The Proliferating and Malignant Proliferating Trichilemmal Cyst: An Anatomo-Clinical Study of Three Cases

<b><i>Background:</i></b> The proliferating and malignant proliferating trichilemmal cysts (MPTC) are rare adnexal tumors. We report 3 cases through which we will detail the anatomo-clinical characteristics of these tumors. <b><i>Cases:</i></b> Two patients, 60 and 56 years old, consulted for multiple scalp nodules, one of which had changed with the appearance of a central ulceration. The removal of the remaining scalp nodules was in favor of PTCs. The third patient presented with an ulcerative lesion occupying the vertex. Skin biopsy found trichilemmal-type keratinization associated with areas of necrosis concluding with a MPTC. <b><i>Discussion:</i></b> The PTC is a transitional form between the trichilemmal cyst (TC) and the MPTC. The increase in the size of a TC and ulceration are sufficient signals to suspect this evolution.

Gastric Neuroendocrine Tumor Mimicking Gastrointestinal Stromal Tumor: A Case Report

Gastric neuroendocrine tumors (NETs) are rare lesions that arise from enterochromaffin-like cells of the gastric mucosa. Gastric NETs are classified into 3 types of NETs and poorly differentiated neuroendocrine cancers. Most gastric NETs usually present as hemispherical, yellowish, polypoid lesions with a central depression and often as subepithelial tumors (SETs) because they are confined within the submucosal layer. Here, we report a case of gastric NET presenting as SET mimicking a gastrointestinal stromal tumor (GIST). Endoscopy revealed a 2.3-cm-sized SET with intact surface mucosa, and endoscopic ultrasonography showed a homogeneous hypoechoic lesion with a well-circumscribed margin. Typical features of gastric NET, such as yellowish mucosal changes or central ulceration, were not observed. GIST was suspected, and a laparoscopic wedge resection was performed. The final diagnosis was gastric NET with grade 2 differentiation.

Glomus tumor of the duodenum: a rare case report

Background Glomus tumors (GTs) are mesenchymal neoplastic lesions arising from the glomus bodies and generally occur in the fingers and toes. Gastrointestinal GTs are rare, and most of them originate from the stomach; however, GT arising from the duodenum is exceedingly rare. Case presentation A 68-year-old man was admitted due to abdominal pain. Endoscopy showed a round, smooth, elevated mass in the second portion of the duodenum with central ulceration. Abdominal contrast computed tomography showed a hypervascular tumor measuring 26 mm in diameter in the second portion of the duodenum, and pancreatic invasion was suspected. Endoscopic ultrasonography of the lesion confirmed a hypoechoic mass arising from the fourth layer of the duodenal wall. A biopsy was performed for central ulceration, and immunochemical studies showed positive results for smooth muscle actin (SMA) and negative results for S100, C-Kit, and CD34. Leiomyoma or gastrointestinal stromal tumor was suspected and pancreatoduodenectomy was performed. The specimen exhibited a vascular-rich tumor, 24 × 24 × 19 mm in size, with deep ulceration in the duodenum. Histological examination showed uniform small round cells with central nuclei and a pale cytoplasm (glomus cell) with perivascular proliferation. Immunochemical studies showed that the tumor was positive for SMA and collagen type IV, and negative for C-Kit, CD34, desmin, and S100. We diagnosed the tumor as a GT of the duodenum. Conclusion GTs of the duodenum are exceedingly rare, but should be considered in the differential diagnoses of duodenal submucosal lesions.

Cutaneous Rhinosporiodosis in Lower Limb Mimicking Squamous Cell Carcinoma : A Case Report

Background: Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidiumseeberi. Though cutaneous lesions in Rhinosporidiosis are rare, they may simulate many common dermatological conditions including malignancy thus posing a diagnostic dilemma. Surgical excision is treatment of choice but dapsone can also be used as an adjunct to surgery. Case Presentation: Here, we are reporting a case where a 45 year old male presented with painless progressive polypoidal growth in the right lower limb for five months with central ulceration. Inguinal lymph nodes were also enlarged. Clinically the lesion appeared to be squamous cell carcinoma. FNAC from inguinal lymph node showed reactive changes and the patient underwent wide local excision of the mass. Histopathological report showed that it was a case of Rhinosporiodosis and the patient was referred to department of dermatology for better management. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 164-166

Cutaneous leishmaniasis in a 65-year-old North Texas male, treated with cryotherapy: A case report

We report a case of a 65-year-old male seen in a North Texas dermatology clinic with three erythematous nodules possessing central ulceration and scaling on the left lateral shoulder, present for months. Head, ears, lips, oral mucosa, and other body surfaces did not reveal similar lesions, and review of systems was negative. Shave biopsy was performed and histopathological findings demonstrated granulomatous inflammation in the dermis and parasitized histiocytes containing peripherally located amastigotes. Leishmaniasis was diagnosed and patient was educated on the disease while communication with the Centers for Disease Control and Prevention was initiated. The patient declined systemic medications from infectious disease specialists and, 3 weeks later, returned for follow-up treatment with cryotherapy.

Efficacy and Safety of Intralesional Methotrexate in the Treatment of a Large Keratoacanthoma of the Dorsal Hand in a 99-Year-Old Woman

Several case reports and retrospective studies have demonstrated that intralesional methotrexate (MTX) could be a very effective and safe alternative treatment of keratoacanthoma (KA). Here, we report a rapid clinical efficacy of two intralesional MTX injections (total dose 40 mg) that were performed 1 week apart in the treatment of a large KA lesion of the dorsal hand in a 99-year-old woman. The lesion, with a 3-cm major axis diameter and a thickness of 2 cm with a central ulceration had rapidly appeared on the right dorsal hand. A 3-mm punch biopsy confirmed the diagnosis of a well-differentiated KA-type spinous cellular carcinoma. Due to the presence of comorbidities (arterial hypertension and atrial fibrillation) and chronic treatment with antihypertensive and oral anticoagulant drugs, treatment with intralesional MTX was proposed to the patient. Two intralesional MTX injections of 20 mg each were performed 1 week apart. A very fast resolution of the lesion was observed after the first injection. A week after the second injection a full resolution of the skin lesion was observed, with a nearly complete resolution of the central ulceration. The treatment was very well tolerated. No local or systemic side effects were observed. This case report confirms that intralesional MTX could be considered an effective and safe treatment of KA also in very old subjects.