Exophytic Nodule Research Articles

Giant pretibial cellular fibrous histiocytoma colliding with an epidermal cyst

Histiocytomas are common benign tumors of the skin. In contrast, giant histiocytomas are a rarity. We report a 43-year-old male patient, who presented with a 7 × 6 cm large firm tumor on his left lower leg. This was a long-standing lesion, but within the last three months, the tumor developed an exophytic nodule. A skin biopsy revealed an atypical spindle-cell tumor. We decided to perform a complete excision with a safety margin. Complete histopathological analysis confirmed the diagnosis of a collision tumor composed of a cellular fibrous histiocytoma and an epidermal cyst. The resulting defect was temporarily closed by vacuum-assisted closure before eventually a meshed split skin graft was transplanted. Proliferating fibrohistiocytic lesions should be surgically removed, and a careful histopathologic analysis is necessary to avoid delayed diagnosis of possible malignant lesions.

Two Cases of Unusual Clinical Features of Keratoacanthoma

The Iraqi and the Yemeni dental literature lack documentation of keratoacanthoma (KA). It uncommonly appears at the mucocutanous junction and very rarely reported to arise in the mucous membrane. Nevertheless, it has such a chance; therefore, it is necessary to bring the attention of dental practitioners to this lesion. It is a benign epithelial tumor that frequently affects the face of old people. It usually, appears as an exophytic nodule with a central keratin plug that grows rapidly but with several poses. Clinically and microscopically KA is similar to squamous cell carcinoma (SCC) and can be occasionally misdiagnosed therefore it is important to be biopsied and carefully interpreted. This report presents two clinically unusual cases of KA.

FRI367 An Unusual Presentation Of A Thyroid Nodule: A Thyroid Paraganglioma

Abstract Disclosure: M. Owrangi: None. F. Hasan: None. Introduction: Thyroid paraganglioma (PGL) is a rare thyroid tumor that originates from inferior laryngeal paraganglia. We present a case of a patient initially believed to have a thyroid nodule which turned out to be a PGL. Case Presentation: A 49 year-old white female with history of GERD and mild dysphagia who was found to have a left parathyroid adenoma vs. a left exophytic thyroid nodule. Previous ultrasounds had all showed slow but progressive enlargement of the lesion. Her labs had showed iPTH, Ca, TSH, and free T4 all within reference range and she was clinically euthyroid. She had 2 fine needle aspirations (FNA) which were both non diagnostic. She ultimately underwent surgical excision of the mass. The pathological examination showed cells that were positive for synaptophysin, chromogranin, GATA-3, S100, and neuron-specific enolase. They were negative for Ki-67, PTH, thyroglobulin, TTF-1, CK AE1/AE3, and CD 138. The overall findings were consistent with thyroid PGL. Discussion: In this case Thyroid PGL was diagnosed after pathological examination, including immunohistochemistry, was performed on a surgically excised sample, after 2 FNAs were non-diagnostic. Thyroid PGLs are elusive tumors. One study suggested that since they were first described in 1964, until 2015, there have only been 54 reported cases of thyroid PGLs, with a strong female predominance (88.9%). They often present as asymptomatic thyroid nodules and their diagnosis can be difficult by FNA alone as they can morphologically mimic medullary thyroid carcinoma, intrathyroidal parathyroid proliferation, metastatic neuroendocrine tumor, or calcitonin-negative neuroendocrine tumor of the thyroid gland (CNNETT). Thyroid PGLs are often benign, slow growing tumors and account for only 0.012% of all head and neck tumors with a malignancy rate of 4-16%. They usually present as single nodules averaging 3.5 cm and are often diagnosed with routine ultrasound assessment of the neck. Since they are associated with the parasympathetic nervous system, signs and symptoms including tachycardia, palpitations, and weight loss due to hormonal activity are classically absent from thyroid PGLs. In about 30% of cases, thyroid PGLs have a genetic predisposition and are more than one and associate with other tumors such as pheochromocytoma. Major hereditary disorders associated with paraganglioma include von Hippel-Lindau disease, multiple endocrine neoplasia, familial paraganglioma syndromes 1 to 4, and neurofibromatosis. Therefore, it is highly recommended that patients with a diagnosis of thyroid PGL undergo additional investigations with imaging, hormonal activity assessment, and genetic testing. Given the difference in management of thyroid PGLs compared to its cytology mimics, and their association with some familial cancer syndromes, use of immunohistochemical staining is crucial in making the correct diagnosis. Presentation: Friday, June 16, 2023

