Multiple Nodular Lesions Research Articles

Neurocysticercosis in a Japanese woman with lung cancer who repeatedly visited endemic countries

BackgroundTaenia solium, present in most developing countries, infects many individuals and may result in their death. Neurocysticercosis (NCC) develops after invasion of the brain by parasitic larvae. It is the most common parasitic disease of the human central nervous system. On imaging scans it can be similar to brain tumors. We report a patient with a metastatic brain tumor and NCC. The co-presence of NCC was diagnosed based on specific neuroimaging- and epidemiologic findings.Case presentationA 36-year-old non-smoking Japanese woman with a history of non-small-cell lung cancer had undergone resection of the lower lobe followed by cytotoxic chemotherapy 2 years before apparently suffering recurrence. A positron emission computed tomography (PET) scan incidentally revealed multiple intracranial cold spots exhibiting differences in their shape and size. On brain magnetic resonance imaging (MRI) scans we observed many different patterns of peripheral edema and gadolinium-enhancing effects. As she had often visited Latin America and Southeast Asia and had eaten raw pork and Kimchi, we suspected that the brain lesions were due to NCC rather than metastatic brain tumors. However, serum immunoblotting assay and DNA analysis were negative for T. solium. Rather than performing resection, we administered albendazole (ABZ) and dexamethasone because her earlier cytotoxic chemotherapy had elicited severe pancytopenia. Except for a single large lesion in the left frontal lobe, this treatment resulted in a significant reduction in the size of these lesions and a decrease in perilesional edema. She underwent resection of the residual lesion 10 months later. Histology revealed it to be a metastatic tumor. Polymerase chain reaction (PCR) assay for NCC was negative. In the course of 11-months follow-up there has been no recurrence.ConclusionThis is the first presentation of NCC in a Japanese woman with a metastatic brain tumor. NCC was incidentally discovered on PET scans and, based on her travel history and epidemiological findings; it was diagnosed and successfully treated with ABZ. NCC is endemic in most developing countries and as visits to such countries have increased, NCC must be ruled out in patients with multiple cystic nodular brain lesions.

