Seborrheic keratosis in an adolescent: A rare presentation

Key Clinical Message Seborrheic keratosis is a common benign epidermal lesion that typically occurs in the elderly population. Its occurrence in childhood and adolescence is rare and can pose a diagnostic challenge for clinicians and dermatopathologists. We report a case of a 16‐year‐old boy with multiple brown, black oval‐shaped stuck‐on lesions on his face, which were diagnosed as seborrheic keratosis based on histological findings. The patient had no significant medical history or family history of seborrheic keratosis. In this report, we discuss the differential diagnoses of seborrheic keratosis‐like lesions in childhood and adolescence and explain why they were not compatible with our case. We also review the available treatment options. Our case emphasizes the need for dermatologists to consider seborrheic keratosis in the differential diagnosis of cutaneous lesions in young patients

Pulmonary alveolar microlithiasis and interstitial pneumonitis: a case report of the west of Iran

Pulmonary alveolar microlithiasis (PAM) is a rare disease with autosomal recessive inheritance. Herein, a 20-year-old lady referred to the hospital with a dry cough for two years. The chest X-ray findings were bilateral reticulonodular opacities in both lungs and honeycomb appearance suspicious for miliary tuberculosis and idiopathic pulmonary fibrosis. A wedge biopsy of lung showed that there were several intraalveolar laminated concretions in the pathology report compatible with pulmonary alveolar microlithiasis and interstitial infiltration of lymphocytes and neutrophils compatible with interstitial pneumonitis. PAM is a rare progressive disease with the production of microliths in pulmonary alveoli. The pathologist, radiologist, and clinician should be familiar with this entity for diagnosis and appropriate management. The family of the patient especially siblings must be evaluated for earlier diagnosis

Chromophobe renal cell carcinoma or oncocytoma: a manner of challenge in frozen section diagnosis

Chromophobe renal cell carcinoma (RCC) is a rare type of kidney neoplasm that is diagnosed in the 6th decade of life with similar incidence in male and female. We reported a case of 73-year-old man with a chief complaint of nocturia, frequency, dribbling and urinary retention with renal mass in ultrasound examination. Histologic examination and immunohistochemistry study revealed the diagnosis of chromophobe RCC which initially was mistaken for oncocytoma in frozen section diagnosis. The pathologist should be aware of this malignant entity and be cautious in diagnosing oncocytoma in frozen section and routine H & E staining

Leiomyosarcoma after Kidney Transplantation in a Patient with Leukocytoclastic Vasculitis, Lobular Panniculitis and History of Hyperthyroidism

Abstract Leiomyosarcoma is a rare, aggressive malignant connective tissue cancer of mature adults, which increases from smooth muscle and occurs most frequently in the uterus, bowel, vascular tissues, and less commonly in somatic soft tissue or bone. We reported a 35-year-old woman was referred to the gastroenterology service with abdominal pain and vomiting. She was a case of renal transplantation in right side since 5 years ago. An evaluation by ultrasound showed right chest wall soft tissue mass measuring 40x36mm with internal vascularity without rib destruction. The CT Thorax without contrast, showed a solid mass in the right lower thoracic wall measuring 42x32mm with invasion to subcutaneous fat and abdominal wall muscle. The patient had history of hyperthyroidism about two years ago, which was treated and history of cutaneous leukocytoclastic vasculitis (LCV) and lobular panniculitis since last year, which was proven by skin biopsy. Our patient sought surgical advice who asked for a biopsy which showed a malignant spindle cell tumor compatible with leiomyosarcoma extending to peripheral fatty tissue with histological grade 2. In conclusion, treatment of thyroid disorders and LCV in kidney transplanted patients can be caused malignancies. Therefore, evaluation for malignancies like sarcoma is suggested with thyroid disorders and vasculitis in the follow-up of kidney transplanted patient

Report of two cases of myxoinflammatory fibroblastic sarcomas with preceding hematolymphoid neoplasms: Is there any association?

