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Surgical Case Reports May 2024Colorectal cancer (CRC) often metastasizes to the liver, lungs, lymph nodes, and peritoneum but rarely to the bladder, small intestine, and skin. We here report the rare...
BACKGROUND
Colorectal cancer (CRC) often metastasizes to the liver, lungs, lymph nodes, and peritoneum but rarely to the bladder, small intestine, and skin. We here report the rare metastasis of anal cancer in the left bladder wall, followed by metastases to the small intestine and skin, after abdominoperineal resection and left lateral lymph node dissection with chemotherapy in a patient with clinician Stage IVa disease.
CASE PRESENTATION
A 66-year-old man presented with 1-month history of bloody stool and anal pain and diagnosed with clinical Stage IVa anal cancer with lymph node and liver metastases (cT3, N3 [#263L], M1a [H1]). Systemic chemotherapy led to clinical complete response (CR) for the liver metastasis and clinical near-CR for the primary tumor. Robot-assisted laparoscopic perineal rectal resection and left-sided lymph node dissection were performed. Computed tomography during 18-month postoperative follow-up identified a mass in the left bladder wall, which was biopsied with transurethral resection, was confirmed as recurrent anal cancer by histopathologic evaluation. After two cycles of systemic chemotherapy, partial resection of the small intestine was performed due to bowel obstruction not responding to conservative therapy. The histopathologic evaluation revealed lymphogenous invasion of the muscularis mucosa and subserosa of all sections. Ten months after the first surgery for bowel obstruction and two months before another surgery for obstruction of the small intestine, skin nodules extending from the lower abdomen to the thighs were observed. The histopathologic evaluation of the skin biopsy specimen collected at the time of surgery for small bowel obstructions led to the diagnosis of skin metastasis of anal cancer. Although panitumumab was administered after surgery, the patient died seven months after the diagnosis of skin metastasis.
CONCLUSIONS
This case illustrates the rare presentation of clinical Stage IVa anal cancer metastasizing to the bladder wall, small intestine, and skin several years after CR to chemotherapy.
PubMed: 38714637
DOI: 10.1186/s40792-024-01913-x -
AME Case Reports 2024Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus...
BACKGROUND
Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus membranes. Although the exact pathogenesis of PG is unknown, many theories discussed the potential of an angiogenic stimulus and an imbalance of inducers and inhibitors triggering the hyperplastic and neovascular response. The most frequently used modality for treatment of PG is surgical treatment. The proposed case represents an unexpected evolution to a possible therapeutic measure.
CASE DESCRIPTION
We represent a case of a 32-year-old male, known to have T-cell acute lymphoblastic leukemia treated successfully with chemotherapy, currently maintained on methotrexate (MTX) 40 mg and 6-mercaptopurine, 100 mg, presented with 1-month history of painful rapidly growing ulcerated nodules on his right-hand palm and middle finger. Both skin lesions developed approximately 3 months following patient initiation of maintenance treatment. Physical examination revealed two crusted nodules. A proximal lesion was observed over the palmar aspect between the second and third fingers, with the other one occurring alongside the distal phalanx of the third finger, measuring 2.5 cm × 1.5 cm, and 2.5 cm × 3.5 cm respectively. Skin biopsy was obtained from both lesions. The results of the histologic examination both revealed inflamed PG. Tissue cultures of both specimens tested positive for growth while no fungal and tuberculosis were cultured. Ciprofloxacin 500 mg twice daily, a 2-week course was started. Both lesions completely resolved at 10-day of antibiotic course with no recurrence.
CONCLUSIONS
This is a case of a patient with lobular capillary hemangioma of the hand treated successfully with no recurrence using an oral antibiotic. The proposed case represents an unexpected evolution to a possible therapeutic measure. The unexpected role of a conservative measure rather than the conventional surgical method in treating vascular tumors has been highlighted. Moreover, the contribution to an excellent cosmetic outcome has also been demonstrated.
