A Rare Presentation of Undifferentiated Pleomorphic Sarcoma in the Subpectoral Space.

Soft tissue sarcomas (STS) are often described as asymptomatic, rapidly expanding masses, particularly in the extremities or trunk. Undifferentiated pleomorphic sarcoma (UPS), a high-grade variant of STS, ranks as the second most prevalent subtype in the United States. It predominantly affects males between their fifth and seventh decades. Its often benign symptomatology, however, can lead to initial misdiagnosis and subsequent mismanagement. We present the case of a 57-year-old Caucasian male, previously in good health, who experienced a recurring subpectoral lesion causing discomfort and mass-related effects. Initial management included incision and drainage, which provided temporary relief. The biopsy revealed a diagnosis of grade 3 UPS. The lesion's recurrence two months later was accompanied by local invasion into adjacent skin and musculature as well as metastasis to the right hemiliver. A comprehensive understanding of UPS among medical professionals is vital for accurate diagnosis and facilitating prompt intervention to prevent avoidable complications and optimize patient outcomes.

A Case of Non-purpuric Neonatal Alloimmune Thrombocytopenia Secondary to ABO Incompatibility.

Neonatal alloimmune thrombocytopenia (NAIT) is a condition in which maternal IgG antibodies are directed against fetal platelets and cross the placenta, destroying fetal thrombocytes. It is typically caused by maternal alloimmunization to human leukocyte antigens (HLA). ABO incompatibility, on the other hand, is a rare cause of NAIT due to the variable expression of ABO antigens on platelets. Here, we present the case of a first-time mother (O+) who delivered a 37-week 0-day gestation newborn (B+) that was anemic and jaundiced with critically high total bilirubin levels. This required the initiation of phototherapy and intravenous immunoglobulins. Despite treatment, jaundice was slow to improve. Given infectious concerns, a complete white blood cell count was ordered. Incidentally, it revealed severe thrombocytopenia. Platelet transfusions were administered, although only minimal improvement was observed. This warranted maternal testing for antibodies to HLA-Ia/IIa, HLA-IIb/IIIa, and HLA-Ib/IX antigens given suspected NAIT. Results returned negative. Due to the severity of the condition, patient care was continued at a tertiary facility. When screening for NAIT, special consideration should be given to type O mothers with ABO incompatibility to their fetus - they can uniquely make IgG against A or B antigens, which, unlike IgM and IgA, can cross the placenta and cause potential sequelae harming the newborn. Early recognition and timely management of NAIT are important to prevent certain complications, such as fatal intracranial hemorrhage and developmental delay.

Adult-Onset Immunoglobulin A Vasculitis Following Hemodialysis Treatment: An Unusual Presentation.

Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura (HSP), is a small vessel vasculitis due to perivascular deposition of dominant IgA immune complexes. It classically presents with symptoms such as palpable purpura, abdominal pain, kidney dysfunction, and joint pain. It most commonly affects children less than 10 years old. We present the case of a 53-year-old male who developed purpuric rashes a few hours after receiving hemodialysis. Initially, the lesions were localized to his legs and buttocks. They continued to spread over his back, abdomen, and arms. He experienced joint pain in both of his wrists, as well as abdominal tenderness. Labs revealed elevated IgA levels: 422 mg/dL (normal: 61 - 356 mg/dL). C3, C4, and antinuclear antibody (ANA) levels were within normal limits. Oral prednisone and topical diphenhydramine resulted in significant improvement in his symptoms. To our knowledge, there are only five reports documenting the occurrence of HSP in adults undergoing hemodialysis. Although HSP is a rare finding in adults, recognition of the disease is important as it can cause significant morbidity and mortality if left untreated.

The Pseudo-Sign of Leser-Trélat: A Rare Presentation.

The true sign of Leser-Trélat is a rare cutaneous marker suggestive of an underlying malignancy. Its hallmark finding is the abrupt onset of multiple seborrheic keratoses (SKs) that increase rapidly in number and/or size within weeks to months. When the ominous finding is present, the associated tumor is usually aggressive and portends a poor prognosis. The "pseudo-sign" of Leser-Trélat also presents with the rapid onset of multiple SKs, but without any underlying disease. It is less well-known, and there are only a few reports documenting the phenomenon. This paper reports the case of an 89-year-old male who presented with multiple SKs that rapidly progressed over his scalp, neck, arms, back, trunk, and legs within two to three weeks. A clinical workup revealed elevated pancreatic tumor markers. His cancer antigen (CA) 19-9 levels were 52 U/mL (normal range 0-37 U/mL). Computed tomography (CT) of his abdomen/pelvis without intravenous (IV) and oral contrast showed no evidence of cancer. Bothersome SKs, such as those where his clothes were rubbed against, were destroyed via cryotherapy or shave removal under local anesthesia depending on their size. The patient has remained without any symptoms or findings of an underlying malignancy, confirming that his presentation was consistent with the pseudo-sign of Leser-Trélat. Because it can be concerning when a patient suddenly develops multiple large SKs, recognition of the pseudo-sign is important to determine the appropriate course of action.