Extension of Multinodular Goiter to the Parapharyngeal Space - a Case Report.

parapharyngeal space can have a mass of thyroid origin following metastasis from the thyroid or ectopic thyroid tissue. The extension of multinodular goiter into the parapharyngeal space is rare. A 54-year-old female presented with a 5-month history of neck mass and dyspnea. On examination, a large mass was seen on the right side of the neck which was bulging into the right parapharngeal. In the sonography, a large 50 × 57mm cyst seen at the upper end of the right lobe of the thyroid. Computed tomography (CT) identified a 46 × 56mm lesion medial to the right carotid sheath with a mass effect on the parapharyngeal space from the posterolateral aspect and appeared to be an exophytic cystic nodule arising from the upper pole of the right thyroidal lobe. The patient underwent total thyroidectomy, and the final pathology of multinodular goiter was reported. The spread of masses of the thyroid origin to the parapharyngeal space should be considered one of the differential diagnoses of these space masses.

Melanocytic Matricoma With Atypical Histopathological Features: A Case Report of an Extremely Rare Entity and Review of the Literature.

Melanocytic matricoma with atypical features is a rare, biphasic adnexal neoplasm displaying hair matrix differentiation, with only 3 reported cases worldwide. Generally, the lesion comprised a solid matrical and supramatrical cell proliferation, admixed with intermediate cell aggregates with sparse anucleated "shadow cells" and a prominent pigmented melanocytic hyperplasia. We report the case of a 78-year-old man with a slow-growing crusted lesion on the frontal left scalp, which in a matter of 1-2 months became a 0.6 cm well-defined, black purplish exophytic nodule. Histopathologically, the lesion presented a well-circumscribed border with a nodular dermal growth pattern, presenting different architectural features varying from benign pilomatricoma-like changes to atypical features such as moderate-to-high nuclear pleomorphism in both basaloid (matrical/supramatrical) and epidermal (keratinous) components. Strong nuclear and cytoplasmic positivity for β-catenin was observed in matrical cells, whereas prominent cytoplasmic membrane positivity for Melan-A in dendritic melanocytes. Owing to the evidence of atypical cytological features, we propose the "atypical/borderline" category of melanocytic matricoma as part of a possible spectrum among matrical neoplasms. Pathologists should be aware of any atypical histopathological features while reporting cases due to their potential malignant transformation.

Metastatic Breast Carcinoma with Cutaneous Metastasis and Right Pleural Effusion

Cutaneous metastasis is when cancerous cells spread from a primary tumour to the skin. This is a case of a 75-year-old patient who developed skin metastasis with underlying primary breast. A 75-year-old lady presented with a 3-week history of the progressive appearance of multiple asymptomatic nodular lesions on the chest. Eight months earlier, she was diagnosed with right breast carcinoma and underwent neoadjuvant chemotherapy followed by a right modified radical mastectomy. She presented with progressive skin lesion over the right upper limb and anterior chest wall. She denied any fever, pain or pruritus and any preceding burn or trauma. She also completed a course of antibiotic for the lesion. Physical examinations revealed an erythematous lesion with multiple exophytic nodules. It was painless and extended from the anterior chest wall to the right upper limb. Lung auscultation revealed reduced air entry over the right upper zone. She was then referred to the Oncology Department and diagnosed with metastatic breast carcinoma with right pleural effusion and cutaneous metastases. As she was unfit for further systemic therapy, she was discharged home and continuation of supportive care. Chest radiograph revealed right upper lobe opacity and bedside ultrasound confirmed right upper lobe pleural effusion. Other investigations were unremarkable. Cutaneous metastasis accounts for 24% of breast carcinoma and may manifest as the presenting lesion or after the tumour diagnosis. The commonest manifestation is the presence of nodules in the ipsilateral chest wall to the primary tumour, their size varies, is painless and are commonly spread via lymphatic drainage. Skin biopsy helps in diagnosis confirmation. Definitive treatment depends on the management of the primary malignancy. As it may mimic benign lesions, one should be highly suspicious of skin metastasis as he might be the first person to identify the primary tumour. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S22

Co-infection of distinct papillomavirus types in a captive North American porcupine

