Concomitant granular cell tumor and balanitis xerotica obliterans of the foreskin: A case report and literature review

AbstractBalanitis xerotica obliterans is a chronic dermatosis that frequently involves the glans penis and the foreskin. Granular cell tumor is a benign tumor that may rarely involve the penis, but involvement of the foreskin is exceedingly rare. It may result in thickening and ulceration of the overlying epidermis, which can mimic squamous cell carcinoma. An association of these two lesions, one very common and one extremely uncommon, arising concomitantly in the penile foreskin has not been previously documented. A 23-year-old patient with phimosis and a subcutaneous foreskin nodule presented for a medical circumcision. The microscopic examination demonstrated balanitis xerotica obliterans and granular cell tumor, occurring in continuity in the foreskin. To our knowledge, this is the first reported example of these two lesions arising simultaneously in the male genitalia

Intramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report

<p>Abstract</p> <p>Background</p> <p>Extremity lipomas may occur in any location, including the proximal forearm. We describe a case of a patient with an intramuscular lipoma presenting as an unusual posterior elbow mass.</p> <p>Case presentation</p> <p>We discuss the case of a 57-year-old Caucasian man who presented with a tender, posterior elbow mass initially diagnosed as chronic olecranon bursitis. A minor sensory disturbance in the distribution of the superficial radial nerve was initially thought to be unrelated, but was likely caused by mass effect from the lipoma. No pre-operative advanced imaging was obtained because the diagnosis was felt to have already been made. At the time of surgery, a fatty mass originating in the volar forearm muscles was found to have breached the dorsal forearm fascia and displaced the olecranon bursa. Tissue diagnosis was made by histopathology as a myxoid lipoma with no aggressive features. Post-operative recovery was uneventful.</p> <p>Conclusion</p> <p>We present a case of an unusual elbow mass presenting with symptoms consistent with chronic olecranon bursitis, a relatively common condition. The only unexplained pre-operative finding was the non-specific finding of a transient superficial radial nerve deficit. We remind clinicians to be cautious when diagnosing soft tissue masses in the extremities when unexplained physical findings are present.</p

Acute hepatic failure and multi-system organ failure secondary to replacement of the liver with metastatic melanoma

BACKGROUND: Metastatic malignant melanoma to the liver resulting in fulminant hepatic failure is a rare occurrence. CASE PRESENTATION: A 46 year old man presented to hospital with massive hepatomegaly, elevated liver enzymes and increased lactate three weeks following resection of a malignant melanoma from his shoulder (Clark level 5). Initially stable, he decompensated 24 to 48 hours subsequent to presentation with respiratory failure requiring mechanical ventilation, distributive shock requiring high dose vasopressor infusion, coagulopathy refractory to plasma infusion, progressive rise in liver enzymes and severe metabolic abnormalities including hyperkalemia, acidosis, hyperphosphatemia, hyperuricemia and hypocalcemia. Refractory to aggressive physiologic support he received palliation. Autopsy revealed >80% liver infiltration by metastatic malignant melanoma. CONCLUSION: We report a case of fulminant hepatic failure secondary to metastatic malignant melanoma infiltration of the liver

Concomitant granular cell tumor and balanitis xerotica obliterans of the foreskin: A case report and literature review

Balanitis xerotica obliterans is a chronic dermatosis that frequently involves the glans penis and the foreskin. Granular cell tumor is a benign tumor that may rarely involve the penis, but involvement of the foreskin is exceedingly rare. It may result in thickening and ulceration of the overlying epidermis, which can mimic squamous cell carcinoma. An association of these two lesions, one very common and one extremely uncommon, arising concomitantly in the penile foreskin has not been previously documented. A 23-year-old patient with phimosis and a subcutaneous foreskin nodule presented for a medical circumcision. The microscopic examination demonstrated balanitis xerotica obliterans and granular cell tumor, occurring in continuity in the foreskin. To our knowledge, this is the first reported example of these two lesions arising simultaneously in the male genitalia. Keywords: Granular cell tumor, Balanitis xerotica obliterans, Foreskin, Penis, Glan

Intestinal Thromboangiitis Obliterans in a Woman: A Case Report and Discussion of Chronic Ischemic Changes

