Eccrine porocarcinoma: a case report.

Eccrine porocarcinoma is a rare malignant sweat gland tumour. Clinical presentation can vary from an indurated plaque to a polypoid ulcerated and bleeding lesion. Diagnosis of eccrine porocarcinoma on clinical observation only is quite impossible. Here we present the case of a 64-year-old female patient with a small reddish nodule of the knee that, on histological evaluation, proved to be an eccrine porocarcinoma.

Axillary giant lipoma: a case report.

Lipoma are the most frequent mesenchymal soft tissue tumours but rarely present huge sizes in their cutaneous localization. Some cases of so-called "giant lipomas" have been reported in the literature and here is presented a giant lipoma of the axillary area which is, to our best knowledge, the second report of such a giant lipoma in this localization.

Apocrine adenocarcinoma of the nipple: a case report.

Apocrine adenocarcinoma of the skin is a rare and, most of the time, clinically misdiagnosed malignant adnexal tumour. A 66-year-old female patient presented with an asymptomatic swelling of the left nipple that on pathological evaluation was confirmed as an apocrine adenocarcinoma. Surgery is to be considered as the mean treatment for such a lesion and the diagnosis is always difficult to establish. To our best knowledge, this is only the second reported apocrine adenocarcinoma arising from a nipple and the first presenting with Paget's phenomenon.

Cutaneous cysts: a plea for systematic analysis.

So-called cutaneous cysts are extremely frequent tumours that could need surgical attention. Most of the time, due to their quite pathognomonic clinical presentation and indolent course, they are simply enucleated. Often, the clinical diagnosis is easily confirmed at surgery by the typical appearance of a cystic formation filled with a creamy fluid. It is frequent for such "typical" lesions to escape histological investigation following removal. However, some mimicking lesions could also be found as "cutaneous cysts" and have quite different prognoses. This paper present five patients with such lesions, three basal cell carcinomas, one benign proliferating trichilemmal cyst and a malignant proliferating trichilemmal cyst. None of the lesions was clinically distinguishable from a classical epidermis cyst.

Basal cell carcinoma of the dorsum of the hand.

Although extremely frequent elsewhere on the body, basal cell carcinomas are infrequent on the hands (< 1% of all basal cell carcinomas). Chronic sun exposure is considered as the main etiologic factor for its development but it does not explain low frequency of hand involvement. Presented here is a series of seven patients with basal cell carcinoma of the hand. All were treated by surgery alone. Clinical presentation was classical: a slowly growing chronic ulceration. None of the patients was chronically exposed to chemical agents but two of them developed their tumour in previously irradiated areas, focusing on this specific etiologic factor for basal cell carcinomas of the hands.

Peri-areolar skin-sparing mastectomy and immediate tram flap reconstruction.

The association of peri-areolar skin-sparing mastectomy with immediate autologous tissue breast reconstruction could be proposed to selected patients necessitating mastectomy to control their breast cancer. A prospective series of 14 consecutive patients were operated using this association and evaluated. Mean age at time of surgery was 52 years. Mean operating time for reconstruction was 163 minutes. There were two minor local complications, one needing secondary adaptation under local anaesthesia. Cosmetic result was judged good to excellent by all the patients with a mean follow-up of 13.2 months.

Immediate breast reconstruction with implants and adjuvant chemotherapy: a good option?

Immediate breast reconstruction using implants is a currently practiced intervention. However, it is exposed to the potential adverse effects of adjuvant therapies necessitated for cancer control. Patients with implants, receiving adjuvant chemotherapy, were compared with those not necessitating chemotherapy to evaluate the real impact of this combination of treatment modalities on the final outcome. Cosmetic results were not influenced by the adjunction of chemotherapy, but a higher rate of implant infection was observed in the chemotherapy group (10.7% versus 1.5% p = 0.0084). This observation needs to be kept in mind when selecting patients for immediate breast reconstruction with implants.