TISSUE IS THE ISSUE: CASE OF PRIMARY PULMONARY PERIPHERAL T CELL LYMPHOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Primary pulmonary lymphoma is a rare disease. It accounts for 0.5-1% of all pulmonary malignancy and less than 1 % of all Non-Hodgkins Lymphoma (NHL) (1). Mostly they are of B cell origin; however, there are fourteen reported primary pulmonary peripheral T Cell Lymphoma cases (2). We report a case of a patient presenting with primary pulmonary peripheral T cell Lymphoma. CASE PRESENTATION: A 58-year-old woman presented with complaints of dyspnea, high-grade fever, and cough for the past 4-5 days. Physical exam was unremarkable except for the fever, tachycardia, tachypnea, and oxygen saturation of 87% on room air. Laboratory workup was unremarkable except for elevated ESR, CRP, LDH, and ferritin. Rheumatological workup was unremarkable. Infectious workup, including COVID-19 PCR, blood cultures, and respiratory viral panel, were unremarkable. Chest CT showed bilateral consolidation of lungs with hilar and mediastinal lymphadenopathy (fig 1). She was started on broad-spectrum antibiotics and admitted to the medical floor. Her dyspnea got progressively worse, and she was intubated a week after her admission. Bronchoscopy was done with bronchoalveolar lavage and transbronchial biopsy; however, results were unremarkable. Video-assisted thoracoscopic surgery ( VATS ) was done for mediastinal lymph node biopsy, and biopsy results came positive for peripheral T cell lymphoma(Fig 2, 3 ). Bone marrow biopsy was unremarkable. The patient started to desaturate even on the maximal ventilator setting and was placed on venovenous extracorporeal membrane oxygenation (V-V ECMO). She was given the first cycle of Gemcitabine and oxaliplatin. However, she developed multiorgan failure. She was transitioned to comfort care and expired. DISCUSSION: Primary pulmonary peripheral T cell lymphoma usually manifests with the symptoms of dyspnea, cough, and fever. The mean age of presentation is fifty-three years. Radiographically it presents with lung consolidation, atelectasis, pleural effusion, and multiple nodular lesions. (3) Our patient had bilateral lung consolidation with hilar and mediastinal lymphadenopathy. Diagnosis is made by lobectomy, open lung biopsy, transthoracic needle biopsy, and mediastinal lymph node biopsy. (3) There is still no recommended standard treatment for primary pulmonary T cell lymphoma due to the scarcity of cases (4). Resection, radiotherapy, and chemotherapy are the treatment options used in patients suffering from this disease. CONCLUSIONS: Primary pulmonary peripheral T cell lymphoma is a rare and aggressive cancer. It presents with pneumonia-like symptoms. We recommend clinicians to consider bronchoscopy for those patients with pneumonia who do not get better with antibiotics. REFERENCE #1: Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J. 2002;20(3):750-762. doi:10.1183/09031936.02.00404102 REFERENCE #2: Zhang S, Liang B, Jiang S. Primary pulmonary peripheral T-cell lymphoma: A case report and review of the literature. Thorac Cancer. 2014;5(1):104-107. doi:10.1111/1759-7714.12042 REFERENCE #3: Sangho Lee, Bongkyung Shin, Hyungseok Yoon, Jung Yeon Lee, Gyu Rak Chon, A case of primary pulmonary NK/T cell lymphoma presenting as pneumonia, Respiratory Medicine Case Reports, Volume17,2016, Pages 1-4, ISSN 2213-0071, https://doi.org/10.1016/j.rmcr.2015.11.003. 4) Bernabeu Mora R, Sánchez Nieto JM, Nieto Olivares A. Bilateral pulmonary nodules as a manifestation of primary pulmonary T-cell lymphoma. Int J Hematol. 2009;90(2):153-156. doi:10.1007/s12185-009-0372-8 DISCLOSURES: No relevant relationships by Neil Amin, source=Web Response No relevant relationships by Olufunmilayo Folaranmi, source=Web Response No relevant relationships by Junaid mir, source=Web Response No relevant relationships by Salmaan Mumtaz, source=Web Response No relevant relationships by Ateeb Ur Rahman, source=Web Response

S3024 Case of a Young Adult With Small Intestine Predominant Henoch Schonlein Purpura

Introduction: Henoch Schonlein Purpura (HSP) is the most common systemic vasculitis in young children, but is less commonly seen in adults. Diagnosis is based on the presence of palpable purpura without thrombocytopenia and with at least one other disease manifestation (arthritis, renal involvement, and/or abdominal pain). Gastrointestinal (GI) manifestations rarely precede the classic rash. Here we describe a young adult who initially presented with solely GI involvement of HSP. Case Description/Methods: A 25-year-old healthy male presented with two weeks of nausea, persistent sharp peri-umbilical abdominal pain of variable severity, and melena. Labs were notable for WBC 10.9 K/uL with neutrophilic predominance, CRP 66 mg/L, ESR 4 mm/hr, creatinine 0.88 mg/dL. Abdominal X-ray with mildly dilated gas-filled small bowel loops in central abdomen. CT abdomen/pelvis was unrevealing. EGD revealed antral-predominant nodular erythematous mucosal lesions in the stomach but otherwise normal appearing gastric mucosa (Fig 1a), histologically with surface hemorrhage. In the duodenum, diffuse erythematous mucosa with spontaneous hemorrhage was seen (Fig 1b), pathology consistent with duodenitis and erosions/ulcerations. Colonoscopy revealed right-sided erythema and granularity with biopsies showing non-specific inflammation. Interestingly, the day after endoscopic evaluation the patient developed bilateral lower extremity petechial rash (Fig 1c). Punch biopsies were diagnostic of IgA-mediated leukocytoclastic vasculitis. The overall presentation was consistent with HSP without renal involvement. Further work-up showed low C3 (consistent with HSP), negative ANA screen and ANCA, normal gastrin level, negative cryoglobulins, and unremarkable infectious work up. Discussion: HSP in adults is rare, especially if it presents with isolated GI disease. However, clinicians should maintain a high index of suspicion in adults with manifestations of small bowel inflammation. HSP mainly affects the small intestine, because the villi contain end-capillaries that get obstructed by immune complexes and cause necrosis. The rest of the GI tract is generally not involved by medium-vessel vasculitis due to its redundant circulation. The skin and epiphyseal plate have similar capillaries and are therefore frequently affected by HSP. Treatment with corticosteroids is controversial as most patients improve with supportive care. In this case, decision was made to treat with corticosteroids as patient returned with worsening disease activity.Figure 1.: a) Endoscopic view of gastric antrum/pylorus with multiple small nodular erythematous mucosal lesions; b) Endoscopic view of second portion of the duodenum showing diffuse erythematous mucosa with many erosive purple-hued mucosal lesions in a diffuse distribution with associated spontaneous bleeding; c) Classic purpuric rash on medial aspect of right foot.

