Surgical approach for nodular neck lesions mimicking primitive thyroid neoplasms Report of three cases.

AIM: The finding of a neck nodular lesion provides strong suspicion of primary thyroid malignancy. Direct extension into the thyroid parenchyma of carcinomas arising from pharynx, larynx, trachea or esophagus, nervous structures has been also observed in the minority of cases. The intent of our study is to present and discuss rare conditions presenting asymptomatic neck masses, with particular emphasis on pre-operative characteristics and diagnostic criteria. MATERIAL OF STUDY: In our retrospective analysis, we present three cases of nodular neck lesions that have mimicked primitive thyroid pathologies at the first diagnosis. RESULTS: A 53-mm nodular mass in the right thyroid lobe was observed in one patient. The definitive diagnosis was Castleman's disease. The second case presented a 20-mm hypoechoic lesion in the contest of a multinodular goiter. The pre-operative suspect was thyroid carcinoma with lymphnode metastases but the definitive histology documented an 'ancient schwannoma'. A further patient presented bilateral supra-clavear and cervical lymphnodes in a multinodular goiter, initially interpreted as thyroid carcinoma with loco-regional spread. After a total thyroidectomy and cervical lymphadenectomy, the definitive histology documented foci of poorly differentiated carcinoma in cervical lymphnodes and a multinodular goiter without atypical cellularity. The patient is considered to have an occult tumor, probably arising from the breast, and she was scheduled in an oncological program. CONCLUSIONS: Nodular neck lesions are frequently misdiagnosed as primitive thyroid nodules in the common clinical practice. In these rare conditions, surgical exploration is advocated to reach the definitive diagnosis, to indicate the most appropriate treatment and to avoid unnecessary thyroidectomy. KEY WORDS: Ancient Schwannoma, Castleman's disease, Nodular neck lesion, Thyroid nodule.

A diagnostic dilemma: dystrophic calcified nodule of the testicle in a patient with no other symptoms - case report and review of the literature.

Dystrophic calcified nodule of the testicle represents an exceptional lesion with an unknown etiology and controversial diagnostic approach. There are very few reports in the literature that have examined this feature. Here, we report the fourth case of dystrophic testis nodule, identified in a 46-year-old man who presented the urologist with a palpable mass on his left testicle and no other symptoms. Histopathological findings were discussed and pooled with those of all previously published series. We believe that this description is particularly innovative because of the absence of symptoms and testicular pain associated with the lesion, and interesting as an attempt to determine the recognition of this rare entity.

Malignant PEComa: a case report with emphasis on clinical and morphological criteria.

BACKGROUND: Malignant perivascular epitheliod cell tumor (PEComa) is a very rare entity composed of distinctive perivascular epitheliod cells with variable immunoreactivity for melanocytic and muscle markers. At present this neoplasm does not have a known normal cellular counterpart and the natural history is often unpredictable. Up to now, few cases of PEComa have been described and treatment modalities are still controversial, particularly in advanced conditions. CASE PRESENTATION: We handled the case of a 42-year-old man with unresectable PEComa of the abdomen. A 7 cm hepatic hypodense lesion between segment V and VIII of the liver and diffuse intraperitoneal nodules of 0,3-3,5 cm along the right subcapsular hepatic region, were documented by a CT scan. Radiological images showed abnormal lymph nodes of the right internal mammary chain and anterior mediastinum. The patient underwent an explorative laparotomy for uncontrolled intraabdominal hemorrhage without a well-defined preoperative tumor diagnosis. At surgery, multiple lobulated nodules containing hemorrhagic fluid on the liver surface, peritoneum and omentum were confirmed. The procedure had a palliative intent and consisted of hemostasis, hematomas evacuation and omentectomy. The diagnosis of PEComa was made after surgery on the basis of morphological and immunohistochemical criteria. Radiological and intra operative findings suggest that the mass has an hepatic origin with diffuse involvement of hepatic capsule and suspensory ligaments. The patient received medical support care with blood and plasma transfusions. In our experience, PEComa was clinically malignant, leading to a fatal outcome 25 days after hospital admission of patient. CONCLUSIONS: Here we report and discuss the peculiar clinical, radiological and morphological presentation of unresectable PEComa. Although in the majority of the reported series, PEComas show a more better prognosis, our case presents with a particular aggressive biological behaviour. The importance of a correct preoperative diagnosis, the need for more effective targeted therapies based on tumor molecular knowledge and evidence-based clinical studies are emphasized together with a revision of the concerning scientific literature.

Leishmania life cycle images in the cutaneous cytologic smear of an immunocompetent patient.

Cutaneous leishmania life cycle images on cytology smears are very rare. We report herein a gallery of cytologic images from a case of sporadic cutaneous leishmaniasis in a 61 year old man presenting with ulcerative skin lesion.