Four-Cell Population Collision Tumor of the Scalp: A Case Report and Review of Literature

Background: Most cases of collision tumors (CTum) usually present with 2 histologic cell types. We report a unique CTum case comprised of 4 cell populations. Additionally, we performed a systematic review of the current literature published on head and neck collision tumors (HNCTum). Methods: Eighty-one-year-old male presents with a scalp lesion of several years’ duration. PET/CT scan demonstrated increased uptake in the scalp. Wide local excision with free flap reconstruction was performed and tissue pathology reviewed. Database search of HNCTum was performed and reported. Results: Specimen histopathology consisted of melanoma, squamous cell carcinoma, basal cell carcinoma, and pleomorphic dermal sarcoma. Thirty-one articles met inclusion criteria: 11 thyroid, 7 cutaneous, 7 laryngeal, 2 lymph nodes, 2 salivary gland, 1 glottic, 1 maxillary sinus, and 1 tonsil. Conclusion: We present a highly unique CTum case of 4 different cell populations. The systematic review provides a comprehensive report of HNCTum in literature.

Aplasia cutis congenita in a newborn

Aplasia cutis congenita (ACC) is a localized congenital absence of skin with a reported incidence of 3 per 10000 live births. Most common location is the scalp. The diagnosis is made clinically. The management of the lesion depends on the size and most of them are managed conservatively but larger lesions need surgical closure. Although aplasia cutis congenita is rare, it is very important for the general pediatrician to recognize this and consider it in the differential diagnosis of skin lesions specially the lesions on the scalp. We present a newborn infant with scalp lesion which was clinically diagnosed as aplasia cutis congenita and was managed conservatively.

An Uncommon Case of Colonic Neuroendocrine Carcinoma with Scalp Metastasis

Introduction/Objective Neuroendocrine neoplasms of the colon account for <1% of all colorectal malignancies. While visceral metastasis of neuroendocrine neoplasms is commonly observed, cutaneous distant metastasis has infrequently been reported and correlates with an advance stage and progression of disease. To our knowledge, there have been only 10 cases of neuroendocrine neoplasms with metastasis to the scalp reported in the literature. Herein, we report an unusual case of colonic neuroendocrine carcinoma with scalp metastasis, that can be microscopically indistinguishable from the highly aggressive cutaneous neuroendocrine carcinoma, Merkel Cell Carcinoma. Methods/Case Report A 47-year-old female with a history of ileocecal neuroendocrine carcinoma and status post right hemicolectomy had developed liver metastasis and subsequently had an orthotopic liver transplant. PET scan later revealed multiple areas of increased activity involving the ribs, scalp and cervical lymph node that were concerning for malignancy. The scalp lesion consisted of a 7mm non-tender, mobile, violaceous, erythematous dermal nodule that was clinically concerning for cutaneous metastasis. A skin punch biopsy microscopically revealed a subcutaneous infiltrate of nests composed of neoplastic monotonous blue cells with the classic nuclear “salt and pepper” chromatin and scant eosinophilic cytoplasm. The lesional cells showed positive immunoreactivity for synaptophysin and chromogranin. With the given patient’s clinical history and presentation, the observed histological findings and immunophenotypic expression of the tumor cells supported a diagnosis of metastatic neuroendocrine carcinoma. Results (if a Case Study enter NA) N/A Conclusion Metastatic neuroendocrine carcinoma to the scalp is a rare entity and is infrequently encountered in dermatopathology. Given the location and the gross appearance of the scalp lesion, a wide differential diagnosis would include both benign and malignant tumors. In particular, Merkel Cell Carcinoma can grossly and histologically mimic metastatic colonic neuroendocrine carcinoma. Both entities would show synaptophysin and chromogranin uptake. However, metastatic tumors originating from the colon will demontrate CDX2 and SATB2 nuclear staining. We share this rare case of metastatic colonic neuroendocrine carcinoma as it is an important differential diagnosis for primary cutaneous Merkel Cell Carcinoma.