PubMed: 38711894
DOI: 10.21037/acr-23-159 -
BMC Infectious Diseases May 2024The incidence of Talaromyces marneffei (T. marneffei) infection has increased in recent years with the development of organ transplantation and the widespread use of... (Review)
Review
Disseminated Talaromyces marneffei infection initially presenting as cutaneous and subcutaneous lesion in an HIV-Negative renal transplant recipient: a case report and literature review.
BACKGROUND
The incidence of Talaromyces marneffei (T. marneffei) infection has increased in recent years with the development of organ transplantation and the widespread use of immunosuppressive agents. However, the lack of clinical suspicion leading to delay or misdiagnosis is an important reason for the high mortality rate in non-human immunodeficiency virus (HIV) and non-endemic population. Herein, we report a case of disseminated T. marneffei infection in a non-HIV and non-endemic recipient after renal transplant, who initially presented with skin rashes and subcutaneous nodules and developed gastrointestinal bleeding.
CASE PRESENTATION
We describe a 54-year-old renal transplantation recipient presented with scattered rashes, subcutaneous nodules and ulcerations on the head, face, abdomen, and right upper limb. The HIV antibody test was negative. The patient had no obvious symptoms such as fever, cough, etc. Histopathological result of the skin lesion sites showed chronic suppurative inflammation with a large number of fungal spores. Subsequent fungal culture suggested T. marneffei infection. Amphotericin B deoxycholate was given for antifungal treatment, and there was no deterioration in the parameters of liver and kidney function. Unfortunately, the patient was soon diagnosed with gastrointestinal bleeding, gastrointestinal perforation and acute peritonitis. Then he rapidly developed multiple organ dysfunction syndrome and abandoned treatment.
CONCLUSIONS
The risk of fatal gastrointestinal bleeding can be significantly increased in kidney transplant patients with T. marneffei infection because of the long-term side effects of post-transplant medications. Strengthening clinical awareness and using mNGS or mass spectrometry technologies to improve the detection rate and early diagnosis of T. marneffei are crucial for clinical treatment in non-HIV and non-endemic population.
Topics: Humans; Male; Middle Aged; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Dermatomycoses; Drug Combinations; Fatal Outcome; Kidney Transplantation; Mycoses; Talaromyces; Transplant Recipients
PubMed: 38711014
DOI: 10.1186/s12879-024-09351-8 -
Dermatology and Therapy May 2024Hidradenitis suppurativa (HS) is a debilitating chronic skin disorder characterized by painful inflammatory nodules, abscesses and sinus tracts involving intertriginous... (Review)
Review
Hidradenitis suppurativa (HS) is a debilitating chronic skin disorder characterized by painful inflammatory nodules, abscesses and sinus tracts involving intertriginous areas and has an adverse impact on patient quality of life. Over the past decade, the therapeutic options of HS have increased significantly to comprise multiple modalities, including topical medication, systemic therapies (mainly antibiotics, retinoids, and biologics), surgical approaches, and lifestyle modifications. Biologics alone or in combination with surgery remain the treatment of choice for moderate to severe disease. However, non-biologic therapies (including retinoids) may be used as monotherapy for mild disease and in combination with biologics and surgical treatment in moderate to severe disease. Retinoids, specifically isotretinoin, acitretin, and alitretinoin, are historically used in the management of HS, supported by anecdotal evidence and with variable treatment response. Although the current American and European guidelines offer different recommendations on the use of retinoids in HS, retinoids remain a valuable ally in HS management. This review provides a comprehensive analysis of the current scientific literature on retinoid therapy (topical and systemic) in HS, highlighting disparities in mechanisms of action, efficacy, and safety to clarify their role in HS treatment.
PubMed: 38700645
DOI: 10.1007/s13555-024-01169-1 -
Case Reports in Dermatological Medicine 2024Biostimulators are the latest trends in cosmetic procedures, substances such as PDLLA are used to induce collagen synthesis by a subclinical inflammatory reaction. We...
