Rubbery Nodules Research Articles

Multiple rubbery nodules on the scalp

A 60-year-old woman presented with two slowly-growing pink, firm, rubbery nodules on her scalp. She had a personal history of acral melanoma and of spiradenomas and trichoepitheliomas of the scalp. Her familial history was negative for skin tumors. Physical examination found numerous pink, red, and bluish smaller nodules on her scalp (Fig 1). The two larger nodules were surgically excised; histologic examination showed lobular structures in a jigsaw puzzle pattern with focal subcutaneous extension, each well circumscribed by a hyaline basement membrane.

P2-125 - Late Recurrence of Malignant Melanoma Mimicking Primary Peritoneal Cancer

ABSTRACT Background Malignant melanoma is an extremely malignant tumor with an unpredictable profile of spread and variable periods of remission. The late recurrence of malignant melanoma after diagnosis and treatment is a rare but characteristic metastatic behavior of malignant melanoma. When the late recurrence of malignant melanoma occurs, the most common sites of metastasis are the skin, subcutaneous tissue and lymph nodes. Case A 41-year-old woman presented with recurrent malignant melanoma which had clinical features of an acute state mimicking peritoneal cancer. Seven years after the excision of the primary tumor, the patient noticed diffuse abdominal distention. The patient underwent computed tomography and magnetic resonance imaging examination, which demonstrated extensive nodularity of the peritoneal surfaces, soft tissue thickening of the omentum and large amount of ascites. Therefore, primary peritoneal cancer was initially considered the most likely diagnosis. The patient underwent an exploratory laparotomy. Macroscopically, a numerous number of white-yellow rubbery nodules of tumor were present diffusely in the ovaries and omentum and on the uterine serosal surface. The pathological examination showed poorly differentiated adenocarcinoma of peritoneum. The tumor cells showed strong positivity by immunohistochemistry for S-100, melan A and vimentin. The diagnosis was established post-operatively by immunohistochemistry. Our case was an unusual recurrent case of malignant melanoma occurring 7 years after diagnosis and treatment of malignant melanoma. Conclusion The incidence of malignant melanoma has been increasing. The late recurrence of malignant melanoma may be seen frequently in the future. A variety of imaging and pathological methods including an exploratory laparotomy may be necessary in cases of patients suspecting peritoneal cancer with a previous history of melanoma.

Flesh-Colored, Rubbery Nodules in a Young Girl

Flesh-Colored, Rubbery Nodules in a Young Girl

Epidemic resurgence of a goat-specific syndrome simulating goat dermatitis in Punjab and Sindh provinces of Pakistan

The present study describes epidemic resurgence of a goat-specific syndrome simulating goat dermatitis at six different places in Pakistani Punjab province and at two places in Sindh province after a lapse of 56 years. The occurrence of the syndrome was limited to February thru July 2004; being absent thereafter till May 2007. Cumulative attack rate of the syndrome was 0.2%; 37 of 181 goats in 11 flocks contracting the syndrome over a 6-month outbreak period. Age-specific attack rates were higher (54.97) in goats younger than 1 year than in goats older than this. Similarly, the overall case fatality rate was higher (88.46%) in goats younger than 1 year than in those older than 1 year (81.81%). None of the cohort sheep in flocks ( n = 11) comprising both goat and sheep developed the syndrome. Significant clinical signs included fever (41.1–42.2 °C), generalized appearance of prickly heat-like tiny reddish dermal papules which successively transformed into thick rubbery intradermal nodules, necrotic blackish striated ulcers, and punched dermal ulcers covered with saucer-shaped black scabs eventually shedding after 38–60 days. Smaller grayish-white nodules were also seen on tongue, gums and nares. Vesicles and pustules were not seen at any stage of the disease. Chicken embryos inoculated with the filtrate via chorio-allantoic membrane route did not support the growth of any microorganism. When the filtrate prepared from the nodules of naturally affected goats was smeared onto the scarified inner skin of the ear of Beetal goats previously, vaccinated against goat-pox, the inoculated goats developed hyperemia and pyrexia (40.5–42.2 °C) after 7–8 days followed by the appearance of dermal lesions compatible with those of spontaneously occurring syndrome. Intradermal inoculation of filtrate on the costal area of goats resulted in appearance of skin swellings and pyrexia 3 days postinoculation. This was followed by successive appearance of typical skin lesions of the syndrome. Goats inoculated with filtrate prepared from dermal lesions and papules in the wake of recovery from the syndrome, inoculated sheep, rabbits and guinea pigs did not develop skin lesions or fever. A 6-day treatment protocol based on the use of antibiotic, antipyretic, VitAD 3E and topical antiseptic with and without antiviral (ribavirin) had no effect on the severity as well as final outcome of the syndrome. Vaccination against goat-pox did not stop occurrence of new cases. Contrarily, autogenous caprination with supernatant prepared from rubbery nodules of affected goats stopped the further progression of the disease to yet unaffected goats. The recrudescence of a contagious fatal goat-specific syndrome over a wide geographical region after an apparent lapse of 56 years signifies the need to include this goat disease in active surveillance program of caprine diseases.

