Red-brown Nodules Research Articles

Congenital Dermatofibrosarcoma Presenting as an Atrophic Plaque

Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma that most commonly occurs on the trunk of adult patients. However, DFSP can present congenitally, and this rarity may lead to misdiagnosis or late diagnosis. The authors present a case of a congenital DFSP that was not diagnosed until the patient was 17 years old. Her tumour was successfully treated with Mohs micrographic surgery. It is important to have DFSP on the differential for atrophic plaques or violaceous to red-brown nodules, even at a young age.

Pediatric Occurrence of Osteonevus of Nanta: A Case Report

Secondary ossification is a process that occurs in various cutaneous conditions. When this occurs within a melanocytic nevus, it is termed Osteonevus of Nanta (ON). This rare phenomenon typically presents in elderly female individuals usually located on the upper trunk. In this report, we present a unique presentation of ON in a pediatric patient. A 2-year-old female with no significant past medical history presented to a plastic surgeon for excision of an asymptomatic soft tissue mass on the right scalp. The parents described the gradual postnatal development of the 1.2 x 0.4 x 0.3 cm red-brown nodule. Excisional biopsy was performed and histopathological analysis found the lesion to be most consistent with ON. To our knowledge, there are no other published reports of ON in the pediatric population. This exceedingly rare case serves to expand our current understanding of this lesion and may provide further insight into the pathogenesis of these nevi.

Clinicopathological characteristics of placental chorioangioma: A clinicopathological study of 30 cases.

The objective is to explore clinicopathological characteristics, diagnosis, differential diagnoses, treatment, and prognoses of placental chorioangioma (PCA). The pathological data of 30 cases of PCA were collected; the color Doppler ultrasound, Down's screening, fetal survival, and pathological characteristics were observed; and the literature was reviewed. Of the 30 patients, the ages ranged from 20 to 38 years, with an average of 29.6 years. Pregnancy comorbidity occurred in 14 patients; intrauterine fetal death occurred in 4; the gross appearance of the tumor: a reddish-brown nodule, slightly round, 0.5-8 cm in diameter, can be seen on the cut surface of the placenta Pregnancy comorbidity occurred in 14 patients and intrauterine fetal death in 4. On sectioning the placenta, tumors grossly appeared as reddish-brown nodules, slightly round and ranging in diameter from 0.5 to 8 cm. Microscopically, the tumor has small, densely packed capillaries with fibrous connective tissue in the stroma. There were 10 cases with high risk of Down's syndrome screening, and the immunophenotype CD34 (+) and Ki-67 proliferation index were less than 10%. PCA is rare and may be misdiagnosed as malignant tumor, which may be related to pregnancy comorbidity and high risk of Down's screening, so improving the understanding of PCA can provide the basis for clinical diagnosis and intervention. PCA is a rare tumor which may be misdiagnosed as a malignancy. It may be related to pregnancy comorbidity and high risk of Down's screening. Improving the understanding of PCA could provide the basis for clinical diagnosis and intervention.

A rare case of localized peliosis hepatis during adjuvant chemotherapy including oxaliplatin mimicking a liver metastasis of colon cancer

BackgroundOxaliplatin-based regimens are commonly used as adjuvant chemotherapy following surgery for colorectal cancer. Adverse events associated with oxaliplatin include blue liver, which is caused by sinusoidal dilation and diffuse peliosis hepatis. We report herein a case of localized peliosis hepatis closely resembling a metastatic liver tumor.Case presentationThe patient, a 50-year-old male, underwent a robotically assisted colectomy for rectosigmoid colon cancer, which was discovered when hematochezia occurred. The patient received a diagnosis of pStage IIIb and was treated with four courses of CAPOX as adjuvant chemotherapy starting at postoperative month 1. At postoperative month 4, contrast-enhanced computed tomography (CT) of the abdomen revealed a 20-mm, low-density area with heterogeneous internal structure in S6/7 of the liver. Abdominal ultrasound and gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings led to a diagnosis of metastatic liver tumor, for which a laparoscopic partial hepatectomy was performed. The resected lesion was a dark reddish-brown nodule with indistinct margins that appeared to be continuous with the surrounding area. Histopathological analysis revealed severe, localized dilatation of the sinusoids and congestion consistent with the gross nodule. Based on these findings, localized peliosis hepatis associated with oxaliplatin-induced sinusoidal damage was diagnosed.ConclusionsLocalized peliosis hepatis associated with oxaliplatin use can be difficult to distinguish from a metastatic liver tumor on imaging studies.