Juvenile hyaline fibromatosis: A clinicopathological study of five cases

Juvenile hyaline fibromatosis (JHF) is an extremely rare autosomal recessive disease that typically presents in infancy or early childhood. Largely due to the rarity, JHF is still not widely recognized by clinicians and pathologists in China. It is not uncommonly to misdiagnose the disease as other types of disorders. In this study, we present our experience with five cases of JHF to enhance the recognition of this rare but distinctive entity. There were 4 males and 1 female, with age at presentation ranging from 5 to 44 years. All patients presented with multiple subcutaneous nodular lesions of varying size in various parts of the body since birth or early childhood. Three patients also had joint involvement. Pathologically, the lesions were poorly circumscribed, located mainly in the dermis and subcutis. All five cases were characterized by abundant homogeneous hyaline-like matrix that differs sharply from the adjacent connective tissue, which stained strongly with periodic acid-Schiff (PAS) and was diastase resistant. Embedded within the eosinophilic glassy matrix were cords or small clusters of plump spindled to epithelioid cells, frequently with clear cytoplasm. Familiarity with the characteristic features of JHF is not only important in avoiding misdiagnosis but also essential for clinical management and prognostic evaluation.

Atypical scrotal masses: Surgical surprise.

We present three unusual cases of atypical scrotal lesions in children. The first was a firm left scrotal mass with the testis indistinguishable. The second with apparently a large hydrocoele, which was a cyst, and the third with multiple nodular lesions, pushing the left testis into the right hemiscrotum. These turned out to be a pigmented neuroectodermal tumour, a lymphatic malformation and neurofibromas respectively. Paediatric surgeons should be aware of such surgical surprises.

Cutaneous pilar leiomyoma completely treatable by surgical resection, a case report.

Background: Cutaneous pillar leiomyoma (CPL) is a benign skin tumour of errector pili muscles and is rare condition. Clinically it appears as small nodule which are in the form of small groups. These are tender to touch, pressure, cold, and emotional stimuli. Different modalities have been tried to reduce pain and discomfort. Surgery is a treatment of choice in lesion which are very tender and associated with disturbance of social life. The objective of treatment in to achieve complete cure from pain with functional and aesthetic improvement. Case: A case of a male patient age 28 years, with multiple cutaneous leiomyomas on the left anterior chest wall and lateral chest wall. On clinical examination there were multiple nodular skin lesions that manifested as brownish erythematous. The lesions increased gradually during the last 2 years, extending to the left lateral chest wall. Complete surgical excision of tumor was done, followed by coverage with split thickness skin graft taken from the thigh. Patient was followed up fortnightly up to six month. Results: After surgical treatment, there was complete pain relief and acceptable cosmetic outcome, which allowed the social reintegration. Conclusion: Cutaneous pilus leiomyomas is difficult to treat. The radical resection of tumor is important to resolve the symptoms with prevention of tumor recurrence.

Mycobacterium tuberculosis SIT42 Infection in an Abused Dog in Southern Italy.