BackgroundOnly two cases of papillomavirus infections in North American porcupines (Erethizon dorsatum) have been described thus far, and molecular investigation linked these cases to two distinct papillomavirus species.MethodsIn this report, we present the clinical, histological and molecular investigation of a third case of a porcupine papillomavirus infection. Papillomatous lesions occurred on the upper and lower lip of an otherwise healthy three-year old female that was kept in captivity. Within one month, the lesions progressed into exophytic black nodules, followed by a temporary stabilization and ultimately spontaneous regression within seven months of their initial observation. PCR-based screening using specific primers for Erethizon dorsatum papillomavirus 1 and 2 revealed the presence of both these virus types, after which nanopore sequencing was used to determine the complete sequences of the two virus genomes.ResultsOne of the genomes shares 99.9% similarity with the only known sequence for Erethizon dorsatum papillomavirus 1, while the second represents a distinct lineage of Erethizon dorsatum papillomavirus 2, sharing only 93.3% similarity with the previously discovered strain.ConclusionsThis report marks the first observation of a papillomavirus co-infection in a North American porcupine, although the individual contribution of the two virus types to the clinical presentation was not assessed.

Deep Dermatophytosis Presented as Multiple Exophytic Masses caused by Trichophyton rubrum in Immunocompromised Patient with Rheumatoid Arthritis; A Case Report

Dermatophytes invade the stratum corneum and infect the skin, nails, and hair, mostly resulting in superficial infections. Deep dermatophytosis involving the dermis and subcutaneous layer has rarely been reported in immunocompromised individuals. Herein, we report a case of deep dermatophytosis caused by Trichophyton rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules in both the lower legs. The patient was taking immunosuppressive agents for rheumatoid arthritis and antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathological findings showed diffuse granulomatous infiltration with multinucleated cells, lymphocytes, histiocytes, and neutrophils in the dermis. Septate and branched hyphae were observed in the dermis using periodic acid-Schiff diastase and Gomori methenamine silver staining. T. rubrum was identified in fungal culture from the tissue sample and confirmed through phylogenetic analysis of the internal transcribed spacer and large subunit regions in ribosomal ribonucleic acid gene. Intravenous amphotericin B was administered for septic shock before the confirmation of the causative organism, which rapidly improved the condition.

PSAT351 Thyroiditis following COVID-19 vaccination

Abstract Background COVID-19 vaccination has resulted in several unexplained side effects. However, thyroiditis has not been commonly reported. Clinical Case A 46- year-old woman without notable past medical history presented with new neck tenderness that began five days after the 1st Pfizer COVID vaccine. Symptoms progressed to nightsweats, heat intolerance, palpitations, mild tremors and fever of 101 F. Her neck tenderness was 4 out of 10 with muscle stiffness and 3 lb weight loss after receiving the vaccine. She took NSAIDS for fever every 12-24 hours. She denied any compressive symptoms, visual symptoms or sleep disturbances. She had no cough, sore throat or close contact with a COVID positive individual/sick contact. RT-PCR was done for COVID-19 and was negative. There was no personal history of radiation exposure or family history of Graves’ disease. There was no prior history of drug allergies. On examination, she was afebrile. Right thyroid gland was visible and tender to touch without overlying redness. A right thyroid nodule was appreciated without discrete margins and was not fluctuant. Left lobe was palpable without any nodules. She was tachycardic and had fine tremors on her hands. The remaining of the exam was unremarkable. Laboratory data showed TSH 0.01 mIU/L (0.3-5.50) with elevated FT4 of 3.05 ng/dL (0.76-1.70) and FT3 of 10.5 pg/mL (1.9-3.9). CBC showed a mild anemia with normal white blood cell count. ESR was elevated. TPO antibodies, thyroglobulin antibodies and Thyroid stimulating Immunoglobulins (TSI) were unremarkable but thyroglobulin level was significantly elevated at 1132 ng/mL (0-35). Thyroid scan demonstrated thyroiditis. Neck US showed diffusely heterogenous thyroid gland with asymmetric enlargement of the right lobe and isthmus and a new right exophytic thyroid nodule measuring 0.6×1.0×1.2 cm. Vascularity was not increased. Several non-enlarged lymph nodes were noted as well. Beta blockers was started in addition to NSAIDs. Neck tenderness resolved within 2 weeks. She received her second dose of COVID-19 vaccine as scheduled. Within 2 months of the initial presentation, thyroid functions normalized. Four months from the initial presentation, symptoms of mild hypothyroidism were noted with a TSH of 5.88. Levothyroxine 50 mcg daily was initiated. Repeat thyroid labs were normal. Follow up thyroid US showed resolution of the right exophytic thyroid nodule, and atrophic thyroid gland. She has remained on levothyroxine replacement with biochemical and clinical euthyroidism. Conclusion Clinicians should be aware of thyroiditis as rare side effect of COVID-19 vaccine on thyroid gland. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSAT202 A Rare Case of Four-Gland Parathyroid Adenomas