THU643 Hyperandrogenism Caused By A Steroid Cell Tumor Of The Ovary In A Postmenopausal Woman

Abstract Disclosure: M.S. Myint: None. A. Pinero-Pilona: None. Introduction Steroid cell tumor-not otherwise specified (SCT-NOS) is a subtype of steroid cell tumors which, in turn, is a subtype of sex cord-stroma tumors of the ovary. SCTs are exceedingly rare, account for less than 0.1% of all ovarian tumors, can secrete androstenedione, α-hydroxyprogesterone, and testosterone, and cause hyperandrogenism. We present a case of SCT-NOS, which was revealed postoperatively and was associated with breast cancer. Clinical Case A 74-year-old postmenopausal woman presented approximately a year after the onset of hirsutism, frontal alopecia and an elevated serum total testosterone (TTST) 341 ng/dl (reference range 3 to 41 ng/dL) and free testosterone (FRTST) 10.5 pg/mL (reference range 0.0 to 4.2 pg/mL). She has no clitoromegaly, acne, striae, or changes in voice and no history of infertility or PCOS. Physical examination was significant for cushingoid appearance, frontal alopecia, and hirsutism on the face. Her estradiol level was 213 pg/mL (reference range 0 to 30 pg/mL), FSH and LH levels were in the postmenopausal range, 17-hydroxyprogesterone, DHEA-sulfate, androstenedione, and morning cortisol were normal. Pelvic ultrasonography and CT of the abdomen and pelvis did not reveal an adrenal or ovarian abnormality. We suspected an ovarian source and thus recommended bilateral oophorectomy due to the markedly elevated testosterone level and postmenopausal status. We also started spironolactone. Before setting up for surgery, she was diagnosed with invasive lobular left breast cancer and underwent surgery and radiotherapy. Then, she had bilateral salpingo-oophorectomy. After surgery, TTST dropped to 4 ng/dL and FRTST to 2 pg/mL. Her hyperandrogenic symptoms significantly subsided. Pathology revealed a 1.5 cm red-brown nodule within the left ovary. The nodule contains polygonal cells with vacuolated cytoplasm arranged in nests, cords, and sheets. Cells were positive in calretinin and inhibin and negative in Reinke crystal. A steroid cell tumor, NOS was confirmed. Pathologic features associated with aggressive clinical behavior were not present. Conclusion The incidence of SCT-NOS is highest in women of childbearing age but rare in postmenopausal women. There were only a few case reports of SCT-NOS, most of which are relatively larger and revealed on imaging. In our case, the imaging did not localize the tumor. Sex cord-stromal tumors are often not visualized on imaging. Failure to identify a tumor on imaging does not rule out the presence of a tumor. One should always rule out androgen-secreting tumors in cases of significantly high testosterone. When imaging fails to reveal a tumor, bilateral oophorectomy should be considered in postmenopausal women and an ovarian and adrenal venous sampling in women of childbearing age. It is worth doing so because hyperandrogenism is associated with an increased risk of endometrial and breast cancer. Presentation: Thursday, June 15, 2023

Granuloma faciale in a patient with remitting seronegative symmetric synovitis with pitting edema.

Granuloma faciale (GF) is a rare benign chronic inflammatory dermatologic disease which is characterized by facial lesions. The diagnosis is mainly based on clinical and histopathology findings. It may be resistant to treatments and prone to relapse. Different treatment modalities include corticosteroid therapy, tacrolimus, cryotherapy and surgical methods. We report a case of GF in a patient with remitting seronegative symmetric synovitis with pitting edema (RS3PE). A male patient with RS3PE presented with reddish brown soft nodules on and over lateral aspects of his nose and adjacent areas on his face which were diagnosed histologically as GF. He was treated with prednisolone, methotrexate and clobetasol propionate cream successfully without recurrence. To the best of our knowledge this is the first case report of GF occurring in a patient with RS3PE.