A case of Mycobacterium tuberculosis infection is described in a dead adult male dog in Southern Italy. The carcass was found by the Health Authority in a gypsy encampment. It was admitted to our forensic veterinary medicine unit, with a suspicion of cruelty to the animal. Necropsy showed beating and traumatism signs, and mistreating was confirmed. Gross lesions included multiple nodular hepatic lesions, hemorrhagic enteritis with enlarged mesenteric lymph nodes, body cavity effusions, and an adrenal neoplasm. Bacteriological and molecular analyses were carried out on the liver lesions that enabled to identify M. tuberculosis SIT42 (LAM9). Drug-resistance patterns were evaluated by screening mutations on the rpoB and katG genes that showed susceptibility to both rifampin and isoniazid, respectively. Very few studies report canine tuberculosis, and little is known about the disease in Italy. To the authors' knowledge, this is the first report of Mycobacterium tuberculosis SIT42 infection in a dog in Italy.

Coexisting Metastatic Papillary Carcinoma Thyroid and Clear Cell Neuroendocrine Tumour in Thyroid- A Rare Case Report

Coexisting Metastatic Papillary Carcinoma Thyroid and Clear Cell Neuroendocrine Tumour in Thyroid- A Rare Case Report

A rare case of peripheral T cell lymphoma, not otherwise specified with cutaneous involvement and diffuse systemic metastasis

<p class="abstract">Peripheral T-cell lymphoma (PTCL), a subdivision of T-cell non-Hodgkin lymphomas (NHLs), is rare and different from the more common cutaneous T-cell lymphomas. PTCL is a diverse group of disorders and carries a poor prognosis. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) is the most common and aggressive disorder out of the group, which involves the lymph nodes followed by the skin, liver, and gastrointestinal tract. We hereby report a case of a 60 years old female who presented to us with complaints of multiple painful dark-coloured nodular lesions and indurated plaques over bilateral upper limbs, lower limbs and trunk, for 3 months. After detail laboratory investigations, histopathological and immunohistochemistry which was positive for CD30 antigen we confirmed the diagnosis as PTCL-NOS. Radiological imaging showed involvement of gastrointestinal tract, adrenal gland and vertebrae. After thorough workup the patient was started on palliative radiotherapy, unfortunately she succumbed to death. In conclusion, PTCL-NOS with CD30 positivity is rare and aggressive with a poor prognosis, it is important to identify such cases and work in conjugation with an oncologist for proper management.</p>

Presentation of Sonographic Features of Pulmonary Invasive Fungal Disease in Six Children with Leukemia

Background The early diagnosis of invasive fungal diseases is important because the therapeutic outcome depends on the prompt initiation of appropriate interventions. In this study, we present the feature of ultrasound of pulmonary fungal infection in six children with leukemia. Method and Patients: Between June and November 2020, this cross-sectional study was conducted in the radiology department at Dr. Sheikh Children’s Hospital, Mashhad, Iran. During this period, we reviewed imaging findings of fungal lung infections in six patients with leukemia (ages 5-11 years old) who were referred for chest ultrasound and CT-scan. High-resolution computed tomography (HRCT) of patients showed multiple nodular lesions with/without ground-glass opacity (halo sign or reverse halo sign), and wedge-shape consolidations. In some patients, there were thick wall cavitary lesions with intra-cavitary fungus ball and the air-crescent sign. Ultrasound findings of the lung included the target lesion, the cavitary lesion, wedge-shape consolidation, and extra-pulmonary invasion to the chest wall or sub-diaphragm. The galactomannan test or debridement of para-nasal sinuses confirmed fungal infections; Aspergillosis or Mucormycosis. Conclusion Four characteristic features of pulmonary invasive fungal disease on ultrasound can help in faster diagnosis and monitoring of treatment response in these patients.

A rare case of Haberland syndrome

A 10-month-old male child presented with a mass lesion in the left eye which was present since birth as noted by the parents. It was non-progressive. He also had left eye upper eyelid coloboma and a single nodular lesion on the left zygomaticotemporal region along with multiple nodular lesions on the scalp with non-scarring alopecia. A pediatric consultation was sought for systemic associations and a diagnosis of Haberland syndrome was made. Surgical debulking of the ocular lesion was done along with optical correction and amblyopia therapy for visual rehabilitation.

