Cutaneous Mass Research Articles

Anaplastic Thyroid Carcinoma Initially Presented with Abdominal Cutaneous Mass and Hyperthyroidism

A 63-year-old female was admitted to our hospital with a tender abdominal wall mass about 15 cm in diameter, which she had for 1 month. About 1 week earlier, the patient had also perceived a mass in the neck area. Computed tomography revealed huge thyroid and periumbilical masses. The thyroid hormone levels were consistent with a hyperthyroid state. Pathological examination of the thyroid mass was compatible with anaplastic thyroid carcinoma (ATC) and the abdominal cutaneous mass was shown to be metastatic ATC. Despite palliative radiotherapy and chemotherapy, the patient died of respiratory failure on her 63rd day of hospitalization. This case demonstrates that abdominal cutaneous metastasis and hyperthyroidism can occur as initial manifestations of ATC. To our knowledge, this is the first reported case.

Neuronal Embryonal Tumors in Fish

This article describes 11 cases of neuronal embryonal neoplasia in captive adult teleost fish. Neoplasms were located within 1 or both eyes of 8 fish and the skin of 3 other fish. Ocular neoplasms most often presented as unilateral or bilateral exophthalmia. Seven ocular and 1 cutaneous mass were composed of small triangular (carrot-shaped) neoplastic cells with Flexner-Wintersteiner-type rosette formation. Mass location and histologic and ultrastructural features were suggestive of retinoblastomas. One ocular mass was composed of ribbons and rosettes of neoplastic cells with multiple areas of neuronal differentiation and was diagnosed as a teratoid medulloepithelioma. A cutaneous mass from an electric eel (Electrophorus electricus) consisted of rosettes and streams of elongate neoplastic cells. The epidermal electroreceptor (ampullary) organ was considered as an origin. Although distant metastases were not observed, neoplasms were generally locally aggressive with postexcision recurrence. There was occasional spread to or de novo occurrence within the contralateral eye.

Spontaneous Regression of Congenital Cutaneous Hemangiomas in a Calf

Congenital vascular tumors of the skin have been described in people and a few animals, but unlike infantile hemangiomas in children, spontaneous regression has not been described in animals. A 2-day-old male Belgian Blue cross calf was presented for multiple congenital cutaneous masses that were soft, alopecic, and hyperemic; the calf had no other apparent abnormalities. Two weeks later, one mass had regressed. Surgical excision of one of the remaining masses was performed; histopathologic and immunohistochemical findings were considered diagnostic for epithelioid hemangioma. Eight months following initial presentation, all the masses had regressed spontaneously. This constitutes the first account in the veterinary literature of spontaneous regression in a congenital vascular tumor.

Deux cas d’éléphantiasis pénoscrotal traités par la technique d’Ouzilleau

Two cases of penoscrotal elephantiasis treated following Ouzilleau's technique. The authors present two cases of penoscrotal elephantiasis operated following Ouzilleau's technique. This pathology is characterized by his painless, that the reason of a long time evolution and hence in consultation. Filariosis is the common etiology in tropical area. In our cases, the aetiology is unknown. Scrotal and penis elephantiasis is responsible of aesthetic and functional embarrassment. Resection of a considerable cutaneous mass associated with a reconstruction of the scrotal purse and the cutaneous sleeve of the penis using local flaps remain the suitable means to give a comfort of life.

Disseminated Cutaneous Mast Cell Tumors with Epitheliotropism and Systemic Mastocytosis in a Domestic Cat