Abstract Background Amongst patients diagnosed with primary hyperparathyroidism, 80% have been identified to have a single parathyroid gland involvement, with 10% involving two glands or more. Case A 71-year-old female with medical history of hypothyroidism, multinodular goiter, CKD stage 3a, recurrent nephrolithiasis and hyperparathyroidism presented for evaluation of hypercalcemia. She was diagnosed with hyperparathyroidism 9 years prior to presentation however she preferred medical management with cinacalcet. For the past 5 months, she had been experiencing worsening fatigue, constipation, body aches and appetite loss. Further blood analysis revealed PTH 1176 pg/mL (14-64 pg/mL), TSH 2.69 uU/mL (0.35-4.94 uU/mL), free T4 1.12 ng/dL (0.60-1.89 ng/dL), vitamin D, 25-Hydroxy 24 ng/mL (30-80 ng/mL), serum calcium 12.6 mg/dl (8.9-10.4 mg/dL), ionized calcium 1.65 mmol/L (1.14-1.33 mmol/L), phosphorus 1.9 mg/dl (2.4-4.8 mg/dl), magnesium 1.0 mg/dl (1.8-3.0 mg/dL). Thyroid ultrasound revealed a left isthmus heterogenous solid nodule measuring up to 2.0 cm and a separate nodule superior to the isthmus measuring up to 0.6 cm. Subsequent NM parathyroid scan was limited due to diffuse uptake of enlarged nodular thyroid. Although limited, imaging did reveal a small focus of uptake lateral to the right lower pole concerning for parathyroid adenoma. A CT 4D neck with and without contrast demonstrated a suspicious parathyroid adenoma posterior to the inferior aspect of the left thyroid measuring up to 1.7 cm, an additional 0.8 cm questionable node, and a 4 cm multicystic mass inferior to the right thyroid lobe concerning for exophytic thyroid nodule or multi cystic parathyroid adenoma. Due to persistence of symptoms and significantly elevated PTH levels concerning for carcinoma, decision was made to undergo a four-gland parathyroid exploration and a right hemithyroidectomy. A right superior parathyroid adenoma was identified; after resection, intraoperative PTH levels failed to improve which prompted further exploration. Left superior and inferior parathyroid adenomas were identified and resected. An ectopic nodule located in the right superior mediastinum with surrounding normal parathyroid tissue was identified and dissected, leaving parathyroid tissue behind. Post operatively, PTH levels appropriately decreased to 54 pg/ml. Pathology of identified parathyroid glands had hypercellular parathyroid tissue with fibrous capsule, consistent with adenomas. Interestingly, the pathology of the presumed ectopic nodule was consistent with atypical parathyroid adenoma. Immunostatins with parafibromin demonstrated nuclear immunoreactivity in the lesional cells, consistent with a benign neoplasm. Patient developed symptomatic hypocalcemia following surgery. She was gradually weaned off calcitriol and is currently normocalcemic. Conclusion It is extremely rare to have adenoma of 4 parathyroid glands simultaneously in the absence of genetic conditions associated with hyperparathyroidism. Age of onset of hyperparathyroidism and absence of other endocrine abnormalities clinically was reassuring, however; further biochemical and genetic testing will be considered in this patient. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

RF11 | PMON26 A Lump By Any Other Name: A Case of Diffuse Large B Cell Lymphoma of the Thyroid

