Photo-Induced Sweet Syndrome: A Case Report.

Sweet syndrome is a rare dermatologic condition frequently accompanied by fever and neutrophilia. Underlying triggers and etiology of the sweet syndrome remain elusive, although infection, malignancy, medications, and more rarely, sun exposure have been associated with its development. We present a case of a 50-year-old female who developed a painful, mildly pruritic rash on sun-exposed areas of the neck, arms, and legs. She also reported chills, malaise, and nausea upon presentation. Before developing the rash, she had preceding upper respiratory infection symptoms, used ibuprofen for joint pain, and had extensive sunlight exposure on the beach. Laboratory findings were significant for leukocytosis with absolute neutrophilia, elevated C-reactive protein, and elevated erythrocyte sedimentation rate. Skin punch biopsy demonstrated papillary dermal edema with dense neutrophilic infiltration. Further evaluation for hematologic or solid organ malignancy was negative. Following the administration of steroids, the patient demonstrated significant clinical improvement. While rare, ultraviolet A and B sunlight has been shown in rare situations to be associated with the development of the Sweet syndrome. The underlying mechanism for the development of photo-induced Sweet syndrome remains unknown. However, excessive sunlight exposure should be considered a potential cause when evaluating the underlying triggers for the development of the Sweet syndrome.

Cutaneous nocardiosis in an immunocompromised patient.

We describe a case of a 79-year-old man with chronic lymphocytic leukemia (CLL) who presented with ataxia; falls; vision loss; and numerous mobile erythematous nodules on the chin, neck, scalp, and trunk. Computed tomography of the head and chest revealed cavitary lesions in the brain and lungs. Clinically, the skin nodules were believed to represent an infectious process. Two punch biopsies were obtained, which revealed an unremarkable epidermis with a mixed inflammatory infiltrate with abscess formation in the dermis. Gram stain highlighted gram-positive branching bacterial organisms. Similar organisms were identified in a bronchoalveolar lavage specimen. Cultures from skin and blood were positive for Nocardia. Our case serves as a reminder to clinicians and pathologists to keep a broad differential diagnosis when dealing with infectious diseases in immunocompromised patients.

Adenoid Cystic Carcinoma of the Maxillary Sinus with Isolated Trigeminal Anesthesia.

Adenoid cystic carcinoma (ACC) is a rare malignant secretory gland tumor. It is characterized by slow growth, long clinical course, local recurrences, and distant metastases. In the sinonasal tract, it most commonly arises in the maxillary sinus. It often presents at an advanced stage with perineural spread (PNS). Our patient presented with left-sided facial numbness without other symptoms. The numbness was localized to the left cheek, left side of nose, and left upper lip. Magnetic resonance imaging (MRI) of the brain revealed an enhancing lesion involving the left maxillary sinus with orbital invasion and posterior extension into the cavernous sinus. Transnasal endoscopic exploration with tissue removal revealed ACC. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed no evidence of distant metastases. Presentation of sinonasal ACC (SNACC) is variable depending on the involved structures. Characteristic PNS with ACC may cause neuropathic symptoms. This case displays a unique presentation of an advanced ACC of the maxillary sinus manifesting as isolated unilateral trigeminal anesthesia without sinonasal symptoms. The patient also failed to demonstrate any ocular or oculomotor symptoms despite extensive involvement of the orbit and surrounding structures. This case highlights the importance of recognizing ACC due to its association with late symptomatic manifestations. It also reinforces the need for clinical diligence with the workup of new onset neuropathic symptoms in the maxillary distribution of the trigeminal nerve.

A Case of Small Cell Lung Carcinoma in a 15-Year-Old Boy and Literature Review.

Small cell lung carcinoma (SCLC), also known as high-grade neuroendocrine tumor of the lung, is exceedingly rare in the pediatric population. SCLC is usually fast growing and often has metastasized at diagnosis. It frequently responds well to therapy initially, however, has a high relapse and mortality rate. There are limited published data on SCLC in children and no existing pediatric treatment protocols. In this report, we present a case of extensive stage SCLC in a 15-year-old boy who responded to single-agent gemcitabine therapy and review similar cases reported in the medical literature.

Metastatic Adenocarcinoma of the Prostate Diagnosed in a Colon Polyp: A Unique Clinicopathologic Scenario.

Adenocarcinoma of the prostate is the second most common cause of cancer-related deaths among males in the U.S. Metastatic disease commonly involves the bones, lymph nodes, lungs, liver, and brain. Rarely, colonic involvement is seen and it is generally due to direct extension to the rectum. It is exceedingly uncommon for distant metastasis to occur in the right colon and small bowel. We present a case of prostatic adenocarcinoma metastasizing to the appendiceal orifice in a 78-year-old male. Our patient had a history of adenocarcinoma of the prostate diagnosed four years prior to presentation. He also had a history of adenocarcinoma of the distal colon 30 years prior which resulted in a partial colectomy and permanent diverting colostomy. Prior to his presentation, follow-up colonoscopies failed to reveal disease progression or additional malignancy. During routine colonoscopy, he was found to have a 2.5 cm polyp near the appendiceal orifice. Histologically the polyp demonstrated colonic mucosa with an infiltration of the lamina propria by individual cells with abundant cytoplasm and round nuclei with prominent nucleoli. The neoplastic cells were strongly positive for PSA and negative for CK7, CK20, and CDX2 supporting a diagnosis of metastatic prostatic adenocarcinoma. Metastatic disease of extracolonic origin arising in a polyp is extremely uncommon, but metastases have been reported to involve breast, ovary, stomach, esophagus, and kidney. This case contributes to the scarce information available regarding metastatic spread of prostate cancer to the ascending colon and enlightens the community of pathologists, surgeons, gastroenterologists, and urologists about this unusual presentation of a common carcinoma.