Prostate Cancer Detected by Choroidal Tumor and Complete Response to Hormonal Therapy: Case Report and Literature Review of 24 Patients With Choroidal Metastasis From Prostate Cancer

Metastatic choroidal tumors derived from prostate cancer are rare. In this study, we report a patient who manifested a choroidal tumor as the initial presenting sign of prostate cancer and review 23 patients with choroidal metastasis of prostate cancer in the literature to answer a clinical question how the choroidal metastases would respond to hormonal therapy. A 73-year-old man presented with a choroidal tumor in the right eye. He was in good health and had no previous history except for current hemodialysis in 3 years due to chronic renal failure as a sequel to glomerulonephritis. With the diagnosis of a probable metastatic tumor, positron emission tomography was performed to disclose high-uptake sites in multiple bones, lymph nodes, and the prostate, together with multiple nodular lesions in bilateral lungs on computed tomography (CT) scan. Serum prostate-specific antigen (PSA) was elevated to 541 ng/mL, which supported prostate cancer as the primary site. He had degarelix injection, and the choroidal tumor resolved rapidly and became flat degeneration in a month. Prostate biopsy showed poorly differentiated adenocarcinoma, and he underwent surgical castration. He had no medication until 3 years later when he showed gradual increase of serum PSA up to 6.05 ng/mL and multiple bony metastases on CT scan. Bicalutamide, switched to enzalutamide and then to abiraterone, led to the undetectable level of serum PSA until the last visit with no relapse of the choroidal metastasis, 6.8 years after the initial visit. In the literature review of 24 patients with choroidal metastasis of prostate cancer, including this patient, 8 patients presented a choroidal tumor as the initial sign and the choroidal lesions mostly showed complete response to hormonal therapy. Among 13 patients who were frequently in the course of hormonal therapy, choroidal metastases showed complete or partial response to external beam radiation to the eye in 11 patients and episcleral plaque radiotherapy in 2 patients. In conclusion, metastatic choroidal tumors of prostate cancer would show good response to hormonal therapy when the therapy has not been initiated. Hormone-resistant choroidal metastases in the therapeutic course of prostate cancer could be managed successfully by external beam radiation to the eye.

Kaposi's sarcoma with atypical gastrointestinal involvement.

A 31-year-old human immunodeficiency virus (HIV) positive male presented with weight loss, asthenia and anorexia of three weeks evolution. On physical exam, the patient had painless purple-colored papules on the trunk and upper limbs. Laboratory studies showed severe immunosuppression, with an absolute CD4 cell count of 114 cell/ul and HIV1-RNA level of 180,000 copies/ml. Esophagogastroduodenoscopy showed an exophytic lesion in the distal esophagus composed of three polyps and multiple flat and nodular maculopapular erythematous lesions in the gastric body, antrum and duodenum. Colonoscopy was also performed and identified several flat erythematous lesions in the colorectal mucosa. A neoplasm composed of small irregular vascular channel proliferation and spindled endothelial cells with minimal atypia was observed in all the esophageal, gastric, duodenal, colic and skin biopsies.

Feline Eosinophilic Keratoconjunctivitis: Nonsteroidal vs Corticosteroid Topical Treatment

