Months Of Excision Research Articles

Localized type tenosynovial giant cell tumor with metastases to lungs and pleura: a case report and literature review

BackgroundTenosynovial giant cell tumor is a rare soft tissue tumor of the synovium of joint, bursae, or tendon sheath. It is divided into localized or diffuse types on the basis of the growth pattern. Localized tenosynovial giant cell tumors are usually benign and treated successfully by excision. Diffuse tenosynovial giant cell tumors, in contrast to localized type, can destroy bone and cartilage and are associated with frequent local recurrences and distant metastasis. Localized type tenosynovial giant cell tumors rarely metastasize to distant organs. Here, we report a case of localized tenosynovial giant cell tumor presenting with lung metastases and systematically review literature.Case presentationA 55-year-old Asian male presented with a dry cough, right-sided chest pain and progressive dyspnea for 1 month. At 18 months before this presentation, he had undergone excision of a painless swelling on his right index finger. The swelling recurred within 3 months of excision, and a biopsy was then suggestive of a giant cell tumor. Given the suspicion of a giant cell tumor, a wide excision of the lesion was performed and the excisional biopsy was consistent with a diagnosis of tenosynovial giant cell tumor, localized type. At admission to our hospital, the patient had tachypnoea and absent breath sounds on the right side. A chest radiograph showed a right-sided pleural effusion with a homogenous opacity in the left mid-zone. A contrast-enhanced computed tomography of the chest and abdomen showed right massive pleural effusion and bilateral multiple lobulated heterogeneously enhancing pleural-based masses with areas of internal calcification. Pleural fluid analysis revealed an exudate with no malignant cells on cytology. A lung biopsy showed osteoclast-like giant cells and mononuclear spindle cells with areas of hemorrhage and necrosis, suggesting tenosynovial giant cell tumor metastasis. A final diagnosis of localized type tenosynovial giant cell tumor of the right index finger with metastases to the lungs and pleura was made. The patient passed away after receiving three cycles of denosumab injection owing to progressive disease.ConclusionLung metastasis is extremely rare in patients with localized tenosynovial giant cell tumor. The survival is usually poor in patients with lung metastasis. A close follow-up of patients with localized type tenosynovial giant cell tumor is necessary for early detection of pleuropulmonary complications.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Urograffin colpography for the diagnosis of transverse vaginal septum and literature review

A case of non-obstructed low transverse vaginal septum presenting with primary infertility and dysmenorrhoea is reported. Diagnosis was made using urograffin colpography. The septum was excised via a perineal approach without complications. Pregnancy occurred within three months of excision. The case is reported because of its rarity and the fact that the mode of diagnosis has not been previously highlighted.

"Hurricane-like" Presentation of a Recurrent Marjolin's Ulcer in a Young Female.

Marjolin's ulcer (MU) with rapid progression and multiple distant metastases is rare. We report a case of an MU of the thigh developing in a postburn scar, which after successful R0 resection developed multiple bony and visceral metastasis to femur, vertebra, skull, lung, and liver within 3 months of excision. We highlight the "hurricane-like" recurrence in an MU, which is unusual for the metachronous disease. We stress that MUs, unlike conventional wisdom, need a thorough metastatic workup at presentation, and prognostication of a possible rapidly progressive course after surgery which may lead to grave prognosis and mortality.