Scattered Reddish-brown Nodules on the Head in an Elderly Man: A Quiz.

Abstract is missing (Quiz)

Keloidal Dermatofibroma of the Face: A Rare Series of Three Cases

Dermatofibroma, also known as benign fibrous histiocytoma, is a cutaneous lesion that commonly affects young or middle-aged adults, with a slight preponderance in females. It usually presents as a single or multiple skin-coloured to reddish-brown nodule, primarily affecting the limbs. In the present case series, the authors reported three cases (two males and one female) of the keloidal variant of dermatofibroma, a benign fibrohistiocytic tumour. These cases involved patients aged between 32 and 55 years. All patients presented with nodular lesions on their faces, clinically diagnosed as dermatofibroma. Upon excision, the tumours exhibited circumscribed features with keloid-like areas, multinucleated giant cells, and inflammatory infiltrate. Keloidal dermatofibroma should be considered as a differential diagnosis when encountering tumours with keloid-like characteristics, especially in cases where incomplete excision may lead to recurrence. The present case series highlights the rarity of all three cases occurring on the face, as the prevalence of keloidal dermatofibroma is only 1% among other variants.

Pulmonary Tumor Thrombotic Microangiopathy (PTTM) Caused by Metastatic Ovarian High-Grade Serous Carcinoma: A Rare Case Report and Literature Review

Abstract Introduction/Objective Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare entity, and often diagnosed in postmortem. PTTM is usually presented as unexplained dyspnea in a patient with known or unknown history of cancer. Tumor microemboli mainly affect the pulmonary microvasculature. PTTM is resulting from coagulation cascade activation secondary to tumor microemboli induced fibrin clot formation and fibrocellular intimal proliferation. Methods/Case Report The patient is a 65-year-old female with past medical history of ovarian high-grade serous carcinoma, and presented to the hospital with chest pain and shortness of breath. Coronary angiography showed no new obstructive disease. Echocardiogram revealed markedly elevated right ventricular systolic pressure (65-70 mmHg), indicated pulmonary hypertension. Computed tomography of the chest revealed diffuse bilateral ground glass and solid centrilobular nodules, with no pulmonary emboli identified. She developed worsening hypoxia and expired. A lung-restricted autopsy was performed. Literature review was conducted. The important gross findings included multiple firm and red-brown nodules (approximately 0.1 cm) in bilateral lungs. Microscopic examination revealed the lung parenchyma demonstrated numerous tumor microemboli in the pulmonary arterioles and occasionally in the small arteries. The tumor microemboli consist of tumor cells with various degree of fibrin deposition and fibrocellular intimal proliferation. The tumor cells were epithelioid with moderate to marked nuclear pleomorphism, occasional cytoplasmic vacuoles, frequent apoptosis and necrosis. Immunohistochemical stains for PAX-8 and WT1 highlight the tumor microemboli. These findings are consistent with PTTM secondary to metastatic ovarian high-grade serous carcinoma. Rare cases of PTTM associated with ovarian cancer were found in PubMed. Results (if a Case Study enter NA) NA. Conclusion PTTM has poor prognosis. There are no sensitive diagnostic modalities, and majority of them are diagnosed at autopsy. We have found four reported PTTM cases caused by metastatic ovarian cancer in PubMed, including one case of clear cell carcinoma and three cases of low-grade serous carcinoma. Our current report of PTTM is associated with high-grade serous carcinoma, which is not seen in the literature. The awareness of PTTM is necessary for patients with ovarian cancer.

A Rare Presentation of Angiolymphoid Hyperplasia with Eosinophilia Involving the Scrotum

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferation that typically manifests as pink to reddish brown papules or nodules. These lesions classically affect the face or neck. Involvement of other structures including the tongue, colon, salivary glands, and muscle are rare. Male urogenital involvement for example, had less than 30 cases reported. Here we present the third reported case of ALHE involving the scrotum in a 17-year-old male.

