ABSTRACT
The aim of this clinical case report is to highlight the unusual presentation of pancreatic malignancy in which multiple foci of primary adenocarcinoma involving the body and tail of the pancreas are associated with another primary pancreatic mass of adenocarcinoma in the pancreatic head with no precursor lesions in two cases. A retrospective medical chart review was performed at a tertiary hospital in Riyadh, Saudi Arabia, to identify cases with confirmed multifocal pancreatic adenocarcinoma. Data collected include clinical evaluations and laboratory and imaging results. Informed consent was waived. There was no evidence of multifocal cancer on imaging. The unexpected intraoperative findings and pathology report necessitated a total pancreatectomy for both cases. A negative imaging does not rule out a multifocal pancreatic adenocarcinoma. Such awareness may help in the early detection of pancreatic cancer. Moreover, the presence of more than one primary cancer in one organ is a distinctive phenomena that needs further study.
ABSTRACT
The Leser-Trélat sign is a rare sign of some malignant tumors and is characterized by the sudden appearance of seborrheic keratosis in association with an underlying malignancy. We describe a 60-year-old Saudi man with mycosis fungoides (MF) who developed numerous, rapidly growing, seborrheic keratoses on his face and back. To the best of our knowledge, this is the first reported case of MF with the Leser-Trélat sign from Saudi Arabia.
ABSTRACT
Skin tumors are tumors arising from keratinocyte and from adnexal structures. Immunohistochemistry is very helpful in diagnosis of difficult cases in epithelial skin neoplasms, especially basal cell carcinoma (BCC) which is positive for BerEP4, a keratin marker, and mostly negative for epithelial membrane antigen (EMA). Squamous cell carcinoma cells are positive for EMA and cytokeratin, which are of higher molecular weight than those found in BCC. In contrast to BCC, trichoblastoma and trichoepithelioma are negative for androgen receptors. Of the malignant dermal spindle cell lesions, spindle cell squamous carcinoma is positive to 34 betaE12, desmoplasmic melanoma is positive to S100, and leiomyosarcoma is positive to desmin. Of the malignant pagetoid cells, Paget's disease is positive to CK7 and cam5.2, whereas the pagetoid variant of Bowen's disease is positive to CK 5/6. Melanoma in-situ is positive to both S100 and melan-A. Immunohistochemistry is an extremely valuable adjunct to standard morphologic diagnosis in diagnostic pathology. Diagnosis of epithelial tumor depends largely on morphological features but, in rare cases, immunohistochemical stains are needed for definitive diagnosis.