Simultaneous nipple and areola reconstruction: a review of 50 cases.

Nipple areola complex reconstruction has historically been a staged procedure, the nipple being reconstructed first by graft or local flap techniques and the areola on a later procedure to gain colour. This paper presents a one-stage combined reconstruction procedure using a local flap and immediate areola tattoo: it presents the advantage of reducing the total number of needed procedures and subsequently diminishes the total time needed to obtain a complete result. In this series of 50 consecutive combined procedures with a mean follow-up of ten months, no necrosis of reconstructed nipple was observed and a total of six patients needed minor revision surgery to correct nipple projection or fading of the tattoo. No local infection or wound complications were observed, underlying the safety of the procedure. Patient satisfaction and compliance were good because the procedure is fast and easy with minimal morbidity.

Breast reduction mammaplasty. Shall we drain?

A prospective study of 35 consecutive patients who underwent breast reduction mammaplasty using the vertical scar technique was conducted to evaluate the safety of closed suction drainage omission following such a surgery. The mean age of the patients was 36.6 years and the mean resected weight per breast was 580 gr. There were two haematomas in this series, and no haematoma-related complication. These results are comparable with previously published series of breast reduction surgery using closed drainage, suggesting as reported in other works, that the absence of drains does not adversely affect postoperative recovery.

Dorsal carpometarcarpal dislocation of ulnar fingers. A case report.

Multiple dorsal dislocations of the carpometacarpal joints are rare. Diagnosis requires a high index of suspicion, careful examination and good radiography. Treatment is controversial and is based on the presence or not of associated fractures. This paper presents a case of combined fifth and fourth finger carpometacarpal joint dorsal dislocation, successfully treated with closed reduction and percutaneous pinning. A discussion of this pattern of injury is also presented.

Lethal cutaneous verrucous carcinoma.

Verrucous carcinoma is a rare subtype of well-differentiated squamous cell carcinoma that may occur anywhere on the skin. It is slow growing, enlarging relentlessly and invading locally. Some cases were reported to occur on chronic scar tissue but demonstrated the same clinical course than in other locations. Herein, we report on a very unusual case of cutaneous verrucous carcinoma arisen from a long-standing (40 years old) burn scar and which involved the pleura five years after the initial surgical resection. To our best knowledge, this is the first case of pleural involvement by a verrucous carcinoma originating from the skin.

Basal cell carcinoma of the external auditory canal.

Carcinomas of the external auditory canal are rare, nevertheless they are associated with a relatively poor prognosis. Among these tumours, basal cell carcinomas are less frequent than squamous cell carcinomas. Anyway, it is difficult to determine if their prognosis is better, as in other localizations on the body. We reviewed six patients, presenting locally advanced basal cell carcinomas of the external auditory canal and considered the history of their disease, the treatment procedures and final oncological outcome. Four of the patients died of the disease within five years from surgery. They presented local recurrences even after radical surgical excision in free tissue margins. From these findings we have the impression that basal cell carcinoma of the external auditory canal behave, even after radical surgery, as an aggressive tumour associated with a really poor prognosis.

Dermatofibrosarcoma protuberans: how wide is wide in surgical excision?

Dermatofibrosarcoma protuberans is a rare mesenchimal tumour mainly characterized by its local aggressiveness and high reported recurrence rates. Classically, wide excisional surgery with at least 3 cm of free tissue margins is recommended as treatment. We present a series of 18 patients with variable gross free tissue margins but confirmed histological free margins in all cases whatever the surgical excision really was. Only one patient presented a local recurrence (5.5%) of a very large (14 cm) sarcomatous variant of dermatofibrosarcoma protuberans. Mean follow-up in this series was 52.1 months. Those results emphasize that histological rather than theoretical "golden rules" are mandatory to locally control this aggressive neoplasm.

Bednar tumor of the foot: a case report.