Abstract Patient is a 49-year-old female with a past medical history of hypothyroidism who presented to the endocrinology office for evaluation of a neck mass. A thyroid ultrasound in 2020 had shown significantly enlarged and diffusely heterogenous thyroid gland compatible with diffuse thyroid goiter without nodules. Her neck swelling worsened and therefore a thyroid ultrasound was repeated and showed a large hypoechoic nodule in the left thyroid gland. She had no symptoms such as night sweats, fevers, or weight loss. A computed tomography (CT) scan of the neck with contrast was obtained on 7/20/2020 showing a markedly enlarged thyroid gland with multiple >1 centimeter (cm) thyroid nodules, with a suspected exophytic extension nodule medial to the left lobe. Multiple adenopathy was present with an enlarged left lower cervical lymph node and a right-sided level 4 lymph node concerning for thyroid malignancy with local metastatic disease. She underwent a fine needle aspiration (FNA) with flow cytometry of the lymph node on 9/2/2020 which was benign. Her goiter continued to increase in size and she was referred to endocrine surgery for fine needle core biopsy of the left thyroid nodule which was favorable for diffuse large B cell lymphoma (DLBCL) with a germinal center phenotype on 4/5/2021. Flow cytometry was positive for CD-10 mature B cells. FNA biopsy of the left lower cervical lymph node showed polymorphic lymphocytes and rare macrophages. She was staged IIE. She underwent 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and received 18 rounds of consolidation radiation after completion of chemotherapy. She had near-complete response to treatment and is now monitored through routine follow-ups. Primary thyroid lymphoma is a rare condition characterized as a lymphomatous process involving the thyroid gland without any contiguous spread or distant metastasis at the time of diagnosis. It comprises nearly 1% to 5% of all thyroid malignancies and is more common in women. DLBCL is the most common histiotype and accounts for 50% to 70% of all cases. Patients may notice a unilateral or bilateral rapidly enlarging neck mass with compressive symptoms, but B symptoms are less common. Nearly 30% to 40% of patients carry a diagnosis of hypothyroidism at the time of diagnosis as the lymphomatous process replaces the normal thyroid parenchyma. Diagnosis is made usually via core needle biopsy and flow cytometry since FNA biopsy is frequently inconclusive. Treatment is with chemotherapy, usually R-CHOP, and radiation therapy with an overall 5-year prognosis of 34.5%. Surgical decompression may be necessary if compressive symptoms are present. While this is a rare disease, providers should be cognizant of DBLCL especially when faced with a presentation such as the one summarized in this report. Presentation: No date and time listed

ODP039 Giant Cystic Pheochromocytoma and GIST in a Patient With NF-1

Abstract Introduction Neurofibromatosis-1 (NF-1) is a genetic condition known to be associated with pheochromocytoma. We report a case of giant cystic pheochromocytoma in a patient with NF-1 and hypertensionincidentally found to have gastrointestinal stromal tumor (GIST) at operation. Clinical case: A 60-years old woman presented with a 5-week history of left sided abdominal lump. Her history is significant for NF-1, flank surgery age 5 and hypertension managed by amlodipine. Examination revealed a large nontender left upper quadrant abdominal mass crossing the midline. Computed tomography showed a20. 0×13.1×21.1 cm septate cystic and/or necrotic lesion arising from the left retroperitoneum versus adrenal gland, displacing the kidney anteromedially. Plasma free metanephrine was 3.38 nM (0-0.49) normetanephrine 3.47 nM (0-0.89),urine metanephrine 2605 mcg/day (36-229), urine normetanephrine 1215 mcg/day (95-650). There were no prior images or screens for pheochromocytoma. After preoperative blockade with phenoxybenzamine, open left adrenalectomy was performed. Intraoperative blood pressure fluctuated significantly. Exophytic firm nodules were incidentally noted and removed from the jejunum. Pathology revealed a22.5×21. 0×11.9 cm pheochromocytoma weighing 3058.9 g and five 0.2-0.7 cm gastrointestinal stromal tumors, spindle type. One-month postoperative metanephrine was 0.16 with normetanephrine 0.53 nM. The blood pressure remained normal without antihypertensives. Discussion Giant cystic pheochromocytomas are rare and may be silent. In populations with NF-1 the prevalence of pheochromocytoma is 0.1-7.7% and GIST 1.2% 1–3 . Their co-existence is seen less frequently. Recommendations for pheochromocytoma screening in NF-1 vary, from only hypertensive or symptomatic patients to routinely every 3 years 2–5 . There is no screening test for GIST 1 . Our patient presented at age 60 with the rare combination of clinically giant unilateral cystic pheochromocytoma, with incidental GIST in the setting of NF-1 and hypertension . Conclusion Routine screening for pheochromocytoma in patients with NF-1, especially those with hypertension may lead to earlier diagnosis and treatment.