A 15-year-old female domestic, medium-haired cat presented to the referring veterinarian with a 2-month history of multiple, raised, disseminated, nodular skin lesions. A biopsy of 1 of the lesions was submitted to the Oklahoma Animal Disease Diagnostic Laboratory for evaluation. Histologically, there were multiple dermal nodules composed of sheets of neoplastic round cells. Multifocally, the neoplastic cells formed multiple small clusters of 3 to 5 cells within the epidermis. Distinct cytoplasmic granules were evident within the neoplastic cells with toluidine blue and Giemsa stains. The neoplastic cells were immunoreactive for c-KIT and lacked immunoreactivity for cluster of differentiation 3 with immunohistochemistry. Based on these findings, multiple epitheliotropic cutaneous mast cell tumors were diagnosed. The cat's health declined rapidly despite aggressive treatment, and the animal was humanely euthanatized. A complete necropsy revealed sheets of similar neoplastic mast cells within the spleen, liver, and individual cells scattered within the bone marrow. Exon 11 of the c-KIT messenger RNA from 1 of the cutaneous masses and the spleen was amplified with reverse transcription polymerase chain reaction, sequenced, and compared with the published c-KIT messenger RNA sequence from fetal cat tissues. The maximum identity was 100% for both tissue samples. To the authors' knowledge, the present report is the first to describe disseminated cutaneous mast cell tumors with epitheliotropism and systemic mastocytosis in a domestic cat.

Sarcoïdose cutanée pseudotumorale associée à un lymphome malin non hodgkinien

Sarcoidosis may be revealed by a variety of cutaneous signs, occasionally atypical. It may also be associated with a lymphoma. Herein we report an original case of pseudotumoral cutaneous sarcoidosis associated with malignant non-Hodgkin's lymphoma (MNHL). A 64-year-old man was hospitalised for follicular and diffuse large B-cell MNHL localised in the cervical, subclavicular and inguinal lymph nodes. The skin examination revealed a bulky, erythematous, purple, infiltrated mass in the right lumbar region and two similar but smaller plaques in the dorsal region. The lesions were asymptomatic, present for six years, and stable. Histological examination of a skin biopsy sample revealed an epithelioid giant-cell granuloma without caseous necrosis. Bacteriological and mycobacteriological samples were sterile. Mediastinal adenopathies and pulmonary micronodules were found on CAT scan. A diagnosis of cutaneous and pulmonary sarcoidosis associated with the lymphoma was made. Polychemotherapy using CHOP combined with rituximab resulted in remission of the lymphoma but was ineffective against the sarcoidosis. Pseudotumoral forms of sarcoidosis are rare and have a misleading clinical aspect. In our case, the cutaneous mass was evocative of a secondary lymphoma site. The diagnosis of sarcoidosis was based on clinical and laboratory findings and after elimination of other potential causes of granuloma. The appearance of a lymphoma in a patient with a history of sarcoidosis is rare but not fortuitous, since the notion of "sarcoidosis-lymphoma syndrome" exists. The incidence of lymphomas is 5.5-fold higher in patients presenting sarcoidosis than among the general population. Their time to onset is around 7 years after the discovery of sarcoidosis. The most common forms involve Hodgkin's disease. The efficacy of therapy on the blood disease underlying the sarcoidosis is variable.

A large infiltrating fibrous hamartoma of infancy in the abdominal wall with rare associated tuberous sclerosis

Tuberous sclerosis is a complex autosomal-dominant neurocutaneous syndrome characterized by hamartomatous malformations of fibrous and connective tissues in various organs. Although various histologic types of soft-tissue masses can occur with tuberous sclerosis, we present a unique case of fibrous hamartoma of infancy presenting as large infiltrating cutaneous and subcutaneous masses in the abdominal wall in a 4-year-old boy with tuberous sclerosis. Although the co-occurrence of tuberous sclerosis and fibrous hamartoma of infancy is very rare, it should be considered in the differential diagnosis of subcutaneous soft-tissue masses found in children with tuberous sclerosis.

Cutaneous fungal granuloma in a horse

This case report describes a 4-year-old-horse with two cutaneous masses on the right crest of the neck. Biopsy revealed chronic nodular pyogranulomatous dermatitis and panniculitis. Giemsa and periodic acid-Schiff stains showed focal spherical, yeast-like organisms. A diagnosis of cutaneous fungal granuloma was made. The size of the masses decreased after oral treatment with fluconazole for 10 days combined with potassium iodide for 30 days, and the remaining masses were excised by laser. Lesions did not recur at the site. Fungal granuloma should be considered as a differential diagnosis in horses with cutaneous or subcutaneous nodules. A definitive diagnosis can only be achieved by histopathological examination or by culture of the affected tissue.

