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>

Proptosis and a Dermal Lesion as the Presenting Sign of Lung Adenocarcinoma

The purpose is to describe a clinical case of orbital metastases as the presentation sign of the primary tumor, and the importance of a multidisciplinary diagnosis. A 70-year-old man attended the Ophthalmology Department referring ocular pain. Mild proptosis and a dermal lesion in the neck were noticed. Biopsy of the dermal lesion and systemic work-up were compatible with lung adenocarcinoma with metastatic dissemination. After one cycle of palliative chemotherapy, patient’s medical condition worsened, and he eventually died. Although rare, orbital symptoms can be the initial clinical presentation preceding the diagnosis of the primary silent lung neoplasm. Ophthalmologist has an important role in diagnoses of metastatic orbital cancer. Involvement of the multidisciplinary team is important for diagnosis and treatment.

Comparative study between the efficacy of long-pulsed Neodymium- YAG laser and Fractional CO2 laser in the treatment of striae distensae

Background: Striae Distansae (SD) are a disfiguring dermal lesion, characterized by lines of dermal atrophy, occurring at sites of dermal damage caused by stretching. They affect adolescents and more than 70% of pregnant females due to stretching of the skin.Objectives: To assess and to compare the effect of 1, 064 nm Long Pulsed (LP) Nd: YAG laser and Fractional CO2 laser clinically and histologically in treating SD.Materials/Methods: Thirty female patients with bilateral symmetrical SD were treated with Fractional CO2 laser on one side and long-pulsed Nd: YAG laser on the other side. All patients treated with 3 laser sessions at 3 weeks interval. Global Aesthetic improvement scale (GAIS) and the score of patient satisfaction were used to evaluate improvement 3 months post treatment. Four mm punch biopsies were taken from each side before treatment and 3 months after the last session to measure epidermal and collagen thickness.Results: More significant clinical improvement was noted with the Nd:YAG laser than Fractional CO2 laser. Both GAIS and satisfaction score were significantly higher in the Nd:YAG laser treated side epidermal and collagen thickness were evidently increased in the lesions treatd by Nd: YAG laser than those treated by Fractional CO2 laser with no significant difference.Conclusions: Long pulsed Nd-YAG laser is clinically more effective than the Fractional CO2 laser in treating SD without serious adverse effects, although there was no significant difference between them histopathologically.

Co-expression of CD34 and h-caldesmon in a benign meningioma-like dermal neoplasm, a case report

Meningioma-like dermal tumor with diffuse coexpression of CD34 and hcaldesmon is rarely reported. Herein, we report a case of a 58-years-old woman who complained of a solitary dome-shaped papule on the left hand. An ellipse of skin measuring 1 x 0.5 x 0.5 cm was excised and sent for histopathological evaluation. Upon sectioning, the specimen showed a whitish firm dermal nodule measuring 3 mm in its greatest dimension. Microscopic examination revealed a well-circumscribed barely encapsulated dermal lesion showing compact round whorled sheets formed of round to ovoid uniform cells with abundant pink cytoplasm. Occasional intranuclear vacuoles were seen. A minor capillary-sized vascular component was seen in the background. Immunohistochemical (IHC) study revealed a diffuse positivity of tumor cells to CD34 and h-caldesmon along with faint reaction to Smooth Muscle Actin (SMA) and ER. However, Desmin, S100, HMB45, EMA, Pan Cytokeratin, and Chromogranin were all negative. Ki67 was very low (1%). The main differential diagnoses of the current lesion are meningioma and glomus family tumors. While the current lesion is morphologically reminiscent of cutaneous meningioma; neither the location nor the IHC stains support that diagnosis. The glomus family is highly suggestive. However, the location, the compact nature of the proliferation, and the positivity of CD34, all are unusual in such entities.

Eccrine spiradenoma: a rare adnexal tumour with atypical presentation, a case report

First described in 1934, eccrine spiradenoma (ES) is a rare, benign adnexal tumour arising from eccrine sweat glands. It commonly presents as a slow-growing nodule on the upper trunk, and head and neck region, mostly in the age bracket of 15-35 years, with no gender preference. While no established guidelines exist for optimal management of malignant ES, some therapies have been studied. The diagnosis of this entity is extremely important as it can harbour a malignant component with disastrous outcomes which may be missed due to its strong resemblance to benign lesions, such as a papilloma. Here, we present the case of a 35-year-old lady who presented with a papilloma-like growth on the upper medial aspect of the thigh which was diagnosed as eccrine spiradenoma upon excision. Keywords: Eccrine Spiradenoma, adnexal tumour, dermal lesion, case report. Continuous...

Autoamputation of Dermatofibrosarcoma Protuberans: A Novel and Rare Presentation of a Familiar Entity

Dermatofibrosarcoma protuberans (DFSP) is categorized as a fibrohistiocytic tumor of intermediate malignant potential. It has significant risk for local recurrence and, less commonly, local or distant metastasis. Initially, these tumors typically arise as a firm plaque on the skin that slowly progresses to a nodular and protuberant dermal lesion. DFSP can also exhibit ulceration, hemorrhage, and accelerated growth, but autoamputation has not been described in the English literature. In this article, we report a case of an asymptomatic classical DFSP on the upper back in which the protuberant portion spontaneously autoamputated. In this case, the residual lesion was treated with Mohs micrographic surgery. The presentation, features, and implications of this interesting mode of presentation are discussed.

Rudimentary Meningocele of the Scalp: A Pitfall in the Diagnosis of Vascular Neoplasms

We present a case of sequestrated meningocele in a 1-year-old girl, who presented with a 1x1cm occipital swelling since birth. CT brain revealed the soft tissue swelling to be extracranial. She underwent surgical excision of the specimen and the excised mass was sent for histopathological examination. The specimen consisted of skin and subcutaneous tissue measuring 2 x 1 x 1 cm. The entire tissue was paraffin processed. Multiple sections studied from the lesion showed an ill circumscribed locally infiltrative dermal lesion. The lesion was composed of whorled proliferations of meningothelial cells enclosing pseudovascular spaces. Immunohistochemically the lesion was positive for EMA, Desmin, and negative for endothelial markers. The present case was documented as a rare case of a rudimentary meningocele.