Características citológicas de cistoadenocarcinoma papilar ovariano em um cão

Background: Ovarian papillary cystadenocarcinoma is a rare neoplasm associated with peritoneal implantation and malignant effusion. Most dogs are asymptomatic until the nodules become large and the abdominal volume is increased. From the clinical suspicion, the diagnosis can be obtained through imaging and histopathology, however, cytological analysis has become an alternative method for the early detection of this neoplasm. In order to demonstrate the importance of cytology in the diagnosis of ovarian neoplasms and its metastasis, it is reported a case of metastatic ovarian papillary cystadenocarcinoma in a dog.Case: Female, intact, teckel, 5-year-old, with increased abdominal volume. Physical examination revealed ascites and intracavitary mass, abdominocentesis and fine needle puncture of the mass were performed for cytological evaluation. In the cavity fluid it was observed: dark red color, cloudy appearance, hematocrit of 35%; (7.6 g / dL), pH (8.0), 22,000 nucleated cells / μL, marked cellularity of pleomorphic epithelial cells arranged in three-dimensional cohesive groups, sometimes in acinar or tubular pattern, nucleus with loose chromatin coarse, scarse to moderate cytoplasm, perinuclear halo, multiple and evident nucleoli compatible with carcinomatous neoplastic effusion. In the cytological evaluation of the tumor, epithelial cells were observed, with the same microscopic characteristics of the abdominal fluid. A laparotomy that did not show metastasis was performed, multiple nodes interspersed with cystic regions containing yellow-red fluid in the right ovary were visualized. Histopathology showed: neoplastic cells proliferation of ovarian glandular tissue, scarce cytoplasm, poorly delimited, nucleus ranging from oval to cylindrical with marked pleomorphism, evident nucleoli and loose chromatin, mitotic figures and papillary growth. Neoplastic cells forming irregular cavities with proteinaceous fluid, scarce connective tissue intermingling the cellular nest and areas of hemorrhage. Cytological and histopathological analyzes were compatible with ovarian papillary cystadenocarcinoma. After three months of excision, the dog returned with thoracic effusion that presented the same characteristics of the abdominal fluid, indicating metastasis.Discussion: Metastasis and effusion were observed in 48% and 86% of dogs with this tumor, respectively. Cell exfoliation, release of fluid through the tumor capsule or rupture of cysts can result in transcelomic metastatic implants that exert pressure and obstruct peritoneal and diaphragmatic lymphatic vessels causing effusion. The macro and microscopic characteristics of the abdominal effusion reinforced the suspicion of neoplasia, and the cytomorphological evaluation of the tumor, which identified carcinomatous cells similar to that of the effusion, allowed the presumptive diagnosis of the neoplasia. The macroscopic presence of multiple nodes interspersed with cystic regions containing red fluid in the right ovary, identified after surgical excision, reinforced the cytologic diagnosis. Histopathological examination identified wellestablished microscopic features that allowed the definitive and confirmatory diagnosis of neoplasia. Radiological analysis of the chest was not enough to detect the metastasis diagnosed by effusion analysis, however, small nodules (less than 6 mm) are difficult to identify by imaging. Thus, it is important to emphasize the importance of cytological evaluation of tumor and effusions for detection of neoplastic cells for the diagnosis of intracavitary neoplasia and metastasis.

Paraspinal Metastasizing Pleomorphic Adenoma

Pleomorphic adenomas (benign mixed tumors) are the most common benign tumors arising in the salivary glands. Rarely, they can undergo malignant transformation (carcinoma ex pleomorphic adenoma) or metastasize via hematogenous or lymphatic spread. We describe a case of a 51-year-old male with a benign metastasizing pleomorphic adenoma of the vertebrae and epidural space of the lumbar spine who presented with lower back pain. He developed spinal metastases within 8 months of excision of his primary tumor, which arose in the right submandibular gland. Most recently, he went on to develop pulmonary metastases about a year after surgical excision of the spinal metastases. We review the literature on benign metastasizing mixed tumors which involve the spine.

Pediatric Hibernoma

We present an unusual case of supraclavicular benign hibernoma in a 12-year-old girl who presented with chest discomfort, night sweats, shortness of breath, fatigue, and pruritus. This is the first case of hibernoma being reported as symptomatic in the world literature. Symptoms persisted for 1 year till excision biopsy. Biopsy of supraclavicular lump revealed a hibernoma. Symptoms resolved within 2 months of excision and 1-year follow-up showed no recurrence of symptoms or supraclavicular swelling.

