Two cases of discrete adenoid pseudogland formation within benign intradermal melanocytic nevi.

We report 2 cases of benign intradermal melanocytic nevi with discrete glandular elements and mucin deposition engendering a diagnostic dilemma. The preliminary differential included entrapment of adnexal structures, collision with an adnexal neoplasm such as adenoid cystic carcinoma or metastatic adenocarcinoma. A colloidal iron special stain confirmed the deposition of mucin; however, a pankeratin AE1/AE3 immunohistochemical cocktail was surprisingly negative. Closer cytological examination of the discrete "glands" combined with nearby pseudoangiomatous (almost kaposiform) change hinted at melanocytic origin, which was confirmed with a positive melanoma antigen recognized by T-cells 1 immunohistochemical stain. Histopathological variations in melanocytic morphology include balloon cell formation, pseudoangiomatous change, lipomatous change, nevus of Nanta (osteonevus) with osseous metaplasia, neurotization, cartilaginous nevus, calcification, increased elastic tissue, psamomma body formation, amyloid deposition, eczematous changes (Meyerson nevus), granular cell change and ancient change/atypia. Mucin deposition, tubule and pseudoacini formation, and now discrete adenoid cystic-like "glands" may also be seen, all of which are important to recognize to avoid misdiagnosis.

Scalp reconstruction: a review of the literature and a unique case of total craniectomy in an adult with osteomyelitis of the skull.

OBJECTIVE: Osteomyelitis of the skull is a rare condition that can lead to systemic illness, bone loss, intracranial complications, and mortality. Osteomyelitis of the skull typically presents as the boney invasion of an overlying infection of the scalp or sinuses, and it is typically treated with antibiotics and proper wound care. Surgical debridement of the affected bone in the form of a craniectomy may be initiated to stop the progression of the infection when antibiotics fail and the underlying bone becomes grossly eroded. METHOD: The authors present the case of a 54-year-old woman who required a total craniectomy after developing full-thickness osteomyelitis. A free omental flap along with dermal grafts and split-thickness skin grafts were utilized for soft tissue coverage. A semi-rigid helmet was used to provide durable protection to the brain. RESULTS: Omental free flap with skin graft coverage provided this patient with durable and long-term soft tissue coverage for a total craniectomy defect, as well as the ability to regain mental status. CONCLUSIONS: Many factors must be analyzed when approaching composite defects of the scalp. Modality of treatment must be customized to the individual, and the decisions should be based on whether the defect is composed of soft tissue, bone or both, its size, etiology, and presence of a cerebral spinal fluid leak. The goals of treatment are restoration of durable soft tissue coverage, protection of vital underlying structures and control of cerebral spinal fluid leaks.