Cutaneous Clear Cell Adnexal Carcinoma in a Dog: Special Reference to Cytokeratin Expression

A 5-year-old, male Bichon-Frise dog presented with a cutaneous mass in the basal region of the auricle. Histologically, the cutaneous neoplasm was comprised of lobules with solid cellular proliferation separated by thin fibrous septa. Neoplastic cells varied in size, with moderate to abundant amounts of PAS-positive cytoplasm, large nuclei and prominent nucleoli. Immunohistochemical examinations showed that tumor cells were positive for pan-cytokeratin (CK) (AE1/AE3 and CAM5.2), CK8 and CK18, but negative for pan-CK (KL1), CK7, CK14, CK16 and CK20. Double-labeled immunofluorescence testing indicated that neoplastic cells frequently co-expressed CK and vimentin, suggesting divergent differentiation of tumor cells. Based on these findings, the tumor was diagnosed as canine clear cell adnexal carcinoma.

Merkel Cell Carcinoma in a Cat

A 17-year-old spayed female Japanese domestic cat presented with a solitary cutaneous mass in the right thoracic area. Histopathologically, the mass consisted mainly of round tumor cells that had infiltrated throughout the dermis and deep subcutaneous tissue. The proliferating pattern of tumor cells was solid but also trabecular or cord-like in some areas, and lined with small cells resembling mature lymphocytes or basal cells. The tumor cells were positive for cytokeratin 20 and synaptophysin. The positive reaction for cytokeratin 20 showed localized to diffuse pattern. This is the first report describing now cytokeratin 20 was clearly beneficial for the differential diagnosis of feline Merkel cell carcinoma.

What is your diagnosis? Preputial mass in a ferret

: A 7-year-old neutered male polecat-type ferret (Mustela putorius furo) was presented for evaluation of a cutaneous mass close to the preputial orifice. Cytologic examination of a fine-needle aspirate revealed numerous large clumps of amorphous pink mucinous material and numerous large clumps of slightly pleomorphic epithelial cells. The cells were arranged in papillary structures, palisades, and loosely cohesive sheets with a vaguely honeycomb appearance. Occasional acinar formations were also seen. The cells had moderate to large amounts of finely granular gray to gray-blue cytoplasm. The cells were round to wispy and elongated, with indistinct borders. Often, anuclear cytoplasmic clumps were seen free in the background or adjacent to intact cells. Nuclei were round to oval and usually off-center. Chromatin was finely stippled and contained 1-3 indistinct nucleoli. Anisokaryosis and anisocytosis were moderate. Binucleated cells were noted occasionally. The cytologic features were consistent with a carcinoma of probable apocrine origin. Histopathologic examination supported a diagnosis of secretory apocrine adenocarcinoma of the preputial skin. Secretory apocrine adenocarcinomas of the prepuce are seen relatively frequently in ferrets, although their cytologic appearance has not been described widely. These neoplasms carry a poor prognosis although prompt surgical removal with wide and deep surgical margins and adjunctive radiotherapy may improve survival.

Imaging findings of juvenile xanthogranuloma of the penis

Juvenile xanthogranuloma (JXG) is a rare benign self-limiting lesion presenting in early childhood. It is the commonest variant of non-Langerhans cell histiocytosis and usually presents as a cutaneous mass. It might have a systemic component and also might be associated with other conditions, notably neurofibromatosis and juvenile chronic myelogenous leukemia. Penile masses are unusual in childhood and we describe a case of JXG involving the penis. Although four cases of JXG of the penis have been reported in the literature, this is the first with imaging of the penile lesion. We discuss the clinical and radiological findings, differential diagnosis and management of these cases. High awareness of these lesions in the differential diagnosis of penile masses presenting in early childhood is important to avoid potentially unnecessary ablative genital surgery. Careful assessment should also be made for any systemic involvement and for associated pathologies.

Cutaneous metastasis from a parotid myoepithelial carcinoma: a case report and review of the literature

Myoepithelial carcinoma of the parotid gland is a rare salivary gland tumour, and its distant cutaneous metastasis has not been reported to date. Here, we report a case of myoepithelial carcinoma of the left parotid gland, which had metastasised to the skin of the right thorax after parotidectomy and radiotherapy. Diagnosis of the primary and metastatic tumour was based on the clinical findings and was confirmed by immunohistochemistry. A literature review of the clinical features of the skin metastases of parotid malignancies and their related pathological mechanisms is included in this case study. It was noted that myoepithelial carcinoma of the parotid gland has the potential to develop distant skin metastasis, which may be indicative of widespread dissemination and poor prognosis. Attention should be paid to initial treatment of the primary tumour and to emerging cutaneous masses whose location is distant from the primary tumour during follow up.

