[Scrotal ulcers revealing pulmonary and genitourinary tuberculosis]. / Úlceras escrotais reveladoras de tuberculose pulmonar e genito-urinária.

A 76-year-old male patient with an angioimmunoblastic T-cell lymphoma under treatment with fludarabine was referred because of scrotal ulcers, evolving for several months. Respiratory, gastrointestinal, and urinary symptoms were denied. Histopathological examination showed the presence of a chronic inflammatory process with epithelioid granulomas. Ziehl-Neelsen stain was positive for acid-fast bacilli. PCR analysis allowed the identification of a mycobacteria strain belonging to the Mycobaterium tuberculosis complex. Skin biopsy was repeated and culture revealed M. tuberculosis sensitive to traditional tuberculostatic drugs. This bacteria was also isolated in bronchial and urinary specimens. Although no abnormal findings were detected on chest radiography or abdominal ultrasonography, scrotal ultrasound showed areas of nodular thickening in the lower part of the epididymis. The diagnosis of cutaneous, lung, and genitourinary tuberculosis was made and the patient was treated with multidrug therapy (rifampicin 600 mg/day, isoniazid 250 mg/day, pyrazinamide 1500 mg/day, and ethambutol 1200 mg/day for the first 2 months, followed by rifampicin and isoniazid with the same dosages for the subsequent 7 months). Complete resolution of skin lesions was observed after two months of treatment. Diagnosis and treatment modalities are discussed. This case emphasizes the importance of considering tuberculosis in the differential diagnosis of genital ulcer.

Tumor-in-tumor of the thyroid with basaloid differentiation: a lesion with a solid cell nest neoplastic component?

This study describes an encapsulated thyroid tumor having 3 different concentric appearances in a 70-year-old man. The most peripheral neoplasm showed features of a microfollicular adenoma; the intermediate lesion displayed typical features of the follicular variant of papillary thyroid carcinoma (FVPTC); and the main, central neoplasm, showed a basaloid configuration. At variance with the other neoplasms, the latter component exhibited high mitotic activity. Necrosis, angio-invasion, or capsular invasions were not observed. The centrally located neoplasm was immunoreactive for several cytokeratins, p63, carcinoembryonic antigen, and galectin-3, and negative for thyroid transcription factor 1, thyroglobulin, calcitonin, CD5, and CK20, featuring a phenotype similar to that of thyroid solid cell nests. A N-RAS mutation was found both in the basaloid and in the FVPTC components. The clinicopathological and immunohistochemical data ruled out the alternative possibilities of intrathyroidal metastasis and tumor from ectopic (thymic, parathyroid, or salivary gland) tissues.

Primary gastric adenosquamous carcinoma in a Caucasian woman: a case report.

INTRODUCTION: Most gastric tumors are adenocarcinomas. Primary gastric adenosquamous carcinoma is a rare malignancy, mostly associated with Asian populations. It constitutes less than one percent of all gastric carcinomas and its clinical presentation is the same as adenocarcinoma. It occurs more frequently in the proximal stomach, usually presents with muscular layer invasion and tends to be found in advanced stages at diagnosis, with a worse prognosis than adenocarcinoma. CASE PRESENTATION: We report the case of an 84-year-old Caucasian woman with an adenosquamous carcinoma extending to her serosa with lymphatic and venous invasion (T3N1M1). Nodal and hepatic metastasis presented with both cellular types, with dominance of the squamous component. CONCLUSIONS: Adenosquamous gastric cancer is a rare diagnosis in western populations. We present the case of a woman with a very aggressive adenosquamous carcinoma with a preponderance of squamous cell component in the metastasis. Several origins have been proposed for this kind of carcinoma; either evolution from adenocarcinoma de-differentiation or stem cell origin might be possible. The hypothesis that a particular histological type of gastric cancer may arise from stem cells might be a field of research in oncological disease of the stomach.

Epithelioid hemangioendothelioma presenting as a vertebral fracture.

Epithelioid hemagioendothelioma (EH) is a rare vascular tumor with an intermediate biological behavior between hemangioma and angiosarcoma. Vertebral location is even more rare, and because the number of reported cases of EH is small and the follow-up periods short, the best surgical treatment, the role of radiotherapy and chemotherapy, as well as the definitive prognosis are still not established. The authors report a case of EH which presented as a vertebral fracture with neurological impairment, where a percutaneous biopsy was inconclusive. Treatment included vertebrectomy, with complete excision of the lesion, spinal canal decompression and vertebral stabilization. Anatomopathological study revealed an epithelioid vascular neoplasm with low mitotic index, and tumor cells reactive to vimentin, CD31 and CD34, leading to the diagnosis of Grade I Epithelioid Hemangioendothelioma. Because of the wide resection achieved and the low aggressiveness of the lesion, no adjuvant radio or chemotherapy was undertaken, and at 6 years follow-up there are no signs of recurrence or metastasis.

Composite adenomatoid tumor and myelolipoma of adrenal gland: report of 2 cases.

Adenomatoid tumor and myelolipoma are benign, hormonally inactive tumors that are often incidental findings in the adrenal glands. Myelolipoma is more common than adenomatoid tumor in this location but both are rare, and as yet, the pathogenesis of both remains unclear. We report 2 cases of composite adenomatoid tumor and myelolipoma, incidentally found in the adrenal gland on investigation for other diseases. To our knowledge, composite adenomatoid tumor and myelolipoma of adrenal gland has not been previously reported.

Congenital composite hemangioendothelioma: case report and reappraisal of the hemangioendothelioma spectrum.

BACKGROUND: Composite hemangioendothelioma is the most recently described entity of the hemangioendothelioma (HE) spectrum. To the best of our knowledge, only eight cases of this entity have been hitherto described. All of the previous cases affected adults; local recurrences were observed in three cases, and one case showed lymph node metastasis. We herein describe a new and previously unreported congenital case of this rare vascular tumor, arising on the acral extremity of the left forearm, which was diagnosed when the patient was 23 years old. RESULTS: The histological examination disclosed a heterogeneous vascular neoplasm composed of retiform HE-like (80%), spindle cell hemangioma-like (15%), cavernous hemangioma-like (approximately 3%), epithelioid HE-like (approximately 2%) areas, and rare foci with an angiosarcoma-like pattern (< 1%). A distinctive and unique finding of the present case was the presence of large granular eosinophilic macrophages filling some vessels of the retiform HE-like areas. A below-elbow amputation was performed. The patient is alive and well, without evidence of residual or metastatic disease 7 years after the treatment. CONCLUSIONS: The authors expand the concept of composite hemangioendothelioma by adding a congenital case and provide a reappraisal of the hemangioendothelioma spectrum.