Atypical Presentation of Salzmann Nodule: A Case Report and Literature Review.

Salzmann's nodular degeneration (SND) is an unusual corneal condition that is slowly progressive and non-inflammatory in nature. It results in millimetric gray-white to bluish nodules formation anterior to Bowman's layer of the cornea. It usually affects both eyes in 80% of the cases. These elevated nodules are located near the limbus or in the mid-peripheral cornea, with some exceptions. Salzmann nodule develops following corneal trauma or inflammation. However, it can present idiopathically. Here, we report an atypical case of idiopathic symptomatic large central SND that was treated successfully with superficial keratectomy.

Metastasectomy of Sequential Asynchronous Metastatic Renal Cell Carcinoma to the Pancreas, Thyroid, Skin, Contralateral Kidney, and Lung with Cumulative Survival Beyond 10 Years: A Case Report and Clinicopathologic Review.

BACKGROUND One-third of renal cell carcinoma cases present with an initial metastasis to various organs, emphasizing the tumor's unpredictable behavior. Prognosis is poor once metastasis is discovered. Multiple-organ involvement with metastatic lesions has a particularly dismal survival rate. Surgical resection alone of metastatic masses can extend patient survival with reasonable quality of life. CASE REPORT Here, we present the case of a healthy 46-year-old woman who initially presented with an incidental localized clear cell renal cell carcinoma. During the follow-up period, she presented with sequential asynchronous metastasis to the pancreas, thyroid, skin, contralateral kidney, and lung. She has no family history of malignancy. Her physical examination and laboratory investigations were normal even upon presentation of most of her metastatic organs. The first metastasis was in her sixth year of follow-up. She underwent consecutive metastasectomy of all the organs described above, excluding the lung. She eventually was started on sunitinib after non-resectable lung nodules were discovered. Her survival is now over 10 years since her first metastasectomy, with good performance status. CONCLUSIONS Metastasis to a single organ has a poor prognosis and dramatically affects survival. Nevertheless, our patient had multiple consecutive examples of metachronous metastasis, yet she has survived for over a decade since the occurrence of metastasis. Our case offers more information to fill the gaps in understanding the favorable role of surgical resection in advanced renal cell carcinoma metastasis.