Metastatic Basal Cell Carcinoma: An Unexpected Diagnosis in a Young Patient With Back Pain.

ABSTRACT: Basal cell carcinoma (BCC) portends a notoriously favorable prognosis in most patients with morbidity limited to localized destruction and recurrence. Metastatic BCC (mBCC) is an unexpected outcome affecting less than 1% of patients with a known primary lesion and predominantly involves regional lymph nodes. Reports of isolated bone involvement and spinal cord compression are rare. In the cases we identified in the literature, patients presented with massive primary lesions on the trunk that had been present for years and that were often still present at the time of diagnosis. Additionally, histology of distant metastatic lesions typically reveals aggressive subtypes. Herein, we report a case of mBCC in a patient with a history of BCC involving the cheek; the lesion was excised more than 10 years ago. He was referred to our institution for acutely worsening back pain and multifocal neurologic deficits. Clinical symptoms and radiographic findings demonstrated isolated bone involvement, with multiple lytic bone lesions and spinal cord compression noted on imaging studies. Biopsy revealed nests of small basaloid cells with peripheral palisading and immunohistochemical staining consistent with the unexpected diagnosis of mBCC, nodular subtype. Our case illustrates that a historically resected primary lesion may cause distant metastasis after a decade and that nonaggressive subtypes can also be implicated. We also provide insight into the potential pathogenesis of this manifestation.

Lymphangiectatic Variant of Eccrine Spiradenoma - A Diagnostic Challenge.

Conventional eccrine spiradenoma is a benign, slow growing and painful tumor of the skin. While the tumor does not usually present a diagnostic dilemma, a rare variant with marked stromal lymphedema can be a challenge to interpret. We present a case of lymphangiectatic variant of eccrine spiradenoma in an 82-year-old white male who presented with a persistent left flank lesion for several months. The patient was initially asymptomatic and subsequently developed a suspected abscess that was excised to reveal a 6.5 cm subcutaneous mass. Microscopic examination reveals strands and cords of dark, epithelial, round to oval cells with inconspicuous nucleoli streaming between prominently dilated and congested vascular spaces. Within the cystic component there are small ductular structures. Additionally, prominent stromal lymphedema is present. To the best of our knowledge, there is only one reported case of this entity in the English literature. This case represents a diagnostic challenge and the purpose of reporting it is to alert surgical pathologists, dermatopathologists and dermatologists of the existence of this unusual variant of eccrine spiradenoma.

IgG4-Related Sclerosing Pericarditis in a Young Man With Recurrent Chest Pain.

Many cases of immunoglobulin G4 (IgG4)-related disease involving different organ systems have been reported in the literature since the disorder was first described in patients with sclerosing pancreatitis. This report discusses an interesting case of IgG4-related cardiovascular disease that involved the pericardium and resulted in reoccurring chest pain in a 36-year-old man. The challenging diagnosis was made using established diagnostic criteria for other tissue sites and included the presence of elevated serum IgG4, pericardial infiltration by IgG4-positive plasma cells, focal phlebitis, and fibrosis. The patient's symptoms improved with immunosuppressive therapy.