The effect of serum 25-hydroxy vitamin D levels on malignancy in exophytic thyroid nodules

Aim: The increase in the incidence of thyroid cancer brings about research of new risk factors. In this study, we aimed to investigate the effect of vitamin D status on malignancy in exophytic nodules. Material and Method: Two hundred and sixteen patients with exophytic thyroid nodules were included in the study. All patients’ thyroid nodule ultrasonographic features, fine needle aspiration biopsy cytology results, rate of surgery and surgery histopathological results were recorded. Vitamin D levels were analyzed and patients were divided into two groups as vitamin D sufficient groups (vitamin D≥20 ng/ml) and vitamin D deficient group (vitamin D<20 ng/ml). Results: Malignancy rate was significantly higher in the vitamin D deficient group (%19 vs %8.7; p=0.03). There were no significant difference between two groups in terms of demographic characteristics and ultrasonographic features including diameter, hypoechoic nature, having irregular border and microcalcifications. Conclusion: In exophytic nodules, vitamin D deficiency increases malignancy risk. Determining vitamin D levels may be useful in patients with exophytic nodules.

P221 Deep dermatophytosis presented as multiple exophytic masses caused by Trichophyton rubrum in immunocompromised patient with rheumatoid arthritis; a case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Dermatophyte invades the stratum corneum and infects the skin, nails, and hair, mostly resulting in superficial infection. Deep dermatophytosis involving dermis and subcutaneous layer was rarely reported in immunocompromised state. Herein, we report a case with deep dermatophytosis caused by Trichophyton (T.) rubrum. A 71-year-old woman presented with multiple erythematous exophytic and subcutaneous nodules located on both lower legs. She was taking immunosuppressive agents for rheumatoid arthritis and had taken antifungal agents for tinea pedis and onychomycosis, which was improperly ceased. Histopathologic examination revealed pseudoepitheliomatous epidermal hyperplasia with microabscess formation in epidermis and diffuse granulomatous inflammation consisting of multinucleated giant cells, lymphocytes, neutrophils, and histiocytes in dermis. Imuunohistochemical staining with periodic acid-schiff (PAS) and Gomori methenamine silver (GMS) showed septate and branched fungal hyphae in dermis. Trichophyton rubrum was identified in fungal culture with tissue and confirmed through phylogenetic analysis of internal transcribed spacer (ITS) and large subunit regions (LSU) in ribosomal RNA. Prior to identification of causative organism, her condition deteriorated into septic shock. Amphotericin B was administered empirically for 6 days in order to prevent hematogenous dissemination and skin lesions were simultaneously resolved. Since deep dermatophytosis appears in various clinical manifestations, it is easy to be mistaken for another disease. If treatment is delayed, immunocompetent patients can progress to severe disease courses like hematogenous dissemination, so clinicians should differentiate this disease and conduct treatment at an appropriate time.

Genistein anticancer efficacy during induced oral squamous cell carcinoma: an experimental study

BackgroundAbout 7 million people die from various types of cancer every year representing nearly 12.5% of deaths worldwide. This fact raises the demand to develop new, effective anticancer, onco-suppressive, and chemoprotective agents for the future fighting of cancers. Genistein exhibits pleiotropic functions in cancer, metabolism, and inflammation. It functions as an antineoplastic agent through its effect on the cell cycle, apoptotic processes, angiogenesis, invasion, and metastasis.Aim of the studyThe current study aimed to study the genistein onco-suppressive effects during 7,12-dimethylbenz[a]anthracene (DMBA)-induced oral carcinogenesis in hamsters’ buccal pouch utilizing flow cytometry analysis (FMA), as a fast-diagnosing tool, in addition to the histopathology.Material and methodsThe buccal mucosa of adult male Syrian hamsters was painted with paraffin oil only (group 1), DMBA mixed in mineral oil (group 2), or orally administrated genistein along with painting DMBA (group 2B). The buccal mucosa was utilized for flow cytometric analysis and histopathological examination.ResultsGrossly, DMBA-induced carcinogenesis started at the 9th week. Progressive signs appeared in the following weeks reaching to large ulcerative oral masses and exophytic nodules at the 21st week. Histologically, invasive well-differentiated oral squamous cell carcinoma (OSCC) appeared in the underlying tissues from the 12th week, showing malignant criteria. Genistein had delayed clinicopathological change, which started 6 weeks later, than the DMBA-painted hamsters, as mild epithelial dysplastic changes. This became moderate during the last 6 weeks, without dysplastic changes. Flow cytometry revealed that DMBA led to considerable variation in DNA proliferation activity, aneuploid DNA pattern, in 47.22% of hamsters and significantly raised the S-phase fragment (SPF) values, which drastically reduced after genistein treatment.ConclusionTaken together, genistein could be employed as an onco-suppressive agent for carcinogenesis. Moreover, FMA could be used as an aiding fast tool for diagnosis of cancer.

