Trousseau Syndrome Secondary to Carcinoma Gall Bladder: Case Report

Trousseau syndrome is the phenomenon in which an occult visceral malignancy is the underlying cause of an unexpected thrombotic event. Trousseau syndrome has a well-established association with advanced primary pancreatic and pulmonary malignancies and others like prostate, stomach, colon, and hematologic malignancies can be associated. Here we report a case from whose initial presentation we thought that it was stroke, but later she developed DVT in both legs and after investigation it was suspicious of carcinoma gall bladder. Keywords: DVT- deep vein thrombosis, VTE- venous thromboembolism, trousseau syndrome.

Sebaceoma of the External Auditory Canal

Sebaceomas of the external auditory canal (EAC) are extremely rare. The recognition of sebaceoma is important as this benign tumor can be be part of the spectrum of the Muir-Torre syndrome (MTS), which is associated with visceral malignancy and multiple adenomatous polyps. Proper histological identification is thus important for further investigation. We describe a rare case of a sebaceoma that was confined to the EAC. Subsequent immunohistochemical (IHC) staining analysis of the mismatch repair genes (MLH1, MSH2, MSH6, and PMS2) was needed to investigate MTS. Even though the patient has had the history of colon cancer, the result was negative. Otorhinolaryngologists should be aware of rare sebaceoma and its potential association with the internal malignancy, besides the limitation of IHC screening test.

Littoral cell angioma of the spleen: A case report

Spleen tumors are an uncommon disease. Littoral cell angioma belongs to the group of vascular tumors. It is believed that this tumor originates from the tissue of the red pulp sinuses, specifically from the cells that are lining the sinuses. If this rare tumor is diagnosed, it is necessary to search for synchronous or metachronous visceral neoplasia. Littoral cell angioma can also mimic metastatic lesion of the spleen. This case report wants to draw attention on this rare tumor of the spleen which is very often associated with other visceral malignancy.

Muir-Torre Syndrome Associated Periocular Sebaceous Neoplasms: Screening Patterns in the Literature and in Clinical Practice

Background: Muir-Torre syndrome (MTS) is defined clinically as the association of cutaneous sebaceous neoplasm and visceral malignancy. Ancillary tests are considered crucial for diagnosis. Although screening guidelines for MTS, including the Mayo MTS scoring system, have been proposed, there are no ophthalmic site-specific guidelines. Summary: A literature review conducted by PubMed search for articles describing patients with periocular sebaceous neoplasm and MTS disclosed 31 publications describing 60 patients, 36 (60%) of whom fulfilled clinical criteria for MTS, 6 (10%) whose diagnosis was based on screening ancillary studies, 14 (23%) who fulfilled clinical criteria and had supporting screening ancillary studies, and 4 (7%) who fulfilled clinical criteria and had supporting diagnostic genetic testing. Most patients were male (34 vs. 15 females), with a median age of 59 years (range 37–79 years). The most common diagnosis was sebaceous carcinoma (40/60, 67%), followed by sebaceous adenoma (16/60, 27%), followed by other tumors with sebaceous differentiation (4/60, 6%). The periocular lesions were identified prior to visceral malignancy in 10 out of 45 (22%) cases, after visceral malignancy in 34 out of 45 (76%) cases, and concurrently with visceral malignancy in 1 out of 45 (2%) cases. Immunohistochemistry for mismatch repair proteins was performed in 41 out of 60 (68%) and 14 out of 38 (37%) of the tumors had lost MSH2. Based on Mayo-MTS scores of 2 or greater, and after removing visceral malignancies not included in their scoring algorithm, 26 out of 30 of patients (87%) with complete data were considered to be appropriate candidates for further work-up. A survey of current practice was conducted by questionnaires, distributed to ophthalmic pathologists, ocular oncologists, and oculoplastic surgeons from national and international professional societies. Of the 103 physicians who participated in the survey, 91 (88%) felt that MTS evaluation guidelines were not sufficiently clear. Key Messages: Our findings suggest that Mayo MTS screening guidelines may be applicable to periocular sebaceous neoplasms. The uncertainty of ophthalmic specialists about optimal screening guidelines for MTS reflects the heterogeneity of defining criteria for MTS and limited molecular genetic data. Larger studies with detailed clinical, histopathologic, and molecular genetic data are required to formally assess screening guidelines for MTS in patients with periocular sebaceous neoplasms.