Background: Feline eosinophilic keratoconjunctivitis is a proliferative eye lesion of chronic aspect with usually unilateral presentation that may initiate as a superficial vascularization that evolves to a proliferative, granular, irregular lesion of whitish-pink aspect. With its association with an immune-mediated response, nonsteroidal anti-inflammatories do not appear to be efficient, although few studies describe its use. This case report describes a case of a feline eosinophilic keratoconjunctivitis with its clinical evolution since the use of nonsteroidal topical anti-inflammatory drug in an undiagnosed patient and the transition to a topical corticosteroid and cure after 14 days since diagnosis.Case: An 8-year-old female cat was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an eye injury with at least 36 days of evolution andunresponsive to treatment (topical tobramycin 0.3% every 12 h / ketorolac trometamol 0.5%/ every 12 h and ophthalmic lubricant/every 4 h). Since the patient had free access to the street, the owners suspected of trauma-induced lesion. At physical examination, it was observed a proliferative lesion at the peri-limbal superotemporal quadrant of the right cornea with approximately 0.4 cm diameter, with color varying of pale to pink, with irregular surface and low vascularity, the adjacent conjunctiva was also affected with similar multiple nodular lesions (0.1 cm). Fluorescein test was negative as well as FIV/FeLV immunochromatography testing. Feline herpesvirus investigation was not possible. The patient was anesthetized and a lesion specimen was acquired with a cotton swab scraping and a fine needle aspiration. Cytology showed predominance of eosinophils and mast cells, with rare corneal epithelial cells, with smear background containing mast cell granules and free eosinophils. Presumptive diagnosis was eosinophilic keratoconjunctivits. After 14 days of topical corticosteroid (prednisolone acetate 1% every 8 h) the patient showed complete remission of the lesions with no relapse in 48 days.Discussion: Misdiagnosis and consequently mistreatment seems a greater prejudice than the risks associated with sample collection of keratoconjunctival proliferative lesions. Due to the lack of cytobrush or cotton swab, apparently, the reported patient was not submitted to ophthalmic cytology due to reluctance of the staff regarding fine needle aspiration of the cornea lesion. Despite a greater risk of iatrogenic trauma with needle aspiration, with eye anatomy well defined, level size and movement amplitude respected, it is unlikely that severe complications could occur. In this case, the undiagnosed patient was submitted to unnecessary 15 days of topical antibiotic and nonsteroidal anti-inflammatory, and no improvement of the clinical signs was observed. Despite non-recommended, few clinical trials as well as case descriptions are available comparing nonsteroidal and corticosteroid treatment of the disease. Once with diagnosis and beginning of topical prednisolone acetate 1% exclusively, the patient showed continuous improvement until complete remission of clinical signs after 14 days. This report reinforces the recommendation of corticosteroid therapy for feline eosinophilic keratoconjunctivitis and the absence of efficacy of nonsteroidal drugs. It also highlights the importance of diagnosis before any medical treatment is considered.

Testicular Metastasis of Merkel’s Cell Carcinoma

Merkel cell carcinoma (MCC) in an uncommon neuroendocrine neoplasia that originates in the skin in which testicular metastasis is atypical. There are only eight cases reported to date. A 65-year-old patient with a history of MCC in the right thigh who had been treated in 2015 with surgery, chemotherapy and radiation therapy; presented to hospital with pain and right testicular enlargement of one-month duration and with normal testicular tumor markers. An ultrasound study confirmed multiple hypoechoic nodular solid lesions compatible with neoplasia and orchiectomy was subsequently performed. The histological examination reported an immunohistochemical pattern compatible with a diagnosis of MCC. The patient received adjuvant immunotherapy with Avelumab. MCC rarely spreads to the testicle and, due to the shortage of studies, the best treatment of testicular metastasis remains uncertain; however, immunotherapy may be appropriate.

Recurrent dermatofibrosarcoma protuberans: A Case report and literature review

Introduction: Dermatofibrosarcoma protuberans is a rare soft tissue tumor which is known for its high recurrence behavior. Adequate excision and regular follow up is the current treatment modality.
 Case report: 42 years male developed multiple nodular lesions on anterior chest wall for which he underwent surgical therapy for five times, but tumor recurred on every occasion. Wide local excision and split skin grafting was performed with negative margin on histopathology.
 Conclusion: Dermatofibrosarcoma protuberans has high recurrence rate due to its infiltrative growth pattern. Regular follow up is required after surgery during early post-operative period to detect any recurrences.

A case of post-inflammatory warty dyskeratoma of the chest: Other dermoscopic features.

Warty Dyskeratoma (WD) is a rare condition consisting in single or multiple papular or nodular lesions of the skin or of the oral mucosamucosa. Histologically, a cupshaped epidermal invagination centred by a plug of epidermal hyperparakeratosis with suprabasal acantholysis and dyskeratosis is typically observed. A case of post-inflammatory WD, which was also observed by dermoscopy, is described. Dermoscopy showed an eight-shape whitish collarette surrounded by light brown pigmentation. A central white structureless area with an adjacent rosette were observed. Some small rust-coloured blood crusts were also observed in the centre of the lesion; no prominent vascular pattern was detected. The etiopathogenesis of this benign neoplasm could be multifactorial. Dermoscopy of WD is not specific but may help to ruling out other skin tumors.

