and 21x20 mm lymph nodes on the right side of the neck. The patient was reffered to an oncology council, which suggested radiotherapy and concurrent chemotherapy. Although rare in clinical practice, lymphoepithelial carcinoma should be considered in cases of tonsil cancer.

Lupus mastitis in men

To analyze the pathophysiological aspects of lupus mastitis (LM), clinical presentation, epidemiology, radiological and histological findings, and treatment, to disseminate it to the academic community and draw attention to this pathology as one of the differential diagnoses in the management of breast lesions in males, especially in the case of breast cancer in men. A literature review was done by searching scientific studies in the PubMed / Medline, Scopus, Scielo, Embase, Web of Science, and Google Scholar databases. Relevant scientifically validated studies related to lupus mastitis in men were selected. The analysis, review and selection of articles carried out in pairs, blindly and separately, based on the reading of the title and abstract, with a third reviewer in case of disagreement. The LM should be suspect in patients known to have lupus erythematosus who present painful breast nodules associated with skin changes. However, LM can be the initial manifestation of lupus and mimic, both clinically and imaging, malignant neoplasms. The histopathological diagnostic criteria are well-established, finding mainly hyaline fat necrosis and lymphoplasmacytic infiltrate. Treatment must be drug-based as invasive procedures can exacerbate the injury. Due to physiological and anatomical aspects, this condition can appear and evolve differently in men. The knowledge of this pathology is necessary to carry out the correct approach since the non-identification of the disease and its erroneous management can lead to complications and irreversible sequelae to the patient.

Renal Involvement in IgG4-Related Disease: From Sunlight to Twilight

IgG4-Related Disease (IgG4-RD) is a fibroinflammatory condition characterized by a typical histopathological pattern (dense lymphoplasmacytic infiltrate with prevalent IgG4+ plasma cells and storiform fibrosis), which may involve the kidney both directly (IgG4-related kidney disease, IgG4-RKD) or indirectly, as a consequence of post-renal ureteral obstruction due to retroperitoneal fibrosis (IgG4-RD RF). The most frequent presentation of IgG4-RKD is IgG4-related tubulointerstitial nephritis (TIN), but a glomerular disease can be present, in most of the cases a membranous nephropathy. Albeit steroid-responsive, in some cases renal manifestations may lead to progressive and permanent organ damage. In this review we describe four clinical cases representative of typical and less typical renal manifestations of IgG4-RD, emphasizing a potential, subclinical, early involvement of the kidney in the disease.

Lymphoepithelial carcinoma of the larynx: An unusual response to EXTREME regimen therapy. A new option for treatment?

Lymphoepithelial Carcinoma (LEC), an aggressive variant of Squamous Cell Carcinoma (SCC), is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. Most cases of LEC occur in the nasopharynx, while it rarely involves other sites. LEC of larynx and hypopharynx is an extremely rare and aggressive neoplasm, characterized by a high propensity to loco-regional dissemination and a poor prognosis; it represents the 0,2% of all tumours of the larynx. Since it is such a rare tumor, the current literature provides only recommendations and there are no treatment guidelines available. A 70-year-old man with laryngeal LEC and both distant and nodal metastases was treated with chemotherapy, following EXTREME regimen therapy. It was classified as a cT3 N3b M1 glottic cancer (Stage IVC, AJCC 8th Ed.), stage IVC. As the response on metastases was unexpectedly encouraging, surgical treatment on T could be performed. Patient underwent to total laryngectomy and bilateral neck dissection. To date, eight months after surgery, the patient is disease free. The unusual clinical course is reported.

Penile Lymphoepithelioma-Like Carcinoma: A Rare Case With PD-L1 Expression

Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.