Atypical subcutaneous fatty tumors: a review of 37 referred cases.

We reviewed 37 referred, atypical, subcutaneous fatty tumors. There was a male preponderance (28:9). The median age was 51.5 years (26-83); the median duration of symptoms was 18 months (three weeks to 35 years); the median size was 5.5 cm (1.5-20) and the posterior cervico-dorsal areas (17 cases) was the commonest location. We divided tumors into five histological categories: (1) subcutaneous fibrolipomas with slight fibroblastic atypia (five cases); (2) subcutaneous spindle cell lipomas with atypia (mixed spindle cell/pleomorphic lipomas) without lipoblasts (three cases); (3) subcutaneous atypical well-differentiated fatty tumors (pure pleomorphic lipomas) without lipoblasts (nine cases); (4) subcutaneous atypical well-differentiated fatty tumors (pleomorphic lipomas) with lipoblasts (17 cases); (5) subcutaneous atypical fatty tumors with poorly differentiated or de-differentiated areas (three cases). Follow-up information was obtained in 25 cases (68%). The follow-up times were from three to 192 months (median 31). Five tumors (20%) recurred, two as the same and three as a higher histological category. Two were originally referred because of a recurrence. Four recurred once and one, initially a category 4 tumor, recurred twice as a category 5 tumor. Two category 1 and three category 4 tumors recurred. There were no recurrences in the other three groups. All recurrent tumors were located outside the cervico-dorsal areas. The sizes of two tumors that recurred were 2.8 and 3 cm and the time to first recurrence was from one to 85 months. Two recurrent tumors of high histological category were controlled by re-excision and either radiotherapy or combined chemotherapy and radiotherapy. This series suggests that atypical subcutaneous fatty tumors comprise a continuous and potentially transforming histological spectrum, which ranges from mildly atypical fibrolipomas through various mixed spindle cell and pleomorphic lipoma patterns to tumors indistinguishable from de-differentiated liposarcomas. Despite a sometimes alarming histological appearance, none in the present series metastasized.

Two case reports of breast carcinoma associated with prolactinoma.

Two cases of breast carcinoma associated with prolactinoma are presented. Literature review reveals only five previous case reports of this association. Both of our cases occurred in women, aged 55 and 34. Both were typical of the reported cases in that they had long histories of amenorrhea before diagnosis of prolactinomas and breast carcinomas. One patient had a three and a half year history of atypical ductal hyperplasia and a prominent intraduct component in the invasive tumor. Both had axillary lymph node metastases. The significance of the association of breast carcinoma with prolactinoma is discussed. Whereas studies in animals have shown prolactin to be an initiator and promoter of breast carcinoma, studies in humans have been inconclusive. Some studies have shown raised levels of prolactin in patients with breast carcinoma and their daughters, while others have not. The paucity of case reports linking breast carcinoma and prolactinoma may indicate that the association is mere coincidence, but studies evaluating the relationship between breast carcinoma and all forms of hyperprolactinemia need to be conducted before a causal link is dismissed. Prolactin may act as a cofactor with, for example, estrogen or stress, to induce breast carcinoma.

Multiple hepatic abscesses due to Yersinia enterocolitica.

We report a case of multiple hepatic abscesses due to Yersinia enterocolitica in a 58 yr old male. This case is typical of the other 39 cases reported in the literature in that the patient had alcoholism, malnutrition, iron overload and a subsequently diagnosed malignancy. Ultrasound showed multiple hypoechoic areas in the liver which were confirmed by CT scan. The patient also had a rectal lesion initially thought to be malignant, leading to a presumptive diagnosis of metastatic disease. A CT-guided fine needle aspiration biopsy of a liver lesion unexpectedly revealed pus which subsequently grew Yersinia enterocolitica. The organism was also isolated from the patient's blood and feces. This case illustrates the need for histological microbiological investigation of radiologically diagnosed presumptive malignancy.

Pyemotes species strongly implicated in an outbreak of dermatitis in a Queensland country hospital.

An acute outbreak of itchy papulovesicular dermatitis occurred among nursing home patients in a small Queensland country hospital west of Toowoomba. Mites, Pyemotes species, were found in the immediate environment of the hospital and have been implicated as the causative agent. This case illustrates the importance of examination of environmental specimens for ectoparasites in cases of unexplained dermatoses.