CARCINOMA EX PLEOMORPHIC ADENOMA FROM PALATAL MINOR SALIVARY GLAND: A CASE REPORT

Carcinoma ex pleomorphic adenoma is a high-grade salivary gland cancer in which malignant transformation occurs in a previously benign pleomorphic adenoma. A 56-year-old woman attended the Hospital Dental Center presenting an exophytic sessile nodule on the hard palate. She had been diagnosed with a pleomorphic adenoma in this region a year prior. Computed tomography revealed a hypodense image in the left region of the hard palate. Microscopic examination demonstrated a neoplasm composed of epithelial and myoepithelial cells, organized in ductal structures, cords, and nests. Islands with epithelial cells, presenting nuclear pleomorphism, clear cells, and cystic spaces bounded by mucous cells characterized the malignant component. Keratin pearls were also present in the center of some islands. The specimen's margins were compromised. A final diagnosis of carcinoma ex pleomorphic adenoma was obtained. The patient was referred for removal of surgical margins and remains to undergo clinical follow-up.

ORAL PLASMABLASTIC LYMPHOMA DIAGNOSIS AND TREATMENT FOLLOW-UP: CASE REPORT

Plasmablastic lymphoma (PBL) is a rare variant of large diffuse B-cell non–Hodgkin lymphoma with predilection for extranodal localization in the oral cavity. A 43-year-old HIV-positive female patient attended a stomatology service for evaluation of a painful oral mass with 6 months of duration. At the extraoral examination, swelling in the left hemiface and facial increased lymph nodes were present. Intraorally, a purplish red exophytic sessile nodule presenting indefinite borders and an ulcerated surface was found. Areas of necrosis were observed at the upper alveolar ridge, palate, and left buccal mucosa, and adjacent teeth were mobile. The clinical impression was a malignant neoplasm, and the patient was submitted to an incisional biopsy. The histopathologic and immunohistochemistry were consistent with a PBL. The patient was referred to the hematologic service and submitted to DA-EPOCH chemotherapy. After 3 months of follow-up consultations, partial remission of the lesion without considerable systemic or oral intercurrences was observed.

Crusted Keratotic Exophytic Nodule on the Lower Lip

ABSTRACT Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of a slowly growing crusted keratotic exophytic nodule on the lower lip.

Multiple distal lower limbs exophytic ulcerated nodules

A 31-year-old woman, originally from Nigeria, presented to the dermatology clinic with a 6-month history of insidious, painful, exophytic nodules and ulcerations with multiple purulent discharging sinus tracts bilaterally in the gaiter area (Fig 1). She had experienced a similar episode 5 years ago, which was managed with intravenous antibiotics. Other medical history included hypertension and childhood hepatitis B. She had no history of foreign travel for the past 7 years, no history of trauma to the affected areas, and no other associated symptoms.

Computer optimization of conductive gels for electrochemotherapy

Electrochemotherapy (ECT) requires covering the entire tumor and safe margins with a suitable pulsed electric field (PEF). The PEF distribution depends on the biological and electrical parameters. The biological tissue may have diffractive geometry with non-linear conductivity behavior due to electroporation. That characteristic may provoke ECT-insufficient electric field regions, also known as blind spots. The conductive gels can fill holes and bumps, being a tool to homogenize the electric field. We executed an in vitro vegetal tissue experiment to validate a numerical model under different gels conditions. We used a study case in silico experiment to investigate gel influence on PEF distribution and electrical current. We propose a case-oriented methodology to optimize the gel during the ECT pre-treatment. Results show that the optimized gel completely treats a region of interest while avoiding unnecessary current increase and damage to healthy tissue by over treatment. The optimized gel conductivity may be lower than the previously reported (0.5 to 1 S/m) and may be in the range of the commercially available gels. For a veterinary mastocytoma exophytic nodule ECT case study, using needles electrode, the 0.2 S/m gel is the optimum gel.