Pilomatricomas in Turner Syndrome

Pilomatricomas are benign, cutaneous tumors of the hair matrix cells, which present predominantly in childhood. Although usually an isolated finding, they have been described in association with several inherited conditions. We report a 10-year-old girl with Turner syndrome who has two pilomatricomas, including one giant tumor. In combination with a previous report of pilomatricoma in two patients with Turner syndrome, our observation indicates that it is likely a real, although uncommon, association of pilomatricomas with Turner syndrome exists. This apparent predisposition may be etiologically related to the abnormalities of hair-bearing skin observed in Turner syndrome. Doctors involved in the diagnosis and management of cutaneous masses in children should be aware of this association.

Cytomorphologic differentiation of benign and malignant mammary tumors in fine needle aspirate specimens from irradiated female Sprague–Dawley rats

Fine needle aspiration (FNA) offers a rapid and minimally invasive means to distinguish malignant from benign neoplasms. However, few studies have been published regarding the cytopathology of mammary tumors in rats despite widespread use of the rat model for breast cancer formation and inhibition. The purpose of this study was to determine the diagnostic accuracy of FNA cytology and to develop distinguishing cytologic criteria for the diagnosis of radiation-induced benign and malignant mammary tumors in rats. In a study of radiation-induced mammary carcinogenesis, 100 Sprague-Dawley rats with cutaneous masses were randomly chosen for FNA. The aspirates were smeared, fixed, and stained with a modified Papanicolaou procedure for diagnostic evaluation. Cytologic and histologic diagnoses (benign vs malignant) were compared, and diagnostic accuracy was calculated using the histologic diagnosis as the criterion standard. FNA smears were scored semiquantitatively on a scale of 1-4 for cellularity, atypia, nuclear size, chromatin pattern, nuclear membrane thickness, nucleoli, and mitoses. The background was evaluated for necrosis, hemorrhage, inflammation, and mucosecretory material. Cytomorphologic features were compared statistically between benign and malignant tumors, based on the histologic diagnosis. The sensitivity of FNA was 92.3% and specificity was 89.4% for the detection of malignancy. However, 14% of specimens, all fibroadenomas by histology, had insufficient cells for cytologic evaluation, for an overall accuracy rate of 78.0%. Malignant tumors had significantly higher scores for all cytomorphologic features, and were significantly more likely to contain cell clusters and necrotic debris. FNA is an accurate method for differentiating benign and malignant rat mammary tumors.

Metastatic Hepatocellular Carcinoma of Skin Diagnosed With Hepatocyte Paraffin 1 and a-Fetoprotein Immunostainings

A rare case of skin metastasis of hepatocellular carcinoma diagnosed with an aid of immunohistochemical stainings of hepatocyte paraffin 1 and a-fetoprotein is reported in this study. An 86-year-old Japanese man was admitted to our hospital due to cutaneous mass in the right chest. An incisional biopsy was performed, which showed proliferation of malignant cells with eosinophilic or clear cytoplasm arranged in solid nests. No trabecular pattern was recognized. Sebaceous carcinoma, clear cell sarcoma, malignant granular cell tumor, metastatic renal cell carcinoma, and metastatic hepatocellular carcinoma were suspected on hematoxylin and eosin preparations. An immunohistochemical study showed that the tumor cells were positive for cytokeratins, hepatocyte paraffin 1, and a-fetoprotein but negative for vimentin, desmin, a-smooth muscle actin, S-100 protein, epithelial membrane antigen, carcinoembryonic antigen, chromogranin, neuron-specific enolase, CD10, CD30, CD34, CD45, CD68, and HMB45. Metastatic hepatocellular carcinoma of the skin was diagnosed pathologically. This case suggests that skin tumors with eosinophilic cytoplasm should be examined by hepatocyte paraffin 1 and a-fetoprotein.

