Dermal Granuloma Annulare After SARS-CoV-2 Vaccination: A Rare Complication.

Granuloma annulare (GA) is an inflammatory granulomatous skin disease of unknown etiology that is self-limiting in nature. However, it is hypothesized that trauma, medications, malignancy, viral infections, different vaccines, and hypersensitivity reactions can trigger the formation of GA. Only three cases of post-SARS-CoV-2 vaccination-related GA have been reported so far. Here, we report the fourth documented case of post-SARS-CoV-2 vaccination-related generalized GA.

A Rare Presentation of Lichen Sclerosus Involving the Vaginal Canal After Radiation Therapy: A Case Report and Review of the Literature.

Vaginal lichen sclerosus (LS) is an extremely rare entity. Classically, LS is referred to as a chronic, inflammatory skin disease with a distinct predilection for the anogenital skin that is observed in post-menopausal women and typically manifests clinically as white, atrophic plaques. Here, we report a case of a 61-year-old patient who presented for a follow-up visit three years after vaginal brachytherapy as an adjuvant treatment for endometrial adenocarcinoma. This lesion was biopsied and confirmed to be vaginal LS on histological analysis. While LS has been previously observed to impact mucosal areas outside of the anogenital region, such as the mouth, reported cases of vaginal LS are very rare in the literature. Our case highlights both the underrecognized location of this disease as well as radiation as a potential risk factor.

Large Water-Clear-Cell Parathyroid Adenoma: A Report of a Rare Case.

Water-clear-cell parathyroid adenomas are extremely rare tumors characterized by cells that contain clear, foamy cytoplasm. Here we report a case of a large water-clear-cell parathyroid adenoma in a 70-year-old male. The patient was presented to an outside hospital with severe abdominal pain and supporting CT imaging confirming a small bowel obstruction. Initial laboratory studies revealed hypercalcemia and elevated parathyroid hormone levels. Subsequent ultrasound imaging revealed a 2.7 × 2.1 cm neck mass suspicious for a parathyroid adenoma. A parathyroidectomy was performed, and microscopic evaluation revealed an expansile proliferation of cells with characteristic water-clear cell features. Although rare, water-clear-cell parathyroid adenomas are clinically indistinguishable from more common subtypes and should be considered in the differential diagnosis of an anterior neck mass.

Scalp Metastasis as an Initial Manifestation of Squamous Cell Carcinoma of the Lung: Case Report of an Extremely Rare Entity.

Cutaneous metastasis of primary visceral neoplasm is an unusual phenomenon. However, cutaneous metastasis as an initial presentation of clinically silent visceral neoplasm is exceedingly rare. We are reporting a unique case of an elderly male patient who presented with a solitary scalp metastasis as an initial manifestation of underlying lung cancer. Further diagnostic evaluation revealed neoplastic primary lung disease. This case report emphasizes the importance of physicians being aware of these unusual clinical presentations of visceral malignancies. It is also critical to order appropriate diagnostic tests promptly to establish an accurate diagnosis and begin the proper treatment for a better prognosis. Skin lesions can be a diagnostic manifestation of lung cancer and predict a poor prognosis. We conclude that in patients with a history of smoking or lung cancer who present with cutaneous lesions, the possibility of skin metastasis of primary lung cancer should always be considered in the differential diagnosis.

Collision Tumor Comprised of Atypical Fibroxanthoma and Invasive Squamous Cell Carcinoma: A Case Report of an Extremely Rare Entity.

Single benign or neoplastic dermal lesions are very common. Lesions with two distinct tumors occurring as a single entity are extraordinary and known as collision tumors. In the present case, the lesion was diagnosed on biopsy, and later, wide local skin excision was performed. Excision revealed that the lesion was composed of two distinct cell populations exhibiting the characteristics of two separate neoplastic entities. The histopathology revealed a single lesion comprised of moderately differentiated squamous cell carcinoma that appeared to invade an atypical fibroxanthoma. This is unprecedented in the English literature and the first such case to be reported.

Rhabdomyosarcoma of the urinary bladder in an adult: Case report and review of the literature.

Rhabdomyosarcomas with bladder involvement in adults is an extremely rare tumor with approximately 35 cases reported. Because of its rarity in adults the exact treatment modalities are not entirely clear. Treatment is based on Children's Oncology Group in RMS. There is no significant difference in stage, lymph node status, gender, and site between adults and children. The 5 year survival for pediatric RMS is 66% and for adults 22%. It is clear that our understanding and treatment of pediatric RMS is much greater than that of adult patients and the possible reason for these differences are discussed.

Autoimmune Hepatitis (AIH) in Acquired Immune Deficiency Syndrome (AIDS): A Case Report and Review of Literature.

The common causes of abnormal liver chemistries in human immunodeficiency virus (HIV) infected patients are multifactorial. Diagnosis of autoimmune hepatitis (AIH) in HIV infected patients is intriguing but data is scarce. Unmasking of AIH during immune reconstitution in HIV patients after starting antiretroviral therapy is reported but not with advanced acquired immunodeficiency syndrome (AIDS). Here we present a fascinating case of 32-year-old African-American man with advanced AIDS who presented with elevated transaminases. He was diagnosed with AIH before starting antiretroviral therapy and successfully treated with prednisolone and azathioprine with antiretroviral therapy despite very low CD4 count.