Although traditionally regarded as a disease of distal extremities, mesenteric vasculature can also manifest thromboangiitis obliterans (TAO). There are 31 cases of intestinal TAO in the English literature and the majority of subjects are male. However, cases of women with TAO are becoming more common, coinciding with an increased incidence of smoking in this sex. We describe the sixth case of a female patient with classic extremity manifestations paralleled by paroxysms of abdominal angina. Intestinal TAO can mimic extremity disease of smoldering chronic ischemia punctuated by unpredictable acute episodes of gangrene. In the present case, chronic ischemia manifested as partial bowel obstruction due to stricture deformity of the ileum and profound adipocyte atrophy of mesentery

Stromal lipofuscinosis of the seminal vesicle: Incidental finding in two patients treated for prostatic adenocarcinoma by prostatectomy and cryotherapy

Stromal lipofuscinosis of the seminal vesicles has been described in only one prior report as an incidental finding in two patients who underwent prostatectomy for prostatic adenocarcinoma. We report two additional cases of lipofuscinosis occurring in the seminal vesicle stromal cells, identified incidentally in two patients treated for prostatic carcinoma by radical prostatectomy and cryotherapy, respectively. A 50-year-old patient had prostatic carcinoma, Gleason Score 3 + 4 = 7 (Grade group 2) on needle biopsy. At radical prostatectomy, a marked stromal lipofuscinosis was identified in both seminal vesicles, but was not found in the prostatic tissue. The second case was a 74-year-old patient in whom stromal lipofuscinosis was identified in one of the targeted biopsies of the seminal vesicles, as part of the surveillance post-cryotherapy assessment. The patient underwent cryotherapy 36 months previously for prostatic carcinoma, Gleason score 3 + 4 = 7/10 (Grade group 2). The stromal lipofuscinosis seen in the first case was more florid and extensive compared to the focal and more discrete lipofuscinosis, found in the patient treated by cryotherapy. Both patients had no prior history of a malabsorption syndrome, or exposure to a common pharmaceutical agent. Stromal lipofuscinosis represents an extremely rare, incidental and idiopathic finding in patients treated for prostatic carcinoma. This report also documents the first example of stromal lipofuscinosis observed in a post-cryotherapy treatment setting. Keywords: Seminal vesicle, Lipofuscinosis, Stroma, Prostate adenocarcinom

IgG4 prostatitis associated with prostatic adenocarcinoma: A case report and literature review

A 66-year-old male patient had a prostate biopsy for an elevated serum prostate specific antigen which revealed prostatic adenocarcinoma, Gleason score 3 + 4 = 7 (Grade group 2) with marked background chronic inflammation. A radical prostatectomy showed prostatic adenocarcinoma accompanied by IgG4 prostatitis, which had not been appreciated in the biopsy. The patient had chronic asthma and 4 years prior to the biopsy he had been diagnosed with IgG4-related orbital disease. This history was however unknown during the initial interpretation of the prostate biopsy and prostatectomy. No autoimmune pancreatobiliary involvement was documented at any point, either initially or during the follow-up. IgG4-related prostatitis and prostatic adenocarcinoma have been previously reported to occur simultaneously only in 2 cases. We provide additional evidence that prostatic adenocarcinoma and IgG4-related disease may be found synchronously in the prostate. Therefore, it is important to consider the possibility of an unrecognized IgG4 prostatitis, whenever a heavy lymphoplasmacytic inflammation is found in the prostate, particularly in the absence of a marked granulomatous reaction. To our knowledge, IgG4 prostatitis and prostatic adenocarcinoma accompanied by orbital IgG4-related disease, but without a pancreatobiliary involvement, have not been previously documented. Keywords: IgG4-related disease, prostatitis, prostatic adenocarcinoma, IgG4-orbital disease, dacryoadeniti

A definitive diagnosis of primary Hodgkin lymphoma on endoscopic biopsy material utilizing in-depth immunohistochemical analysis

The esophagus and stomach can be primary sites for Hodgkin lymphoma (HL). The pathognomonic feature of HL is the Reed-Sternberg cell. Because these cells can be rare in HL tumours, biopsies obtained via endoscopy are usually inadequate for establishing a definitive diagnosis. A case of a gastroesophageal junction primary HL is presented that was diagnosed on endoscopic biopsy material with the assistance of the immunohistochemical stains PAX5 and MUM1 which verified the presence of Reed-Sternberg cells. The patient was effectively treated for HL and avoided traditional laparotomy or thoracotomy procedures to obtain the diagnosis. This advanced immunohistochemical approach should be the standard in the diagnosis of primary gastrointestinal HL. An endoscopy-based approach should obviate more invasive, open biopsy procedures for establishing HL diagnosis