ABSTRACT
Plexiform schwannoma is a rare variant of Schwann cell tumor. Occurring in either conventional or cellular type, they are characterized either grossly or histologically by a plexiform pattern of intraneural growth often with multinodularity. Ordinary as well as plexiform schwannoma typically arise in superficial soft tissues and show a predilection for the head and neck region. Infrequent examples arise in the setting of neurofibromatosis type 2 or schwannomatosis. The purpose of this study was to assess the frequency of plexiform schwannoma by location, to determine their syndromic association, and to analyze the clinicopathologic features of tumors affecting the head and neck region. It was found, in this not entirely random population, that plexiform schwannoma represented 4.3% of all schwannomas, 23% of head and neck region examples, 15% of cutaneous schwannomas, and lastly, 2% of 322 oral nerve sheath tumors made separately available for review. Furthermore, the association with neurofibromatosis type 2 and with schwannomatosis was 5% each.
Subject(s)
Head and Neck Neoplasms/pathology , Neurilemmoma/pathology , Skin Neoplasms/pathology , Adolescent , Adult , Child , Cohort Studies , Female , Humans , Immunohistochemistry , Infant , Lip Neoplasms/pathology , Male , Neurofibromatosis 2/pathology , Orbital Neoplasms/pathology , SyndromeABSTRACT
BACKGROUND: The risk for subsequent breast cancer in women diagnosed with radial scar lesions (RS) on benign breast biopsy remains controversial. We studied the relative risk of radial scar lesions in a large cohort of patients with benign breast disease (BBD). METHODS: Radial scars were identified in a BBD cohort of 9,262 patients biopsied at Mayo Clinic between 1967 and 1991. Radial scar lesions were classified as proliferative disease without atypia (PDWA) unless atypia was present (classified as atypical hyperplasia [AH]). The observed number of breast cancers developing among those with RS was compared to that expected in the general population using standardized incidence ratios (SIRs, mean follow-up interval 17 years). RESULTS: RS were identified in 439 (4.7%) of the cohort members; 382 (87.0%) contained one RS, 42 (9.6%) contained two, 9 (2.0%) contained three, and 6 (1.4%) contained four or more. The majority of RS (356, 82.4%) were less than 5.0 mm in diameter; 60 (13.9%) were 5.0-9.9 mm, and 16 (3.7%) were 10.0 mm or greater. The relative risk for women with PDWA and RS was 1.88 (95% CI, 1.36-2.53), no different than PDWA without RS [relative risk 1.57 (95% CI, 1.37-1.79) (P=0.29)]. Women with atypical hyperplasia and RS (n=60) had a relative risk of 2.81 (95% CI, 1.29-5.35), while those with atypia but without RS had a relative risk of 3.97 (95% CI, 2.99-5.19). CONCLUSIONS: RS imparts no increased breast cancer risk above that of PDWA or AH without RS.
Subject(s)
Breast Diseases/complications , Breast Neoplasms/etiology , Cicatrix/complications , Adult , Aged , Aged, 80 and over , Biopsy , Breast Diseases/epidemiology , Breast Diseases/pathology , Breast Neoplasms/epidemiology , Cicatrix/epidemiology , Cicatrix/pathology , Female , Follow-Up Studies , Humans , Hyperplasia , Incidence , Middle Aged , Risk Assessment , Risk Factors , Time FactorsABSTRACT
BACKGROUND: A 65-year-old woman with a history of liver and kidney transplantation presented with a pruritic and tender rash of 2-year duration on her left knee. METHODS: The patient had a physical examination, and multiple skin biopsies were performed. RESULTS: Examination showed a cluster of dome-shaped, violaceous papules. A skin biopsy specimen showed multiple granules containing basophilic material within the superficial to mid dermis. The grains were embedded in an eosinophilic substance and surrounded by granulomatous inflammation. A Gomori methenamine silver stain showed abundant septate hyphae, and cultures grew colonies of Microsporum canis. A diagnosis of dermatophytic granuloma, or pseudomycetoma, was made. After considering the patient's immune status, a prolonged course of fluconazole was initiated. CONCLUSION: Microsporum canis, a frequently encountered zoophilic dermatophyte associated with tinea capitis and tinea corporis, is rarely associated with a mycetoma-like presentation, grain formation, or systemic infection. The medical literature describes only six cases of M. canis causing mycetoma-like formations in immunocompromised and immunocompetent patients. This case report describes an unusual presentation of a common dermatophyte infection, and the literature review summarizes the importance of recognizing atypical presentations of dermatophyte infections. Such infections may warrant more aggressive treatment in immunocompromised patients.
Subject(s)
Dermatomycoses/immunology , Immunocompromised Host , Microsporum , Aged , Antifungal Agents/therapeutic use , Dermatomycoses/drug therapy , Dermatomycoses/pathology , Female , Fluconazole/therapeutic use , Granuloma/immunology , Granuloma/pathology , Humans , Immunosuppressive Agents/adverse effects , Kidney Transplantation/immunology , Liver Transplantation/immunologyABSTRACT
BACKGROUND: Malignant granular cell tumors are among the rarest of soft tissue cancers, currently understood to be of Schwann cell origin. As with their benign counterparts, malignant granular cell tumors (MGCTs) have a wide anatomic distribution and carry a poor prognosis, with recurrence and metastasis typically within 1 year of diagnosis. Only a handful of MGCTs have been described in the pelvis. CASE: We describe a case of malignant granular cell tumor that presented as a pararectal mass associated with severe rectal pain. The patient underwent pelvic exenteration and postoperative radiation therapy. She recurred with evidence of liver metastases on imaging studies 8 months following her exenteration. CONCLUSION: We discuss the diagnosis and prognosis of malignant granular cell tumors arising in the pelvis.