Biostimulators are the latest trends in cosmetic procedures, substances such as PDLLA are used to induce collagen synthesis by a subclinical inflammatory reaction. We are describing a granuloma-like reaction case presentation 4 months after the application of PDLLA and its complete resolution with injections of triamcinolone. A 45-year-old female with any past medical history of allergies or immune diseases was injected with PDLLA on the mandibular border and cheek area to correct skin laxity. Four months after the application, the patient reported facial edema and granuloma-like reactions according to clinical examination on all the application areas. The ultrasound reports showed the presence of multiple nodules in the injection areas; therefore, we decided to apply triamcinolone to the granulomatous reaction areas 2 times a month and Prednisone 20 mg daily for 3 days followed by 10 mg for 2 days. After 4 applications, the adverse reaction was completely solved. Biostimulators are biocompatible and resorbable substances; however, nodules and/or granulomas have been reported as rare adverse events. Intralesional and oral steroids can allow us to treat this kind of adverse events.
PubMed: 38698953
DOI: 10.1155/2024/6544506 -
Orphanet Journal of Rare Diseases May 2024Cryoglobulinemia with pulmonary involvement is rare, and its characteristics, radiological findings, and outcomes are still poorly understood.
BACKGROUND
Cryoglobulinemia with pulmonary involvement is rare, and its characteristics, radiological findings, and outcomes are still poorly understood.
METHODS
Ten patients with pulmonary involvement of 491 cryoglobulinemia patients at Peking Union Medical College Hospital were enrolled in this retrospective study. We analyzed the characteristics, radiological features and management of pulmonary involvement patients, and compared with those of non-pulmonary involvement with cryoglobulinemia.
RESULTS
The 10 patients with pulmonary involvement (2 males; median age, 53 years) included three patients with type I cryoglobulinemia and seven patients with mixed cryoglobulinemia. All of 10 patients were IgM isotype cryoglobulinemia. All type I patients were secondary to B-cell non-Hodgkin lymphoma. Four mixed patients were essential, and the remaining patients were secondary to infections (n = 2) and systemic lupus erythematosus (n = 1), respectively. Six patients had additional affected organs, including skin (60%), kidney (50%), peripheral nerves (30%), joints (20%), and heart (20%). The pulmonary symptoms included dyspnea (50%), dry cough (30%), chest tightness (30%), and hemoptysis (10%). Chest computed tomography (CT) showed diffuse ground-glass opacity (80%), nodules (40%), pleural effusions (30%), and reticulation (20%). Two patients experienced life-threatening diffuse alveolar hemorrhage. Five patients received corticosteroid-based regimens, and four received rituximab-based regimens. All patients on rituximab-based regimens achieved clinical remission. The estimated two-year overall survival (OS) was 40%. Patients with pulmonary involvement had significantly worse OS and progression-free survival than non-pulmonary involvement patients of cryoglobulinemia (P < 0.0001).
CONCLUSIONS
A diagnosis of pulmonary involvement should be highly suspected for patients with cryoglobulinemia and chest CT-indicated infiltrates without other explanations. Patients with pulmonary involvement had a poor prognosis. Rituximab-based treatment may improve the outcome.
Topics: Humans; Cryoglobulinemia; Male; Middle Aged; Female; Retrospective Studies; Aged; Adult; Tomography, X-Ray Computed; Lung Diseases; Lung
PubMed: 38698461
DOI: 10.1186/s13023-024-03159-0 -
Annals of Medicine and Surgery (2012) May 2024Multiple Endocrine Neoplasia Type 2 (MEN2) is a rare autosomal dominant neoplastic syndrome resulting from RET gene mutations, marked by medullary thyroid carcinoma...
INTRODUCTION AND IMPORTANCE
Multiple Endocrine Neoplasia Type 2 (MEN2) is a rare autosomal dominant neoplastic syndrome resulting from RET gene mutations, marked by medullary thyroid carcinoma (MTC) and increased risk of other endocrine tumors. MEN2 includes subtypes MEN2A, MEN2B, and familial MTC. Prophylactic thyroidectomy is recommended for MEN2A due to high MTC risk.