Sebaceoma of a Meibomian Gland of the Upper Eyelid

Over a period of 1 year, a 74-year-old man slowly developed a painless left upper eyelid intratarsal mass. The skin was movable over the lesion. At surgery, a well-circumscribed, yellow-white, partially cystic tumor was encountered. Histopathologically it was composed of a random mixture of basaloid and sebaceous cells arranged in interconnecting cords. Immunohistochemical evaluation disclosed epithelial membrane antigen, adipophilin, and cytokeratin 14 positivity. These findings led to the diagnosis of a sebaceoma. The tumor cells abnormally failed to express mismatch repair proteins for MLH1 and PMS2. The patient did not have a personal history of any visceral malignancy, but his father had died at the age of 46 years and a daughter at the age of 33 years from colonic carcinomas. The implications of this periocular sebaceoma for the Muir-Torre syndrome are explored.

Isolated Testicular Metastasis Diagnosed More than a Decade and a Half Post Primary Treatment for Prostate Cancer

Prostate cancer is the most common visceral malignancy among men. It rarely metastasizes to the testicles. We herein present the case of a male patient who underwent a radical prostatectomy for a grade group 3 Gleason score 7 (4+3) prostate adenocarcinoma followed by adjuvant radiation therapy and continuous androgen deprivation therapy after his first biochemical recurrence. Despite optimal management, prostate-specific antigen (PSA) levels rose back up, upon which a PET/CT 68Gallium scan demonstrated an isolated left testicular lesion that turned out to be of prostatic origin following orchiectomy. Testicular metastases from prostate cancer are of unknown prognosis, and the current treatment modality favors an orchiectomy.

’Carcinoma en cuirasse' in the neck: extremely unusual initial presentation of gastric cancer

Cutaneous metastasis from visceral malignancy is a relatively rare phenomenon. It is even rarer to have cutaneous lesions as the first mode of clinical presentation in such malignancies. The lesions are usually nodular, although they can have varied appearances. Common sites of primaries include breast, lung, colorectum, kidney, ovary, and headandneck. We report an unusual form of cutaneous metastasis in the neck, known as ‘carcinoma en cuirasse’, in an elderly man that subsequently led to the diagnosis of an occult gastric cancer. Our case highlights the importance of recognising cutaneous metastatic lesions early, as they may herald the diagnosis of an occult internal malignancy.

Sixteen Years of a Pruritic Unilateral Axillary Eruption: A Rare Presentation of Extramammary Paget’s Disease

Extramammary Paget’s Disease (EMPD) is a rare intraepithelial adenocarcinoma of apocrine gland-bearing skin. The most common sites affected are the vulva in women and the perinanal, scrotal, and penile regions in men. One quarter of cases are extensions of an underlying visceral malignancy, usually colorectal or urothelial carcinoma. The typical presentation is an expanding erythematous plaque that shows large cells with vacuolated cytoplasm and centrally located nuclei on histology. Here we present a case of axillary EMPD that was incorrectly diagnosed and treated as various forms of dermatitis for over fifteen years. Fewer than fifteen cases of axillary EMPD have been reported in the literature in the past ten years.

Erythroderma: a marker for visceral malignancy: rare case report

<p>Skin can provide a vital clue to diagnosis of internal disease. Exfoliative dermatitis (erythroderma) is an uncommon potentially serious inflammatory skin disorder characterized by an intense, widespread erythema and variable scaling. It results from aggravation of pre-existing skin disease, or may be caused by drugs or neoplasms. Although various paraneoplastic dermatoses may occur in association with carcinoma lung, erythroderma as the sole presenting feature is infrequently reported in literature. Herein we describe an elderly male in whom recalcitrant erythroderma led to the diagnosis of squamous cell carcinoma lung with fatal outcome.</p>