Case Report: An extremely rare occurrence of recurrent inguinal low-grade fibromyxoid sarcoma involving the scrotum

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (<5%), immunonegativity with desmin and S100, confirming the diagnosis of LGFMS. Postoperative recovery was good and no recurrence was seen after two years. The patient is in good health, realizing multidisciplinary outpatient follow-up and performing continuous testosterone replacement. Surgical resection with negative margins for localized disease remains the standard treatment for LGFMS.

Magnification linked color imaging characterization of the irregular vessel network of diffuse mucosal rectal metastatic spread from high-grade serous ovarian cancer

A 62-year-old female patient presented with lower abdominal pain in combination with a 2-kg weight loss and stool retention. Medical history was significant for ovarian cancer that was treated by curative-intent surgery and adjuvant chemotherapy two years before. Imaging studies were consistent with peritoneal carcinomatosis and suggested incipient large bowel obstruction, for which the patient underwent lower GI endoscopy. While a high-grade stricture at the rectosigmoidal junction due to external compression precluded scope advancement, apart from mild unspecific erythema multiple nodular aphthoid-like lesions were identified throughout the rectum (Fig.

S2690 You Cannot Ignore Abdominal Dropsy: A Rare and a Fateful Presentation

INTRODUCTION: Angiosarcoma (AS) is a rare soft tissue sarcoma known to be one of the aggressive malignancies which carry a poor prognosis with 5- year overall survival reported at <43%. AS mainly originates from the breast (35%) and skin (20%), followed by soft tissue (13%) involvement. Hepatic AS accounts for only 0.5%–2% of primary hepatic malignancies. CASE DESCRIPTION/METHODS: A 56-year-old male presents with abdominal pain and 20-pound weight loss for the past two months. His abdomen appeared tense and distended. Results showed a hemoglobin 6.1 gm/dL, platelet count 63 × 103 /mm3, total bilirubin of 3.2 mg/dL, ALP 315 IU/L, AST 305 IU/L, ALT 209 IU/L, and albumin of 2.6 gm/dL. A CT of the abdomen showed multiple hypodense lesions in the liver, and spleen with the peripheral enhancement of the contrast [Figure 1A] suggestive of metastatic lesions. Colonoscopy was normal and EGD demonstrated multiple erythematous nodular lesions in the gastric body [Figure 1B] and duodenum [Figure 1C], biopsies of which were inconclusive. A CT guided liver biopsy showed small aggregates of anastomosing vascular channels with highly atypical cells suggestive of AS [Figure 2A]. Tumour cells were positive for CD-34 [Figure 2B] and focally positive for Factor VIII [Figure 2C]. The patient deteriorated very rapidly and died 2 weeks later due to cardiac arrest. DISCUSSION: Hepatic AS is more commonly seen in males (3:1) with a median age of the presentation around the 5th- 6th decade. Use of anabolic steroids, oral contraceptives, exposure to radiation, and chemicals like arsenic, vinyl chloride, and thorium dioxide are certain risk factors for the development of hepatic angiosarcoma. Often patients report non-specific symptoms such as abdominal pain, anemia, weight loss, fever, fatigue, however, can present with jaundice and ascites in case of advanced disease. Rare but spontaneous rupture of the liver and intraabdominal bleeding can also occur in patients with hepatic AS. Tumor size, visceral tissue involvement, the presence of necrosis, and metastatic disease at the initial presentation are some of the poor prognostic factors. CT angiography is the preferred imaging modality. Pathological diagnosis is often required. Median survival is approximately 6 months without any treatment. Surgery can be considered if they are localized to a lobe. Chemotherapy can be offered for palliation in cases of advanced and multifocal disease. Because of a high recurrence rate, liver transplant is generally not recommended for hepatic AS.Figure 1.: A. (From top to bottom) CT of the abdomen showed multiple hypodense lesions in the liver. B. EGD demonstrated multiple erythematous nodular lesions in the gastric body. C. EGD demonstrated multiple erythematous nodular lesions in theduodenum.Figure 2.: A: Liver biopsy showed small aggregates of anastomosing vascular channels with highly atypical cells suggestive of AS. B: Tumour cells positive for CD-34. C: Focally positive for Factor VIII.