A Case of Scattered Reddish-brown Nodules SimulatingIgG4-related Disease

A Case of Scattered Reddish-brown Nodules SimulatingIgG4-related Disease

26362 Cutaneous polyclonal plasmacytosis presenting with rhinophymatous change in an adult caucasian male treated with carbon dioxide laser

A 69-year-old male with a history of nonmelanoma skin cancer and follicular occlusion tetrad presented to the dermatology clinic with a 4-year history of slow-growing rhinophymatous-like changes on his nose. Physical examination demonstrated multiple indurated, red-brown nodules varying in size from 6 to 10 mm on his right nasal ala, sidewall and bilateral medial cheeks. A shave biopsy was performed and showed a dense dermal infiltrate of plasma cells without cytologic atypia and few lymphocytes.

Kaposi Sarcoma of the Lower Extremity with HIV and Kaposi's Sarcoma

Kaposi's sarcoma is the most common malignancy seen with HIV infection. It is a lymphoangioproliferous tumor first described by Moritz Kaposi in 1872. It is characterized by bluish red or dark brown plaques and nodules, especially in the distal of the lower extremities, often the heels and feet. Organ involvement without skin findings is observed in approximately 15% of the cases. There are four clinical variants, the classical, endemic, iatrogenic and the epidemic associated with AIDS. Kaposi's sarcoma in AIDS cases apart from the skin, it can also be seen in the oral cavity, gastro-intestinal system and respiratory system. Antiretroviral therapy (ART) should be started immediately in newly diagnosed HIV infected patients. In this research, a 65 year old male patient, who was diagnosed AIDS and Kaposi's sarcoma at the same time, is described.

Cutaneous Plasmacytosis: A Pitfall For B and Plasma Cell Neoplasms

Abstract Introduction/Objective Cutaneous plasmacytosis (CP) is an uncommon condition typically affecting Asian males in the 3rd to 5th decades. It is thought to be a reactive process that classically presents with asymptomatic, red-brown, plaques and nodules on the face and neck. It has been associated with polyclonal hypergammaglobulinemia and systemic involvement. Histologically it is characterized by dense superficial and deep dermal infiltrates of mature plasma cells with polyclonal differentiation on in-situ hybridization (ISH). The differential diagnosis includes neoplastic plasma cell processes, characteristically with monoclonal plasma cell infiltrate, and mature B cell neoplasms with polyclonal plasma cell differentiation. Methods We report a case of a 69 year old Caucasian male who presented with asymptomatic, enlarging red-brown nodules on bilateral nasal ala. Histologic examination revealed dense, superficial plasma cell infiltrate, concerning for a plasma cell neoplasm. CD138 and Kappa/Lambda ISH demonstrated plasma cell polyclonality. Further workup ruled out infectious or systemic involvement and a plasma cell dyscrasia was ruled out by Hematology/Oncology. Results These findings supported the diagnosis of CP. Treatment with intralesional steroids showed initial improvement with regrowth of the nodules. To date, treatment with topical steroids and CO2 laser ablation are being considered. Conclusion CP is reported as type of pseudolymphoma, which is described as a reactive lymphoproliferation that histopathologically and/or clinically imitates cutaneous lymphoma. The pathogenesis is unknown, however, there are studies suggesting an association with increased interleukin-6, which is involved in the differentiation of B cells to mature plasma cells. The majority of patients with CP have a favorable prognosis. There has been variable success with both topical and intralesional treatment to include, cyclophosphamide, topical tacrolimus, prednisone, intralesional steroid therapy, topical psoralens combined with ultraviolet A exposure, and other chemotherapies. Familiarity with this rare entity is imperative to prevent misdiagnosis and overtreatment.

