Uncommon Location Research Articles

Incidental diagnosis of primitive neuroectodermal tumor of uncommon location with unusual presentation metastases

Incidental diagnosis of primitive neuroectodermal tumor of uncommon location with unusual presentation metastases

Basal cell carcinoma on the conchal bowl of the ear of a young man

Basal cell carcinoma (BCC) is the most common form of nonmelanoma skin cancer. A review of the literature revealed only a few reports of BCC on the auricle or conchal bowl, usually occurring in elderly patients. Herein, we report an exceptional case of BCC in a young man with an unusual anatomical location of the tumor as a solitary erythematous to black-colored plaque located in the conchal bowl of his right ear. By thoroughly reviewing the literature, there was no other documented case of BCC located in the conchal bowl of the ear of a young adult. Dermatologists should be aware that skin tumors may also occur in uncommon anatomical locations and with unusual presentations in the young population, even if they have no known predisposing factor. Unusual presentations make clinical suspicion of skin tumors very difficult, so these lesions can easily be missed. Early diagnosis can prevent further growth, extensive destruction, and severe consequence of invasive treatments.

Uterine leiomyomas revisited with review of literature.

Uterine leiomyomas, more commonly known as fibroids, are the most common neoplasms of the uterus. These tumors have a profound effect on health care and cost worldwide. Depending on the race, uterine leiomyomas can be seen in 70-80% of all women. Although majority of the women with uterine leiomyomas remain asymptomatic, approximately 30% can present with symptoms. Diagnosing typical leiomyomas on imaging is straightforward. However, when large, located extrauterine and especially with degeneration, the diagnosis can be challenging on imaging. In this article, apart from reviewing the demographics and management of patients with leiomyomas, we describe in detail the imaging appearance of various atypical leiomyomas, uncommon locations outside the uterus and their important differential diagnosis that can have a profound effect on patient management.

Likelihood of Thromboembolic Events After Receipt of the Oxford/AstraZeneca Vaccine

Several cases of thrombosis in uncommon locations (e.g., cerebral venous sinuses, hepatic veins) associated with severe thrombocytopenia have been

A Case Report on Recurrent Merkel Cell Carcinoma with Metastasis to Colon Treated with Pembrolizumab

Merkel Cell Carcinoma (MCC) is a cutaneous neuroendocrine cancer with a poor prognosis. It is characterized by a high rate of recurrence and metastases to regional as well as distant sites. Clinically, MCC often manifests as a single painless, hard nodule in the sun-exposed area. The diameter is often <2cm, but in few cases, it can be >2cm, with rapid growth and metastases to lymph nodes. MCC carcinoma is diagnosed in the advanced stage because of its resemblance with other skin cancers. Because of the aggressive nature of this cancer, the overall prognosis is found to be poor. In this case report, we report a 71-year-old gentle male who presented with a painless mass in the right axilla three years ago, was diagnosed with MCC of the skin and was treated with surgical removal of the mass together with radiation therapy. Two years later, the follow-up visit restaging PET CT scan was done and was found to have a new intense uptake in the soft tissue nodule adjacent to the proximal sigmoid colon. Biopsy confirmed the metastasis of MCC to the colon. We are reporting an uncommon location of MCC metastasis to the intestine for which he got treated with immunotherapy.

A Case of Giant Prolactinoma Characterized by a Nasopharyngeal Extension and Diagnosed by Nasal Cavity Biopsy

Abstract Introduction: Giant prolactinomas represent 2-3% of all prolactinomas and less than 0.5% of all pituitary lesions. Uncommon extensions of giant pituitary adenomas to areas such as nasopharynx or paranasal sinuses are even rarer. There are about 50 cases described in the literature. Here, we report a giant prolactinoma case diagnosed by biopsy from the nasal cavity. Case: A 40-year-old male patient applied to the emergency room after falling on ice. Cranial CT revealed a giant sellar mass destroying the clivus and the sphenoid bone corpus. The patient has had frontotemporal headache for 5 years, and also loss of libido and erectile dysfunction. He had right superolateral visual field defect and right-sided ptosis. Pituitary MRI showed a T2-hyperintense sellar mass measuring 58x58x70 mm, with extension to the nasopharyngeal wall, right cavernous sinus, right petrous apex and ethmoid spaces at the base of the skull. A punch biopsy was taken from the vascular mass located in the right nasal cavity, in between the middle concha and the septum. Pathological examination revealed a neoplasm that showed strong diffuse immunostaining with PRL and CK8, and focal staining with GH. Ki-68 proliferation index was 2%. Serum PRL level was 11881 ng/mL, FSH: 1.5 mIU/mL, LH: 1.3 mIU/mL, testosterone: 35.7 ng/dL, GH: 0.5 ng/mL, IGF-1: 520 ng/mL, ACTH: 73 pg/mL, cortisol: 12 mcg/dL, TSH: 0.04 uIU/mL, fT4: 14.2 pmol/L, fT3: 4.9 pmol/L and electrolytes were normal. Five days later, a right pterygonal craniotomy was performed. The mass showed the same immunostaining characteristics as the earlier biopsy specimen, and also included fibrin, monotonous cells with ischemic necrosis and distorted architecture of the reticulin pattern. According to the post-operative MRI, the right cavernous and clival part of the mass was reduced in size. Cabergoline (0.5 mg/w), levothyroxine (100 mcg/d) and testosterone propionate (250 mg/m) were started. The patient received conventional radiotherapy in a total dose of 1250 Gy, because of the residual mass. Sixth months after radiotherapy, the nasopharyngeal part of the tumor was not visualized. Cabergoline was up-titrated to a maximum dose of 3 mg/w. Prolactin levels decreased to 136 and 22 ng/mL at the third and sixth months of the treatment, respectively. Superolateral right-sided visual field defect persisted. Five years after surgery, secondary hypocortisolism has emerged, and 5 mg/day prednisolone was added to the therapy. Eight years after diagnosis, MRI revealed significant reduction in the size of the heterogeneous residual mass lesion. Discussion: Giant macroadenomas extending to nasopharynx are mostly prolactinomas, but other functional or non-functional pituitary adenomas may also have the same presentation. These lesions tend to be surgically hard to excise due to uncommon localizations, as in our case, and radiotherapy may be needed to control the residual mass.