Extravascular papillary endothelial hyperplasia of the palm masquerading as an angiosarcoma

Cutaneous extravascular papillary endothelial hyperplasia (PEH) is a rare lesion presenting as a cutaneous mass and histologically mimicking angiosarcoma. Herein, we describe a patient who presented with a palm tumor that had developed after trauma. Histologically, the lesion was ulcerated and showed proliferation of atypical epithelioid cells with nuclear enlargement and mitosis. Vascular proliferation was evident, and these were positive for CD31 and CD34, with approximately 20% positivity for MIB-1. We diagnosed this case as an extravascular papillary endothelial hyperplasia because there was no evidence of invasion into the surrounding tissue and elastica staining proved it did not have a vascular structure. To our knowledge, cutaneous extravascular PEH has not yet been reported in the published work.

Vulvar Apocrine Tubular Adenoma

Vulvar Apocrine Tubular Adenoma

Transforming growth factor–β overexpression in cutaneous extramedullary hematopoiesis of a patient with myelodysplastic syndrome associated with myelofibrosis

Extramedullary hematopoiesis (EMH) is a relatively rare, but well-documented, manifestation of chronic myeloproliferative disorders. Microscopically, foci of EMH consist of erythroid and myeloid precursors intermixed with megakaryocytes. It typically occurs in the spleen and liver, but very occasionally manifests as cutaneous EMH. We report a 76-year-old Japanese man with cutaneous EMH arising from myelodysplastic syndrome associated with myelofibrosis. His cutaneous manifestations showed multiple skin-colored firm nodules over the head, trunk, and extremities. We detected high plasma levels of transforming growth factor (TGF)-beta1 in our patient. Immunohistochemical analysis of the skin biopsy sample revealed TGF-beta1 overexpression in immature hematopoietic cells and dermal fibroblasts within the cutaneous EMH mass of the dermis. These findings suggest that TGF-beta could play some role in the onset of cutaneous EMH. Five months after his first visit to our dermatologic clinic, the patient developed bone-marrow failure and died. Based on our observations, accelerated malignancy in the bone marrow should be considered in any patient with cutaneous EMH. It is presumed that TGF-beta released from hematopoietic cells within the cutaneous EMH play a critical role in the activation of hematologic malignancy.

Seeding of the Percutaneous Endoscopic Gastrostomy Tract from Esophageal Squamous Cell Cancer Presenting as an Acutely Bleeding Malignant Gastric Ulcer: A Novel Clinicoendoscopic Presentation

While the clinical presentation of cutaneous stomal metastases after percutaneous endoscopic gastrostomy (PEG) placed for pharyngoesophageal malignancy is well described, the clinicoendoscopic findings with gastric stomal metastases is insufficiently characterized. A novel clinicoendoscopic presentation is reported of significant gastrointestinal bleeding caused by an ulcerated gastric stomal metastasis. A male patient was admitted for melena with a growing abdominal wall mass at a former PEG stoma. A PEG had been inserted 8 months earlier for esophageal obstruction from squamous cell cancer. Abdominal computed tomography revealed an 8 x 7 x 6 cm mass extending from the skin to the gastric wall. Esophagogastroduodenoscopy revealed an ulcerated gastric mass. Pathologic examination revealed squamous cell carcinoma in both the gastric ulcer margin and the cutaneous mass. The patient was transfused 2 units of packed erythrocytes. Review of all 44 identified stomal metastases after PEG revealed only 15 cases of pathologically proven gastric involvement, including only five illustrated endoscopic reports. Previously reported clinical manifestations of malignant gastric stomal involvement include an asymptomatic gastric mass, an asymptomatic gastric ulcer, a gastric ulcerated mass with chronic anemia, or gastric perforation from gastric involvement. The current novel report of significant upper gastrointestinal bleeding from a malignant gastric ulcer at the PEG insertion site, that required blood transfusions, extends the clinicoendoscopic spectrum of peristomal metastases after PEG. Peristomal ulcers occurring in this circumstance should be biopsied at an initial or follow-up EGD, despite the recent gastrointestinal bleeding, to exclude malignancy.