Étude anatomoclinique et immunohistochimique de 8 cas de dermatomyofibromes

Dermatomyofibroma (DMF) is a rare, benign tumour that is little-known among clinicians. However, it has typical clinical, histological and immunohistochemical features that distinguish it from other fibrous tumours. We report herein on the clinical, histological and immunohistochemical aspects of eight cases of DMF identified between 2008and 2019at the dermatopathology laboratory of Strasbourg. Five men and three women of average age at diagnosis of 21 years and 9 months (range: 9 to 54 years) were included. Lesions ranged in size from 1 to 11cm. Most cases involved the upper body (6 cases), with one case on the abdomen and one on the side. The lesions presented as a solitary asymptomatic red or reddish brown nodule or plaque that gradually developed. The plaques were hard and caused functional discomfort on movement of the neck. Well-circumscribed spindle cell proliferation was noted in the reticular dermis parallel to the epidermis, without mitotic figures or cytological atypia. The subcutis was infiltrated in 5 cases. Expression of calponin was positive in all cases but one, while that of caldesmon, PS100 and desmin was negative. Expression of smooth muscle actin was positive in 2 cases, and both cases were also positive for stromylesin-3. CD34 was positive in 2 cases. DMF is an extensive tumour capable of attaining large diameters and must be completely excised. The main differential diagnoses of DMF are dermatofibrosarcoma protuberans, dermatofibroma, fibrous hamartoma, myofibromatosis and cheloid. It can be identified based on various factors, whether clinical (young age, extensive lesion), histological (horizontal proliferation in the reticular dermis) or immunohistochemical (positive expression of calponin).

A case report of rare location of ganglioglioma

BackgroundGangliogliomas are rare tumors of the central nervous system. They can occur anywhere in the central nervous system but are most commonly located in the temporal lobe and are mainly found in children. Anaplastic ganglioglioma can result from either de novo or transformation of a pre-existing lesion.Case presentationWe report a case of de novo anaplastic ganglioglioma in the parieto occipital region, which is a rare location. A 34-year-old lady presented with features of raised intracranial pressure (ICP) with right side hemiparesis. Contrast-enhanced magnetic resonance imaging (CEMRI) of the brain showed well-defined intense heterogenously enhancing solid cystic mass lesion 5.3 × 5.2 cm in the left parieto occipital region with mass effect and midline shift. Intraoperatively, a cystic mass lesion with reddish brown nodule was seen in the left occipital lobe. Complete tumor excision was done. Microscopic and IHC examination was suggestive of anaplastic ganglioglioma. The post-operative period was uneventful. The patient received 60-Gy radiotherapy with temozolamide as adjuvant therapy, and repeat imaging showed no tumor recurrence.ConclusionAnaplastic gangliogliomas are rare tumors with parieto occipital as rare location.

1412 A Rare Case of Post-ERCP Panniculitis

INTRODUCTION: Pancreatic panniculitis affects 0.3-3% of patients with a wide variety of pancreatic disorders. It is characterized by subcutaneous fat necrosis following the release of pancreatic enzymes into the circulation. Endoscopic retrograde cholangiopancreatography (ERCP) is a rare cause of panniculitis. Based on our literature review, this is the fourth case report of post-ERCP panniculitis. CASE DESCRIPTION/METHODS: An 80-year-old female with a history of choledocholithiasis with biliary stent placement presented for elective ERCP. The procedure demonstrated a moderate, inflammatory distal biliary stricture, a migrated biliary stent and choledocholithiasis. A biliary sphincterotomy, cholangioscopy and laser lithotripsy and stent exchange was performed with approximately 80% of stone removal. Post- procedure the patient noted tender erythematous raised nodules on her legs. Skin biopsy was performed with findings consistent with pancreatic pannicultitis. Follow-up ERCP was normal with trace sludge and removal of the biliary stent. At follow-up she was improved without abdominal pain and reported healing of the lower extremity cutaneous lesions. DISCUSSION: Pancreatic panniculitis is a rare skin finding that is independent of disease severity and can occur at any point during the disease process. Post-ERCP panniculitis is rare and only reported in three other cases. Pancreatic panniculitis is typically tender, ill-defined, red-brown nodules located in the lower extremities. The gold standard for diagnosis is biopsy with histopathology significant for a mostly lobular panniculitis without vasculitis with the presence of the typical ghost cells, necrotic and calcified adipocytes. Treatment is aimed at addressing the underlying pancreatic disease and the lesions typically resolve with improvement in pancreatic inflammation.