Large benign rheumatoid nodules of the trunk in an elderly patient: radiologic appearance mimicking a soft-tissue sarcoma

An 80-year-old woman without any evidence of rheumatoid arthritis presented with two large (maximum diameter: 6 cm and 7 cm), rapidly growing, rubbery nodules on the trunk. Although the clinical and radiological appearance suggested malignancy, the nodules were pathologically identical to rheumatoid nodules in rheumatoid arthritis, and the nodules regressed spontaneously. The final diagnosis was benign rheumatoid nodules. Recognition of this rare clinical entity is important to avoid unnecessary examination and treatment.

Early Post-transplant Smooth Muscle Neoplasia of the Colon Presenting as Diminutive Polyps: A Case Complicating Post-transplant Lymphoproliferative Disorder

A 44-year-old woman, 3 years post-transplant for pulmonary sarcoidosis, developed abdominal pain and diarrhea 13 months subsequent to an eradicated diffuse large B-cell-type, post-transplant lymphoproliferative disorder (PTLD) of the cecal region. Endoscopic examination identified multiple pale tan 5-to-9 mm rubbery nodules of the transverse and right colon in an otherwise unremarkable mucosa. Histology was characterized by bland smooth muscle proliferations, focally pushing into the mucosa. Immunohistochemistry (IHC), in situ hybridization (ISH), and polymerase chain reaction (PCR) of the sampled nodules confirmed Epstein-Barr virus (EBV) infection of neoplastic cells. To our knowledge, this is the first reported case of EBV-related post-transplant lymphoproliferative and smooth muscle neoplasms (PTSN) having distinct tropism for the colon. Endoscopic features of early PTSN, which in this case presented as diminutive polypoid lesions, have not been described previously.

Sclerosing polycystic adenosis of major salivary glands. A clinicopathologic analysis of nine cases.

We describe nine cases of a histologically distinct and previously unreported lesion of the major salivary glands. The patients ranged in age from 12 to 63 years and included four males, five females. The lesions were slow-growing masses in the parotid gland (eight cases) and submandibular gland (one case). The clinical impression in each case was a benign salivary gland tumor. Grossly, the lesions were discrete, pale, rubbery nodules embedded within the salivary gland parenchyma. Microscopically, the lesions were unencapsulated, circumscribed masses of sclerotic and hyalinized collagenous tissue. Irregularly distributed throughout the collagenous tissue in a vaguely lobular pattern were hyperplastic ductal and acinar elements that were usually accompanied by cystically ectatic ducts. The dilated ducts frequently showed apocrine-like metaplasia and epithelial hyperplasia, which often formed transluminal bridges in a cribriform pattern. This epithelial hyperplasia sometimes surrounded eosinophilic globules as seen in so-called collagenous spherulosis. The combination of fibrosis, epithelial hyperplasia, and cystic changes were reminiscent of fibrocystic changes of the breast. Focally, acinar elements contained large, intensely eosinophilic, periodic acid-Schiff's-positive, intracytoplasmic granules believed to represent altered zymogen granules. A sparse to focally intense lymphocytic infiltrate accompanied the epithelial proliferations. Previous interpretations of these masses have included mucoepidermoid carcinoma, low-grade adenocarcinoma, benign adenoma, and mixed tumor. The limited available follow-up suggests that this process has a favorable prognosis despite recurrences in two cases. It is postulated that these lesions represent a pseudoneoplastic condition that results in both fibrosis and epithelial proliferation. We suggest the term sclerosing polycystic adenosis for these rare lesions.