Abstract Myxoinflammatory fibroblastic sarcoma (MIFS) is an uncommon soft tissue sarcoma. We present two cases of MIFS: A known case of Hodgkin‘s lymphoma presented with hand mass; a recurrence of MIFS with a history of chronic lymphocytic leukemia

Effect of diabetes mellitus type 2 on salivary glucose, immunoglobulin A, total protein, and amylase levels in adults: A systematic review and meta-analysis of case–control studies

Background: Saliva is a fluid with the complex compound which can be used as diagnostic markers for type 2 diabetes (T2D). This meta-analysis evaluated salivary glucose, immunoglobulin A (IgA), total protein, and amylase levels in adult T2D compared with the controls as well as the correlation of salivary glucose levels with serum glucose and hemoglobin A1C (HbA1c) levels in both groups. Materials and Methods: Web of Science, Scopus, PubMed, and Cochrane Library databases were searched up to July 2017. A random-effects analysis was performed using the mean difference (MD) and 95% confidence intervals . The search terms were “T2D, IgA, amylase, total protein, or glucose” combination with “saliva.” The studied variables were the sample size, the percentage of male, the mean age, the condition of saliva sampling, and the salivary levels of mentioned factors. Results: A total of 25 studies were included in this meta-analysis with 1432 and 900 diabetic patients and healthy controls, respectively. MD of salivary glucose level in patients with T2D, compared with the healthy controls, in fasting and nonfasting conditions were 6.23 mg/dL (P = 0.0002) and 6.70 mg/dL (P < 0.00001), respectively. Furthermore, the fasting salivary total protein in the patients was significantly higher than the controls (MD = 167.96 mg/dL; p = 0.03). Non-fasting salivary amylase and secretory IgA levels were significantly lower in the patients (MD = −48.61 IU/mL; p < 0.00001) than in the controls (MD = −9.42 IU/mL; p = 0.0006), respectively. The pooled estimate showed a significant correlation between salivary and serum glucose in the patients (r = 0.765; p < 0.001) and the controls (r = 0.646; p < 0.001) and between salivary glucose and serum glycated hemoglobin in the patients (r = 0.721; p < 0.001). Conclusion: Measurement of these salivary factors can be helpful for diagnostic and monitoring purposes of T2D. In addition, salivary glucose as a diagnostic tool can evaluate serum glucose and HbA1c levels in the diabetic patients

Effect of Fixed Orthodontic Treatment on Salivary Nickel and Chromium Levels: A Systematic Review and Meta-Analysis of Observational Studies

Nickel and chromium ions released from fixed orthodontic appliances may act as allergens. This study aimed to systematically review the effect of fixed orthodontic treatment on salivary levels of these ions by doing a meta-analysis on cross-sectional and cohort studies. The Web of Science, Scopus, Cochrane Library, and PubMed databases were searched for articles on salivary profile of nickel or chromium in patients under fixed orthodontic treatment published from January 1983 to October 2017. A random-effect meta-analysis was done using Review Manager 5.3 to calculate mean difference (MD) and 95% confidence interval (CI), and the quality of questionnaire was evaluated by the Newcastle–Ottawa scale. Fourteen studies were included and analyzed in this meta-analysis. Salivary nickel level was higher in periods of 10 min or less (MD = −11.5 µg/L, 95% CI = −16.92 to −6.07; P &lt; 0.0001) and one day (MD = −1.38 µg/L, 95% CI = −1.97 to −0.80; P &lt; 0.00001) after initiation of treatment compared to baseline (before the insertion of appliance). Salivary chromium level was higher in periods of one day (MD = −6.25 µg/L, 95% CI = −12.00 to −0.49; P = 0.03) and one week (MD = −2.07 µg/L, 95% CI = −3.88 to −0.26; P = 0.03) after the initiation of treatment compared to baseline. Corrosion of fixed orthodontic appliances leads to elevated salivary nickel and chromium concentrations early after initiation of orthodontic treatment. Randomized clinical trials controlling for factors affecting the saliva composition are recommended on a higher number of patients and among different ethnicities