Glandular odontogenic cyst: Report of a pediatric case in an uncommon location

Glandular odontogenic cyst (GOC), first described by Padayachee and Van Wyk in 1987, is a rare odontogenic cyst of the jaw which is commonly prevalent in the fourth decade. Clinically, it commonly presents as an asymptomatic swelling in the mandibular anterior region. A conclusive diagnosis can be given through histopathological examination. GOC is found to have a high recurrence potential which requires regular follow-up. Here, a rare case of a 14-year-old boy is described who presented with a swelling in left mandibular posterior teeth.

MUCOSECTOMY IN COMPLICATED APPENDICITIS

Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019.
 Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact.
 Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%.

Mesenteric Lymphatic Malformation Causing Midgut Volvulus in an Adult: An Unusual Presentation

AbstractMesentery is an uncommon location for occurrence of lymphatic malformations. Lymphatic malformations causing midgut volvulus are described in pediatric population; however, it is a rare presentation in adults. We present case of 20-year-old man with a large mesenteric lymphatic malformation who presented with acute abdominal complaints. On radiological work up, the lymphatic malformation was seen causing midgut volvulus and closed loop small bowel obstruction with the presence of classical whirlpool sign. The patient underwent emergency surgery and the lymphatic malformation was completely excised along with resection of a segment of small bowel loop.

Verrucous Venous Malformation-Subcutaneous Variant.

Verrucous venous malformation (VVM), previously called "verrucous hemangioma," typically involves the dermis and the subcutaneous fat. We have encountered patients with VVM confined to the hypodermis. During a nearly 20-year period, 13 patients, aged 2-17 years, presented with a subcutaneous mass in the limb without clinically obvious epidermal alterations. Consequently, operative excisions did not include the skin. Histopathologically, the specimens were composed of blood-filled channels with morphologic characteristics of capillaries and veins that infiltrated adipose tissue. Aggregates often formed nodules with variable fibrosis and a component of large and radially oriented vessels. A diagnosis of VVM was supported by endothelial immunopositivity for GLUT-1 (25%-75% immunopositive channels in 16/16 specimens); D2-40 (1%-25% channels in 14/15 specimens); and Prox-1 (1%-50% of channels in 14/16 specimens). A MAP3K3 mutation was identified by droplet digital PCR in 3 of the 6 specimens. Diagnosis of VVM in this uncommon location is challenging because of absence of epidermal changes and lack of dermal involvement. Imaging is not pathognomonic, and mimickers are many. Appropriate immunohistochemical stains and molecular analysis contribute to the correct diagnosis.

Uncommon localisation of Ofuji disease in a Moroccan patient

A Moroccan 18-year-old patient with a history of left mastectomy because of naevoid keratosis of the nipple arrived presenting pruritic papulopustular lesions located on the surgical scar as well as...

Juvenile ossifying fibroma of the orbit: a rare location

<p class="abstract">Osseous tumors in the craniofacial skeleton of young patients are not very frequent, and tumors involving the walls of the orbital cavity are even more infrequent. Despite being usually slow-growing, even small neoformations can have a local aggressive behavior, displacing and compressing vital structures, and so it is important to perform an early diagnosis in order to avoid the tumor to pose problems on the optic nerve and threaten vision. The case that we are presenting shows an ossifying fibroma in a 19-year-old male from Ethiopia, a benign lesion whose progressive growth caused proptosis and downward displacement of the left eye. Following an adequate radiological diagnosis, we were able to delimit the fibroma existence and location. The surgery was conducted in a conservative form, allowing the patient not to suffer from post-surgery malformations. Histopathological diagnosis was compatible with juvenile ossifying fibroma, psammomatoid variant, arising from an uncommon location – the roof of the orbit. </p>

