An unexpected metastasis of breast cancer mimicking wheal rush.

Breast cancer is the most common cancer among women and ranks second in cancer deaths worldwide. Breast cancer can metastasize to the skin but rarely, cutaneous metastases may be the first indication of the cancer. Skin metastases of breast cancer are usually found on the chest and close to the point of the mastectomy. We present the rare clinical entity of a breast cancer which was first diagnosed due to the skin metastasis away from the breast tumor. This is a rare case because the skin lesions usually appear simultaneously or secondary. Also, while the existing metastasis; the only symptom was the wheal rash.

Giant tumour of the heel: acquired fibrokeratoma.

Fibrokeratoma is a rare benign invasive tumour usually located on the digits. We report a 35-year-old patient with a giant acquired fibrokeratoma of the heel. Despite its large size and unusual location, the tumour was microscopically benign and was successfully excised.

One-stage reconstruction of the antihelix and concha using postauricular island flap.

Tissue defects in the antihelix and the concha due to oncological resection and trauma can be successfully repaired with a subcutaneously based postauricular island flap. Alternative methods of regional reconstruction usually need two stages or may require grafts in some patients. We present the one-stage technique, as described by Masson, without grafts, to provide adequate reconstruction and aesthetic restoration of the area, illustrated by 62 patients. In all patients there has been a follow-up period of 12 months. This report provides evidence for the aesthetic superiority of this method. An excellent aesthetic outcome was achieved in 46 patients, an adequate outcome in 15 patients, and a poor result in only 1 patient. No flap necrosis was observed. The method has considerable advantages for the repair of anterior conchal and antihelical defects.

Management of external ear keloids using form-pressure therapy.

Keloids are a frequent finding after physical trauma. Keloids of the pinna (helix and antihelix) as a complication of ear-piercing are the most difficult cases. Clinicians have tended to avoid the surgical approach, preferring local conservative treatment with corticosteroids or other treatments. We report use of intrakeloid resection and a form-pressure device to treat pinna keloids and avoid recurrence. The purpose is to maintain the form of the folds of the pinna. The recommendation for this therapy is to maintain the pressure at 24-30 mmHg, and the duration of the form-pressure therapy in our patients was about 25 weeks.

Expression of cyclin D1 and Ki-67 in squamous cell carcinoma of the penis.

BACKGROUND: Cyclin D1 plays an important role in regulating the progression of cells through the G1-phase of the cell cycle. The aim of the study was to investigate the expression of cyclin D1 and Ki-67 in squamous cell carcinomas (SCC) and in some premalignant lesions of the penis and to correlate it with clinicopathological parameters and patient survival. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded tissues from 21 SCC, 7 lichen sclerosus, 5 condyloma acuminatum and 2 erythoplasia of Queyrat were stained by immunohistochemistry for cyclin D1 and Ki-67. RESULTS: Cyclin D1-positive nuclear staining was overexpressed in 13/21 SCC (61.9%) and in one case of erythoplasia of Queyrat. Strong reactivity for Ki-67 was found in 16 (76.2%) SCC, in 3 condyloma acuminatum and in one case of erythoplasia of Queyrat. A tendency for an association between cyclin D1 expression and tumour differentiation (p = 0.07) but not the level of tumour invasion (p = 0.50) was found. The Ki-67 expression was notably increased with the advance of tumour grade, but the difference did not reach a statistically significant level (p = 0.46). A slight tendency towards a relationship between Ki-67 and cyclin D1 protein expression was observed (p = 0.32). Two patients relapsed and one died from the disease over a median follow-up period of 4.6 years (range 0.1-10.3 years). CONCLUSION: Ki-67 antibody and cyclin D1 overexpression seem to parallel each other, supporting the concept that cyclin D1 serves as a cell cycle activator. Cyclin D1 overexpression may be used as a prognostic factor of poor outcome in penile carcinoma.

Lip defects due to tumor excision: apropos of 899 cases.