A Rare Occurrence of Scalp Metastasis in Hepatocellular Carcinoma: Case Report

Hepatocellular carcinoma (HCC) is the most prevalent primary liver malignancy and the fifth most common cancer worldwide. Extrahepatic spread in this type of cancer is most commonly seen in the lungs and lymph nodes and less commonly in the skeletal system. Skull metastases are exceedingly rare, with an incidence of 0.5 to 1.6% reported to date. We report a similar case of a middle-aged Asian male patient with parietal scalp swelling that was initially diagnosed as meningioma. Surgical resection was performed at a local facility. The abdominal computed tomography scan did not reveal any primary or metastatic lesion. After much deliberation, multiparametric magnetic resonance imaging was requested that showed multiple lesions in the liver. Metastatic scalp lesion should be considered a differential diagnosis in HCC regardless of liver symptoms.

Primary Alopecia Neoplastica: A Novel Case Report and Literature Review

Alopecia neoplastica (AN) is caused by neoplastic cells damaging hair follicles, resulting in patchy hair loss like cicatricial alopecia and alopecia areata. AN has predominantly described cutaneous metastasis to the scalp from primary visceral malignant tumors. Less frequently, AN results from a primary scalp neoplasm. Compared to “secondary AN,” there is a paucity of literature on “primary AN.” Herein, we present a comprehensive literature review of primary AN and introduce a unique case of amelanotic melanoma causing primary AN. Including our presented case, 11 cases of primary AN have been reported with causative scalp neoplasms including angiosarcoma, hemangioendothelioma, syringomatous carcinoma, ectopic extramammary Paget’s disease, and primary desmoplastic melanoma. 27.3% (3 of 11) of cases were misdiagnosed and treated for a primary alopecia, and 36.4% (4 of 11) of lesions were present for multiple years or an unknown amount of time, likely due to difficulty in recognizing scalp lesion or misdiagnosis. All patients required surgical excision with 36.4% (4 of 11) requiring chemotherapy, radiation, or photodynamic therapy. Two patients with scalp angiosarcoma died from their aggressive disease. Due to the risks of malignant primary AN if allowed to progress, primary AN should be considered in patients presenting with scarring alopecia.

Prolonged fever and hyperferritinaemia: a puzzling diagnosis of neonatal herpes simplex virus infection during COVID-19 pandemic

Neonatal herpes simplex virus (HSV) infection is rare, with an estimated incidence of 3.58 per 100 000 live births in the UK and should be suspected in any newborn with fever and bacterial culture-negative sepsis. We describe a case of a previously well full-term male neonate who presented with persistent fever and elevated ferritin level that was carried out during the era of the COVID-19 pandemic as part of SARS-CoV-2 panel investigations. Despite the initial negative HSV serology, HSV-1 PCR from a scalp lesion returned positive. He made a full recovery after acyclovir therapy. This case highlights the importance of maintaining a high clinical index of suspicion of HSV infection in any febrile neonate even with absence of maternal history and negative serology, particularly if associated with hyperferritinaemia. We also address the challenge of interpreting inflammatory biomarkers’ results for SARS-CoV-2 infection in neonates.

Rare cutaneous metastasis from sarcomatoid carcinoma of lung

We present the case of a 57-year-old woman diagnosed with stage 4 sarcomatoid carcinoma of the lung who concurrently developed a scalp lesion, thought to be a cyst, which continued to grow and ulcerate. Excision revealed a rare case, only four previously reported in the literature, of metastatic sarcomatoid carcinoma of the lung. While a very unusual case, we would like to emphasise the importance of considering skin metastases when presented with unusual skin lesions, and importantly listening to the patient’s concerns, showing empathy and respecting their autonomy and referring to an appropriate specialist when considering the management of what may seem to be a minor skin report.

Merkel cell carcinoma associated with chronic treatment with hydroxyurea: a case report

<p class="abstract">Merkel cell carcinoma is a rare neuroendocrine tumour of the skin, that shows a quickly and aggressive behaviour and carries a poor prognosis. Surgery is the standard primary treatment modality, while radiotherapy plays a role in postoperative treatment. Radiotherapy is also an alternative to unresectable lesions or patients who are unfit to surgery. Here we report a 90-year-old male with polycythemia vera that was chronically treated with hydroxyurea for about 30 years. The patient presented a purple and exophytic frontal scalp lesion, which had recurred after primary wide excision. This recurrence had been considered inoperable and the patient was treated with external beam radiotherapy to the lesion and locoregional lymph nodes, showing a complete clinical response after 12 weeks. However, disease progressed rapidly, and the patient died from distant metastasis 4 months later. This report is the second described case in literature of Merkel cell carcinoma as complication of chronic hydroxyurea and highlights the need for these patients to undergo regular and close dermatological evaluation.</p>