Liver Cholestasis Secondary to Syphilis in an Immunocompetent Patient.

Liver involvement is a known feature of secondary syphilis. The prevalence of hepatitis in secondary syphilis ranges broadly from 1 to 50%. We report a case of a 37-year-old man with type 1 diabetes mellitus and sickle cell trait presenting with jaundice and acute liver cholestasis. Abdominal ultrasound revealed mild hepatic fatty infiltration. RPR and Treponema pallidum IgG results were positive with a reflex titer of 1:64. Liver biopsy revealed chronic hepatitis with normal hepatic architecture, Kupffer cell hyperplasia, hepatic cholestasis, and ductal proliferation suggestive of syphilitic hepatitis.

Malignant granular cell tumors: the role of electron microscopy in the definitive diagnosis of an extremely aggressive soft tissue neoplasm.

Granular cell tumors (GCTs) are rare soft tissue neoplasms which may be multicentric. The vast majority are benign, however approximately 100 malignant GCTs have been reported, with only 8 originating in the vulva. Malignant GCTs are very aggressive with very poor survival rates. As the diagnosis of malignant GCT carries an extremely poor prognosis, the utilization of EM ensures that the most accurate diagnosis possible can be rendered.

Ovarian Adenomatoid Tumor Coexisting with Mature Cystic Teratoma: A Rare Case Report.

Adenomatoid tumor of the ovary is rare, and so are collision tumors in this location. The most common histological combination of ovarian collision tumors is the coexistence of mature cystic teratoma with ovarian cystadenoma or cystadenocarcinoma. Presented herein is a rare case of ovarian adenomatoid tumor found incidentally and coexisting with mature cystic teratoma. A 44-year-old woman presented with a one-year history of intermittent right-sided pelvic pain. Ultrasound evaluation revealed a heterogeneous cystic mass in the right ovary, and a clinical diagnosis of teratoma was made. The patient subsequently underwent a right salpingo-oophorectomy. Pathological examination revealed a mature cystic teratoma and coexistent adenomatoid tumor. The two tumors were separate and no transitional features were recognized histologically. To our knowledge, no previous report of coexistence of these two tumors has been reported. Both tumors are benign and completely excised; therefore no adverse consequences are expected.

Oral foregut duplication cysts: A rare and fascinating congenital lesion. Case report and review of the literature.

Oral foregut duplication cysts are extremely rare lesions with approximately 57 cases reported. They are congenital cysts, located in the anterior or ventral tongue, and occur predominantly in males. They are lined by one or more types of epithelia which is limited to gastric, intestinal or respiratory epithelium. The differential diagnosis includes lymphangioma, hemangioma, ranula, epidermoid cyst, teratoma and less likely a malignant process.

Metastatic Colonic Adenocarcinoma to the Extrahepatic Common Bile Duct: The Critical Role of the Pathologist and Immunohistochemistry in Guiding Patient Care Decisions.

BACKGROUND Adenocarcinoma of the colon frequently invades adjacent organs, spreads intraperitoneal, and metastasizes to intestinal lymph nodes, lungs, and the liver. Metastasis solely to the extrahepatic bile duct is extremely rare and has only been previously reported on 15 occasions. The accurate determination that an extrahepatic common bile duct lesion is of colonic origin has critical therapeutic implications. CASE REPORT The patient was a 50-year-old male with a history of colon cancer S/P surgical resection in September 2014. At that time, the tumor extended to the serosal margin, and was staged as pT4a N0 MX stage II. In April of 2016, the patientwas admitted to our facility and an ERCP was performed. A biopsy was performed during the ERCP followed by sphincterotomy and metal stent placement. The surgical pathology revealed an adenocarcinoma with surrounding benign glandular structures. The surrounding benign glands served as an appropriate control when compared to the malignant glands. The benign glands were positive for CK-7 and the malignant glands were negative for CK-7. The malignant glands were also positive for CK-20 and CDX-2, and the benign glands were negative for CK-20 and CDX-2. This profile was consistent with an adenocarcinoma metastasis from colon primary tumor. CONCLUSIONS This case superbly illustrates the critical role of the pathologist, and their knowledge and understanding of immunohistochemistry, in arriving at the correct diagnosis and in assisting surgeons and oncologists in guiding the care, management, and appropriate therapeutic decisions regarding patients. In patients with a history of colorectal carcinoma (CRC), immunohistochemistry is required to arrive at the correct diagnosis as treatment options can be very different based on diagnosis.

Synthetic Cannabinoid Abuse and a Rare Alpha-1-Antitrypsin Mutant Causing Acute Fulminant Hepatitis: A Case Report and Review of the Literature.

Synthetic cannabinoids (SCs) abuse is on the rise because they are easily obtained over the counter; they are potent psychoactive compounds and routine drug testing does not detect them. As their abuse is on the rise, so are their detrimental side effects; however, the occurrence of acute hepatitis due to SCs abuse has been reported only once before. In this case, testing revealed that the patient was also heterozygous for alpha-1-antitrypsin (A-1-AT) with the phenotype of PI⁎EM. This mutant phenotype has never been reported as a cause of A-1-AT disease and the abuse of SCs in a patient with this phenotype has also never been reported. This case illustrates the possible need to expand routine drug testing for SCs and consider A-1-AT phenotyping in certain clinical scenarios.