Reconstructive surgery of the lips after resection of tumors requires a complete understanding of the anatomy of this region. Most lip cancers remain localized and grow slowly, with a propensity for superficial rather than vertical spread. From January 1983 to December of 2005, 899 patients underwent reconstructive surgery for skin tumors involving the lips. SCCs were the most frequent skin tumors on male patients whereas BCCs were most common on the female patients. The lower lip was the anatomic zone most frequently involved in our series. Preoperative evaluation of the patients was performed in all cases. In the last five-years, we have performed preoperative fine needle aspiration (FNA) biopsy of the tumor. The FNA sample was then examined by ThinPrep technique (Cytolyt; Cytyc, Co, Boxborough, MA, USA). In our series, from the 550 patients who had a five-year follow-up we observed 62 recurrences of the primary tumor. The five-year recurrence rate was 11.28%. The aim of this retrospective study is to report our experience in the treatment of lips tumors with selective combination of treatment modalities.

On the morphology of cells of posterior cornea in the iridocorneal endothelial syndrome.

The iridocorneal endothelial (ICE) syndrome is potentially a blinding condition as a result of glaucoma and/or corneal decompensation. The basic pathology seems to be in the corneal endothelium, which many studies confirm takes on a characteristic slit lamp appearance of hammered silver and image reversal with the specular microscope. The origin and morphology of the abnormal cells are unknown. Many histopathological studies of keratoplasty and trabeculectomy specimens reveal as many cell types. This paper reports some general and specular microscopical data from 57 cases of the syndrome, argues that the reason for the variety of histopathological findings in other studies is due to poor sampling of the study material, deduces the morphology of the abnormal cells on specular microscopical criteria, and compares the specular and scanning electron microscopical images in one case with those of other reports. It is tentatively concluded that the appearance of the abnormal cells is a function of their three-dimensional shape and that they produce blister-like vesicles that rupture, collapse, and eventually invaginate.

Lymphangioma circumscriptum of the eyelids and conjunctiva.

A case of lymphangioma circumscriptum of the eyelids and conjunctiva is described. The classification of this disease is given.

Accidental sexual strangulation.

Accidental death by manual strangulation among homosexuals during the act of sodomy is an uncommon event. In our recent case, the pattern of injuries indicates that strangulation resulted from the forearm application on the neck in a manner better known as "choke holding."

The posterior surface of the cornea in the irido-corneal endothelial syndrome: a specular microscopical study.

The corneal endothelia of 21 eyes afflicted with the irido-corneal endothelial (ICE) syndrome have been studied repeatedly with the clinical specular microscope. In all cases a characteristic cell type (the 'ICE-cell') is present but distributed in 4 different patterns. Accordingly, each case could be classified at any one time as one of 4 endothelial variants. One variant, always associated with elevated intraocular pressure (IOP), is characterised by a scattering of ICE-cells throughout the endothelial mosaic. This progresses rapidly to a second variant in which the entire endothelium appears 'replaced' by ICE-cells. In a third variant, associated with normal IOP, ICE-cells 'replace' only a portion of the endothelium which itself shows a great increase in cell numbers/unit area. This, apparently, slowly progresses to a fourth variant which shows a dramatic loss of endothelial cells.

Clinical features of the irido-corneal endothelial syndrome.

Progressive iris atrophy, Chandler's syndrome and the iris naevus syndrome are recognised as subgroups of the irido-corneal endothelial syndrome but in some cases a confusing overlap of the clinical signs is found. The clinical features of five cases selected from 19 patients with this syndrome are described. The findings suggest that the disease can be better subdivided into two groups based on the morphology of the posterior corneal surface as seen with the slit lamp.

Corneal opacities--a diagnostic feature of the trisomy 8 mosaic syndrome.

An infant with trisomy 8 mosaicism had bilateral corneal opacities and multiple systemic anomalies. A review of the literature suggests that corneal opacities are a prominent feature of the syndrome and may have substantial clinical and diagnostic importance.