Multifocal capillary hemangioma (hemangiomatosis) of the spleen.

The spleen is mainly affected by benign tumors that originate from the vascular endothelium. The most common is hemangioma, which presents as a small, localized lesion. Isolated diffuse hemangiomatosis of the spleen is a rare entity in which the entire splenic parenchyma is replaced by a proliferation of neoplastic blood vessels. Here we illustrate the case of a 26-year-old man presenting with splenomegaly due to diffuse hemangiomatosis of the white pulp who underwent a splenectomy. Representative samples of the spleen were stained with hematoxylin and eosin, and immunohistochemical analysis was performed for Mib-1, CD20, CD30, CD15, CD34, CD31, CD8, factor VIII, D2-40, CD68PGM1, and LMP1. Macroscopically, the splenic parenchyma contained multiple, red-brown nodules ranging from 0.4 to 1.5 cm. Microscopically, the nodules were roundish and confluent with an angiomatoid appearance and high positivity for CD34 and factor VIII, while they were negative for D2-40. The differential diagnosis of splenic tumors includes lymphangioma, lymphangiomatosis, peliosis, littoral cell angioma, hemangioendothelioma, hamartoma, angiomatoid transformation of the spleen, and angiosarcoma. It is debated whether diffuse hemangiomatosis is a malformation of the postsinusoidal venous system or a slowly growing neoplasm arising from the splenic sinuses. The positivity of the cavernous vessels for CD8 seems to be in favor of the malformative nature of the tumor.

Cutaneous Plasmacytosis: A Clinicopathologic Study of a Series of Cases and Their Treatment Outcomes.

Cutaneous plasmacytosis (CP) is a rare skin disorder characterized by multiple reddish brown nodules with polyclonal plasma cell proliferation. It has most often been reported to affect the trunk but is also known to affect the face and extremities in adults and is predominantly seen in Asians. The etiology is poorly understood, and there is no consensus on treatment methods. Five cases diagnosed to have CP were collated from our institution. Their clinicopathologic features and treatment outcomes were reviewed. Four of the 5 patients presented with lesions that affected multiple sites of the body including the trunk, axillae, face, and limbs. The remaining patient had lesions localized to his axillae. The lesions were generally asymptomatic. All patients had hypergammaglobulinaemia but only one had a faint monoclonal band detected on immunofixation. Common findings in the biopsy results for all patients were perivascular plasma cell infiltrates without light chain restriction on kappa/lambda staining, as well as mast cell infiltrates. Partial remission of cutaneous lesions was observed in 3 of the patients, with 2 of them responding well to psoralen and ultraviolet A radiation therapy. CP presents with distinctive clinical features and characteristic histological features including polyclonal perivascular plasma cell infiltrates. The axilla seems to be a frequent and characteristic site of involvement and may be a useful clinical clue to the condition. In the management of patients with CP, it is important to exclude secondary causes of plasmacytic infiltrates. While there are no clearly established treatment modalities for CP, psoralen and ultraviolet A radiation therapy may be a viable option in view of the clinical improvement observed in our patients who received it.

A case of cutaneous and systemic plasmacytosis

A 46-year-old male patient developed scatterred reddish-brown plaques and nodules on the back 6 years prior to the presentation. Then, the lesions gradually spread to the axillary fossa and protothorax, and became indurated with slight itching in winter. Laboratory examination revealed hypergammaglobulinemia. Computed tomography (CT) scan showed multiple nodular or patchy shadows in both lungs, lymphadenectasis in axillary, mediastinal and inguinal regions, and spleen enlargement. Histopathological examination of skin lesions showed granulomatous infiltrates with plenty of lymphocytes, histiocytes and mature plasma cells in the middle and lower dermis with the presence of lymphoid follicle-like structures, but no cell atypia was observed. Immunohistochemical study showed positive staining for CD38, CD138, CD79a, κ and λ light chains. According to clinical manifestations and laboratory examination results, the patient was diagnosed with cutaneous and systemic plasmacytosis. Key words: Neoplasms, plasma cell; Skin manifestations; Hypergammaglobulinemia; Plasmacytosis