CASE PRESENTATION
A 38-year-old woman with a family history of thyroid cancer presented with headaches, sweating, and palpable breast mass. Exam revealed skin lesions. Lab abnormalities and imaging indicated a large adrenal mass and thyroid nodules. Inconclusive biopsies led to left adrenalectomy, confirming pheochromocytoma. Subsequent total thyroidectomy revealed MTC.
CLINICAL DISCUSSION
This case represents rare MEN2B presentation, featuring MTC, pheochromocytoma, mucosal neuromas, and marfanoid habitus. Genetic testing for RET mutations is crucial with a positive family history. MEN2A individuals undergo prophylactic thyroidectomy due to high MTC risk. Although rare, pheochromocytoma can be an initial MEN2 manifestation, indicated by paroxysmal symptoms. Surgical resection is the treatment.
CONCLUSIONS
The patient's successful adrenalectomy followed by total thyroidectomy confirmed MTC. Thorough evaluation, including inconclusive initial findings, emphasizes imaging, and biopsies. Early detection and appropriate management optimize MEN2 outcomes.
PubMed: 38694328
DOI: 10.1097/MS9.0000000000001867 -
Cureus Mar 2024Kaposi's sarcoma (KS), linked to human herpesvirus 8 (HHV8), manifests in various clinical forms with iatrogenic KS uniquely tied to immune dysregulation induced by...
Kaposi's sarcoma (KS), linked to human herpesvirus 8 (HHV8), manifests in various clinical forms with iatrogenic KS uniquely tied to immune dysregulation induced by medical interventions. This study describes a 58-year-old male of sub-Saharan origin with a medical history of segmental and focal hyalinosis treated with methylprednisolone and mycophenolate mofetil. The patient developed skin lesions on both thighs, accompanied by post-prandial vomiting and abdominal pain. Clinical examination revealed flesh-colored nodules on the thighs and inguinal lymphadenopathy. Biopsy confirmed the diagnosis of KS, exhibiting positive nuclear labeling to anti-HHV8 and negative HIV serology. Additionally, radiological findings from the thoracic-abdominal-pelvic computed tomography (CT) scan significantly contribute to our understanding of the multiorgan involvement associated with KS in this case, providing valuable insights for diagnosis and therapeutic considerations. This case highlights the iatrogenic subtype of KS, linked to immunosuppression from prior medical interventions. Notably, gastrointestinal involvement was evident, with lesions in the stomach and small intestine. Intravenous paclitaxel administration resulted in a positive clinical response. This study underscores the importance of clinical vigilance, endoscopic evaluation, and early intervention in the nuanced diagnosis and management of iatrogenic KS.
PubMed: 38690506
DOI: 10.7759/cureus.57279 -
Clinical and Experimental Rheumatology Apr 2024Granulomatosis with polyangiitis (GPA) is an uncommon disorder that mainly involves the upper and lower respiratory tract and kidney, presenting as sinusitis, saddle... (Review)
Review
Granulomatosis with polyangiitis (GPA) is an uncommon disorder that mainly involves the upper and lower respiratory tract and kidney, presenting as sinusitis, saddle nose, otitis media, pulmonary nodule and cavity, rapidly progressive glomerulonephritis. It also affects skin, eye, heart, joint and nervous system. Renal involvement in GPA is commonly manifested as necrotising glomerulonephritis, while renal mass is very rare. We herein present two hospitalised cases with fever, pulmonary cavity and renal mass. Clinical course and examinations of the cases, from symptoms to diagnosis, will be discussed in detail, along with a relevant literature review of this unusual renal manifestation.
Topics: Humans; Granulomatosis with Polyangiitis; Male; Middle Aged; Tomography, X-Ray Computed; Female; Incidental Findings; Adult; Biopsy; Kidney; Treatment Outcome
PubMed: 38683205
DOI: 10.55563/clinexprheumatol/ql3zzz