Cellular Schwannoma Mimicking a Nodular Melanoma on the Sole of the Foot, an Avoidable Diagnostic Pitfall.

ABSTRACT: We report a rare case of cellular schwannoma (CS) manifesting as an ulcerated nodular lesion, mimicking spindle cell melanoma on the sole of the foot. CS, a benign variant of schwannoma, typically occurs in deep soft tissues but can rarely present cutaneously. The diagnosis of CS heavily relies on histopathological examination and immunohistochemical staining for specific markers such as SOX10 and S100. In this case, initial clinical suspicion of nodular melanoma was confirmed on biopsy, which revealed a spindle cell neoplasm positive for SOX10 and negative for melanocytic markers. Misdiagnosis of nodular melanoma was averted through complete excision. CS diagnosis demands careful consideration due to its resemblance to other spindle cell neoplasms, especially melanoma. Meticulous histopathological evaluation and immunostaining are important to differentiate CS from similar lesions, ensuring accurate diagnosis and appropriate management. This report contributes valuable insights into the diagnostic challenges and management of CS, particularly in unusual cutaneous presentations.

Diagnóstico y tratamiento quirúrgico de una paciente con una neoplasia trofoblástica gestacional / Diagnosis and surgical treatment of a patient with gestational trophoblastic neoplasia

Resumen ANTECEDENTE: La neoplasia trofoblástica gestacional forma parte del grupo de afecciones derivadas de la proliferación anómala del trofoblasto con capacidad para invasión y metástasis. CASO CLÍNICO: Paciente de 42 años, asintomática, con sospecha ecográfica de mola hidatiforme. El legrado uterino y el estudio anatomopatológico confirmaron el diagnóstico de mola hidatiforme completa. Con la cuantificación consecutiva de tres elevaciones de la β-HCG se diagnosticó: neoplasia trofoblástica gestacional. Se estadificó en estadio I, bajo riesgo y ante el deseo genésico satisfecho la paciente aceptó la histerectomía más salpingectomía bilateral. En el seguimiento posterior la paciente se encontró asintomática, con determinaciones seriadas de b-HCG negativa y ecografías vaginales sin hallazgos. CONCLUSIÓN: La histerectomía con salpingectomía bilateral puede ser el tratamiento definitivo en casos seleccionados de neoplasia trofoblástica. La evidencia disponible es escasa, por lo que es necesario seguir investigando en este campo.

Abstract BACKGROUND: Gestational trophoblastic neoplasia is one of a group of conditions resulting from abnormal trophoblast proliferation with capacity for invasion and metastasis. CLINICAL CASE: 42-year-old asymptomatic patient with ultrasound suspicion of hydatidiform mole. Uterine curettage and anatomopathological study confirmed the diagnosis of complete hydatidiform mole. With the consecutive quantification of three elevations of β-HCG a diagnosis of gestational trophoblastic neoplasia was made. It was staged as stage I, low-risk, and the patient agreed to hysterectomy plus bilateral salpingectomy. At subsequent follow-up the patient was found to be asymptomatic, with negative serial determinations of β-HCG and vaginal ultrasound scans without findings. CONCLUSION: Hysterectomy with bilateral salpingectomy may be the definitive treatment in selected cases of trophoblastic neoplasia. The available evidence is scarce and further research is needed in this field.

[Squamous cell carcinoma of the bladder. Review of our case series]. / Carcinoma epidermoide vesical. Revisión de nuestra serie.

OBJECTIVES: The squamous cell carcinoma of the bladder is a rare tumor in our environment, representing between 1.6-6.7% of all bladder neoplasias. It is more common to find foci of squamous differentiation associated with a transitional cell carcinoma. METHODS: We retrospectively review all squamous cell carcinomas diagnosed and treated in our hospital between 1994 and 2004. We analyze their biological behaviour and the treatment applied. RESULTS: We found 11 cases of squamous cell carcinoma of the bladder, which pathologically were pure squamous cell carcinomas in eight patients and mixed in another three. Mean patient age was 70.9 years ranging from 49 to 88 years, six of them were males and five females. All of them presented locally advanced tumor stages at the time of diagnosis (> or = T2). Although the treatment of choice is radical cystectomy, it could only be applied in three patients; it was associated with adjuvant chemotherapy in one patient. The rest of the patients were treated by transurethral resection of the tumor, with adjuvant radiotherapy in two cases and bilateral cutaneous ureterostomy in one due to the advanced stage. Mean survival was 20 months ranging from 1 to 91 months. Only two patients are alive, both after radical surgery. CONCLUSIONS: The squamous cell carcinoma, in both its forms, pure and mixed, is an aggressive tumor. The late diagnosis of these tumors and their biological behaviour entail a bad prognosis. Only early diagnosis and radical treatment may improve prognosis.