Axillary papules: an uncommon location of lichen nitidus

Axillary papules: an uncommon location of lichen nitidus

Lipoma of Tongue: A Common Lesion at an Uncommon Location

Lipoma of Tongue: A Common Lesion at an Uncommon Location

Uncommon Location for Granular Cell Tumor in a 10-year-old Caucasian Female

Granular cell tumors are uncommon soft-tissue neoplasms of confirmed neural origin and are typically found in females of African descent between 30 and 60 years old.1-3 Most cases are found in the head and neck region, specifically the tongue, although there have been reports of other anatomic variants in patients outside of the typical epidemiology. We report a case of a granular cell tumor in a 10-year-old Caucasian female located on the left ventral upper arm with a biopsy confirming the histopathological diagnosis.

A concealed inguinal presentation of a gastrointestinal stromal tumor (GIST): a case report and literature review

BackgroundGastrointestinal stromal tumor (GIST) can arise anyplace along the gastrointestinal (GI) tract. The uncommon tumor location in groin area is rarely reported.Case presentationWe herein reported a metastasized case presented as GI hemorrhage complicated with indirect hernia, and underwent tumor cytoreduction, herniorrhaphy and chemotherapy for jejunal GIST. The case was described consecutively based on the process of surgical management, with a good follow-up result. A literature review by searching similar case reports from two national medical databases was performed to summarize clinical features of such unusual presentation of GIST, which included hernia characteristics, short- and long-term outcomes of this disease. It showed GIST presenting as groin hernia was rarely reported and all available 11 cases suggested a primary tumor and required both tumor resection and hernia repair. The long-term results indicated 64.3% overall survival at 5 years after the incidental diagnosis.ConclusionsInguinal hernia is an extremely rare presentation of GIST, with limited case reports available in the literature. A radical involving tumor resection plus hernia repair is an optimal surgical approach for such uncommon condition. An adjuvant medication mounting on mutated KIT gene should be strictly followed for high risk cases.

Pleomorphic rhabdomyosarcoma in adult: A very uncommon occipital location

Rhabdomyosarcomeis a commun tumor in children with all its types (pleomorphic, embryonal,alveolarand spindle cell rhabdomyosarcoma). However, it is a very rare tumor in adults, the commun type isthe pleomorphicrhabdomyosarcoma but it is very rare in the head and neck region. The diagnosis of the pleomorphic RMS is made by the histopathologic study, this shows the interest of a biopsy before the surgicalprocedure. The treatment of patients with malignant mesenchymal tumors of the head and neck region is multidisciplinary (radical surgery with postoperative radiotherapy and or chemotherapy) with poor prognosis.

Osteosarcoma of the hard palate in a dog ˗ case report

ABSTRACT The osteosarcoma (OSA) is the most diagnosed primary bone cancer in canine patients. This work reports a case of a canine, six years old, mongrel, female, intact, with an OSA in the hard palate. Physical examination detected a firm mass in the palate. Thoracic radiographs, hematological and biochemical exams, histopathological exams and computed tomography were requested. A chondroblastic OSA was diagnosed and the tumor was characterized by immunohistochemistry. There was never evidence of metastasis in this case. The treatment consisted of the combination of conventional chemotherapy, metronomic chemotherapy, and palliative care, aiming at greater survival and well-being of the patient since surgical excision was not possible due to the location and extension of the tumor. Osteogenic sarcomas of the hard palate are rarely seen and described in the literature. In this article we present a characterization of the osteosarcoma with uncommon localization in the hard palate.

Aneurysmal bone cyst of the calcaneus: An unusual presentation

Aneurysmal bone cysts (ABCs) are vascular bony lesions that are benign, expansile, and locally destructive. The lesion may arise as a primary lesion (65%) or secondary to an underlying lesion (giant cell tumor, osteosarcoma, chondroblastoma, fibrous dysplasia, angioma, and others). The calcaneus is an uncommon location for ABC, accounting only for 1.6% of the cases. Reported is a case of a 21-year-old male patient who presented with chronic pain in his left heel from the past 5 months that got worse and used to aggravate on walking. The magnetic resonance imaging of the calcaneus showed a well-defined multiloculated, expansile cystic lesion in the medullary cavity causing adjacent cortical thinning with intralesional hyperintense septae and fluid level components. On clinicoradiopathological correlation, the lesion was diagnosed as an ABC. Hereby, we report a case of ABC of the calcaneus which is an uncommon presentation.

Primary Intramedullary Frontal Bone Osteoblastoma: A Case Report

Osteoblastoma is a rare osteoid tissue forming tumor commonly affecting the posterior element of the spine. Intramedullary osteoblastoma of the calvarium is extremely rare. Osteoblastoma rarely occurs in the first decade of life. In this report we describe osteoblastoma of a very uncommon location in an 8-years-old male.