Sebocyte-like cell primary cutaneous melanoma: a rare cytologic variant of malignant melanoma.

Although rising incidence rates of cutaneous melanoma have been observed during the last 4 decades in white populations worldwide, the sebocyte-like cell variant has been described only twice in the literature to date. In our case, a 64-year-old man presented for evaluation of a changing pigmented lesion on the left upper back. Excision of the lesion revealed an invasive melanoma with a Breslow depth of 3.3 mm. Microscopic sections showed a predominantly dermal-based tumor composed of sheets and nests of enlarged epithelioid melanocytes, most of which showed an uncommon phenotype with multivacuolated cytoplasms and scalloped nuclei, features that gave them a strong resemblance to mature sebocytes. The lesional cells expressed S100 protein, Melan-A, and p16, whereas adipophilin was positive only within the sebocyte-like component of the neoplasm and showed focal nonspecific staining. The patient's sentinel lymph node biopsy was positive for micrometastases, although a subsequent position emission tomography scan was unremarkable. Sebocyte-like melanocytes are a rare distinctive type of melanocytes that can be found mostly in benign but also in malignant melanocytic lesions. They usually present focally within the lesions and, therefore, do not represent a diagnostic problem in nevus or primary cutaneous melanoma. However, when sebocyte-like melanocytes are the main cellular component of a melanocytic lesion or when they are found in the context of metastatic melanoma, they may create a potential diagnostic pitfall; for this reason, awareness of this cell type is important.

Subungual Acral Fibromyxoma Involving the Bone: A Mimicker of Malignancy.

Superficial acral fibromyxoma (SAF) is a recently recognized myxoid tumor that usually occurs on the fingers and toes of middle-aged adults. We report the case of a 53-year-old man with a SAF on the first left toe that had been slowly growing for 2 years. Hispathologically, the lesion was nonencapsulated and was composed of stellate and spindle cells, arranged in a myxoid matrix. No atypia or mitotic figures were found. Neoplastic cells showed positive staining for CD34 and negative staining for epithelial membrane antigen, actin, desmin, keratins, S-100 protein, and HMB45. Main differential diagnoses of SAF include benign and malignant myxoid and spindle cells tumors, such as myxoid fibrous histiocytoma, superficial angiomyxoma, myxoid neurofibroma, myxoid dermatofibrosarcoma protuberans, and low-grade fibromyxoid sarcoma.

Obstrucción adherencial del intestino delgado, posterior a histerectomía: a propósito de un caso / Obstruction of small intestine caused by adhesions due to hysterectomy: clinical case

En el presente caso clínico valoramos a una paciente con abdomen agudo obstructivo posterior a histerectomía.El objetivo es alertar sobre la formación de complicaciones principalmente de adherencias intestinales e implementar la prevención, empleando métodos adecuados en el período temprano post-operatorio.La obstrucción intestinal ocurre en el período post operatorio temprano, después de la primera semana (2); constituye entre el 5 y 29% de todos los casos de obstrucción intestinal. Es una complicación en un 2.2% de todos los procedimientos quirúrgicos como: histerectomía, cirugía de colon, recto, apéndice.Los resultados del presente estudio clínico son favorables a la intervención quirúrgica para resolver el problema, y destacar el retraso del paciente para buscar atención médica.El antecedente de una intervención quirúrgica en un paciente con obstrucción mecánica de intestino delgado, es fundamental en el diagnóstico.

Clinical case of s a patient with acute abdomen due to hysterectomy.The objective is to alert mainly on the formation of possible complications of intestinal adhesions, and to implement the prevention, using methods adapted in the early post-operative period.The intestinal obstruction happens early in the post operative period, after the first week. It constitutes between the 5 and 29% of all the cases of intestinal obstruction. It is a complication that stands for 2.2% of all the surgical procedures as: hysterectomy, colon, rectum, appendix surgery.The antecedent of a surgical intervention in a patient with mechanical obstruction of small intestine is fundamental in the diagnosis.

Esplenectomía por trauma cerrado de abdomen más paludismo vivax. A propósito de un caso / Case review: Splenectomy in a acute abdomen posterior to a Trauma

Reporte de caso de un paciente con abdomen agudo posterior a un trauma contuso en el cuál se encontró al examen de laboratorio paludismo a vivax +++. En este artículo nos permitimos demostrar el manejo clínico-quirúrgico realizado en un paciente con trauma esplénico grado 4 y paludismo vivax +++, en el hospital cantonal León Becerra de Milagro haciendo hincapié en la importancia del diagnóstico clínico y semiología quirúrgica a pesar de los limitantes en los exámenes complementarios que tenemos en nuestro centro hospitalario, en el cual TAC no está al alcance de nuestro servicio de emergencia.

This is a report about a patient with acute abdomen posterior to a blunt trauma. In the laboratory exam done to the patient it was positive for P. vivax malaria. In this article we demonstrate the clinical-surgical management on a patient with fourth degree spleen trauma and positive for P. vivax malaria at Leon Becerra Hospital in Milagro. In spite of the limitations for complementary exams such as TAC which is out of our reach at our hospital we put special emphasis on the importance of a surgical - clinical diagnosis