Pigmented dermatofibrosarcoma protuberans (Bednar tumor) is a rare neoplasm accounting for approximately 1-5% of all cases of dermatofibrosarcoma protuberans. The majority occurs on the trunk, and the remainders are more or less equally distributed in the upper and lower extremities and the head and neck. Microscopically it is characterized by spindled cells arranged in a tight storiform pattern and admixed with a small population of melanin-containing dendritic cells. The dendritic cells are the primary feature that distinguish this lesion from conventional dermatofibrosarcoma protuberans. We report here a case of Bednar tumor occurring on the dorsal aspect of the foot in a young female.

Immediate breast reconstruction with saline-filled implants: no interference with the oncologic outcome?

The possible adverse effects on cancer control due to immediate breast reconstruction have been addressed recently for both silicone-filled implants and flap reconstruction. To evaluate those possible effects after immediate breast reconstruction with saline-filled implants, 49 patients reconstructed with saline-filled breast implants at the Jules Bordet Cancer Institute were studied. Selection was only based on the possibility to find a matched patient. These patients were matched with a control group of 49 matched women with breast cancer treated in the same center by mastectomy without any type of breast reconstruction. The two groups were comparable according to age at diagnosis (within 3 years), year of diagnosis (same year), stage of the tumor, histology, and nodal status. The only difference between the two groups was that radiation therapy was applied to some of the patients who were not reconstructed (due to tumor location). The results show, in terms of local recurrences, distant metastasis, and deaths, no significant difference between the two groups, even for the irradiated patients, within a mean follow-up period of 72 months (range, 24 to 108) months.

[Fibrosarcomatous variant of dermatofibrosarcoma protuberans: clinicopathologic analysis of 4 cases]. / Variante fibrosarcomateuse du dermatofibrosarcome protuberans: à propos de 4 cas.

We present a series of 4 cases of fibrosarcomatous dermatofibrosarcoma protuberans. This variant, which is composed of areas of typical DFSP associated with more cellular, fascicular foci, reminiscent of fibrosarcoma, should be recognised because of its more aggressive behavior, with a significant metastatic potential (15%). Our series illustrates the clinical, morphological, immunohistochemical and cytogenetic features of this uncommon tumor, with emphasis on differential diagnosis.

Cutaneous verrucous carcinoma.

Verrucous carcinoma is a rare, low-grade, well-differentiated squamous cell carcinoma most commonly seen on mucosa. It has been infrequently reported to occur on the skin, where it is a slow-growing and locally aggressive tumour. It is not uncommon for cutaneous verrucous carcinomas to be mistaken for the more frequent verruca vulgaris and treated accordingly. Three cases of cutaneous verrucous carcinoma are presented with the medical history and follow-up data. Surgery is the treatment of choice; these lesions may sustain a potentially anaplastic transformation after radiation therapy.

Thyroid carcinoma metastasis to the sternum: resection and reconstruction.

Metastases of thyroid carcinoma to the sternum are not so frequent and ablative surgery enables the patients to live longer with a better quality of life. After such a resection, the surgical defect has to be covered either by autogenous or artificial substitutes. We present a 62 years old patient with an asymptomatic sternal metastasis of a poorly differentiated follicular thyroid carcinoma. After radical excision, including the sternum, both clavicular heads and an upper mediastinal dissection, the defect was reconstructed in two layers, combining a Marlex mesh and a pedicled pectoralis major muscle flap. Postoperative course was uneventful and respiratory function was not disturbed.

Metastatic involvement of the humerus: a retrospective study of 51 cases.

The authors performed a retrospective review of 53 patients with 56 completed or impending pathological fractures of the humerus. Sixteen cases were treated with a proximal and one with a distal humeral prosthesis, 38 with an intramedullary device with cement and one with plate fixation. Forty-eight patients with 51 humeral metastases were available to follow-up. No or only occasional pain was observed in 92% of the operated extremities and adequate postoperative function in 90%. No major complications occurred, except one rod migration.