Cutaneous Melanocytomas in 10 Young Cattle

Ten melanocytomas from 10 cattle were diagnosed by histopathologic examination of biopsy specimens submitted to the Veterinary Medical Diagnostic Laboratory, University of Missouri, between 1 January 1986 and 31 December 1993. One tumor was congenital; the others were first noticed between 2 months and 2 years of age (means = 9.9 months). Six tumors occurred in purebred (3) or crossbred (3) Angus cattle; one tumor each occurred in a Holstein, a Shorthorn, a Simmental, and a beef calf of unrecorded breed or coat color. Five calves were female, and five were male. Five tumors occurred in truncal dermis or subcutis (three in abdominal skin), four occurred on a limb, and one occurred on the jaw. Tumors varied in histologic appearance, but all were pigmented and all had few mitotic figures. Outcome was known for 8/10 cattle. In four cattle followed for at least 1 year, the tumor did not recur after surgical excision. Another heifer had residual gray tissue at the tumor site after surgery but remained in the herd without regrowth of the tumor 30 months after excision. Three other calves were slaughtered within 6 months of excision without apparent recurrence of the tumor.

Recurrent Facial Plaques Following Full-Thickness Grafting

REPORT OF A CASE A healthy 44-year-old woman was referred for evaluation of several brownish-red papules arising on the perimeter of a full-thickness skin graft on her left cheek, placed 5 months earlier (Figure 1). The patient recalled a small red plaque first appearing on her left cheek 6 years before this evaluation. It had been treated on four separate occasions with curettage and fulguration for presumed basal cell carcinoma, but always recurred within months of each treatment. She was ultimately referred to a surgical service for therapeutic excision. Following a nondiagnostic punch biopsy specimen, the lesion was excised, and the 3×2-cm defect was repaired with a full-thickness skin graft. Within 4 months of excision, several brownish-red papules appeared in a ring at the periphery of the graft. The excisional specimen was diagnostic (Figure 2andFigure 3). What is your diagnosis? Figure 1. Figure 2. Figure 3. DIAGNOSIS: Granuloma

Neuroblastoma and lumbar hernia: A causal relationship?

Lumbar hernia is a rare occurrence in infants and children. Congenital variants have been described, frequently associated with musculofascial and skeletal abnormalities, specifically “lumbocostovertebral syndrome” (LCV) and/or meningomyelocele. In LCV syndrome, lumbar herniation results from a single somatic defect occurring during the third to fifth week of embryonal development. Meningomyelocele may predispose to lumbar herniation secondary to abnormalities in muscular innervation related to nerve entrapment in the spinal dysraphism. Acquired lumbar hernia generally can be attributed to surgery, infection, or trauma. Localized neuropraxis, temporary or permanent, may be the underlying factor common to all these defects. The author presents two pediatric cases of lumbar hernia associated with intrathoracic neuroblastoma. The first patients, a 15 month old, had a lumbar hernia after excision of a thoracic ganglioneuroblastoma. This resolved within 1 year, without specific therapy. The second patient, a 4 month old with a lumbar hernia and a large intrathoracic neuroblastoma, had “resolution” of the hernia within 4 months of excision of the paravertebral tumor. In these cases it appears that the lumbar hernia resulted from neuropraxis secondary to intrathoracic paravertebral tumor and its management. In both cases, this deficiency was temporary and resolved without specific therapy. The association of lumbar hernia and intrathoracic neuroblastoma has not been reported previously. These cases suggest the advisability of a screening chest x-ray in children presenting with this diagnosis. Similarly, the cases suggest a role for conservative treatment for the hernia itself, when the neural impairment resulting in the defect is of a temporary nature.

POXVIRUS INFECTION OF THE SKIN OF AN EASTERN GREY KANGAROO

A solitary cutaneous papillomatous lesion, present for 6 weeks, was surgically removed from the hind limb of an 18-month old eastern grey kangaroo (Macropus giganteus). The lesion did not recur within 6 months of excision. Poxvirus particles were demonstrated in epidermal cells of the lesion by electron microscopy.