Mycobacterium avium Auricular Infection in an Apparent Immunocompetent Patient: A Case Report.

INTRODUCTION: Soft tissue infections with Mycobacterium avium complex are more likely to appear in immunocompromised patients. However, they may rarely arise in non-immunosuppressed individuals. AIM: To present the case of an ear infection with Mycobacterium avium in the absence of demonstrable immunosuppression. CASE REPORT: Clinical case description, blood tests, routine histology and tissue cultures. DISCUSSION: A female, apparent immunocompetent patient presented with a 6-month reddish, oedematous and painless lesion with fine scaling in the right ear. Histology showed numerous granulomas, composed of epithelioid histiocytes without central necrosis. Cultures grew Mycobacterium avium. An unusual accidental ear injury was the portal of microbial entry. The patient's lesion fully regressed after a 9-month course of antibiotics. CONCLUSION: Although M. avium infections are rare in immunocompetent patients, the possibility of such infections should be considered even in these subjects, when relevant clinical features and exposure to risk factors are present.

Atypical solitary fibrous tumor of the nose and maxillary sinus.

BACKGROUND: Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, also known as benign fibrous mesotheliomas or submesothelial fibromas. SFTs of the sinonasal tract are extremely rare. METHODS: We report a rare case of an atypical SFT of the sinonasal tract presenting with ipsilateral nasal obstruction and recurrent epistaxis. Endoscopy and imaging studies showed a well-circumscribed mass of the nose and the maxillary sinus. The patient underwent total endoscopic resection of the tumor. RESULTS: Permanent histology and immunohistochemical studies revealed an atypical variant of SFT of the sinonasal tract, with negative surgical margins. The patient did not receive any adjuvant treatment. Postoperative monitoring was uneventful. CONCLUSION: In general, these tumors are reported to follow an indolent course. SFTs adopt a biological behavior that cannot be determined as malignant. Total surgical resection of the tumor remains the gold-standard method of treatment.

Eccrine porocarcinoma: cytologic diagnosis by fine needle aspiration biopsy (FNAB).

INTRODUCTION: Eccrine porocarcinoma is an uncommon malignant adnexal tumor of the skin. Eccrine porocarcinoma is an adenocarcinoma of the eccrine sweat gland with a propensity to recur locally and gives metastases to regional lymph nodes. This paper presents a cytologic diagnosis by fine needle aspiration of an eccrine porocarcinoma along with histopathology and immunocyto-histochemistry. CASE REPORT: The cytologic findings of an eccrine porocarcinoma in a 76-year-old female and histologic features of the skin tumor are reported. Cytologically in fine needle aspiration biopsy, the tumor was characterized by atypical malignant cells with basophilic cytoplasm, hyperchromatic nuclei and prominent nucleoli. The cytologic diagnosis was confirmed by histology. CONCLUSIONS: The accurate preoperative diagnosis of eccrine porocarcinoma is crucial to developing a curative surgical plan. Fine needle aspiration cytology provides a convenient, safe and effective approach to solving a challenging differential diagnosis.

Introdução: O porocarcinoma écrino (PE) é um tumor maligno pouco comum dos anexos cutâneos. Trata-se de um adenocarcinoma da glândula sudorípara écrina com propensão para recorrer localmente e para originar metástases ao longo dos gânglios linfáticos regionais. Este artigo apresenta um diagnóstico por citologia aspirativa com agulha fina (CAAF) de um PE, associado ao exame histológico e de imunocito/histoquímica.Caso Clínico: São descritos os achados da citologia de um porocarcinoma écrino numa doente de 76 anos de idade, bem como as características histológicas do tumor cutâneo. A citologia aspirativa revelou que o tumor se caracterizava pela presença de células atípicas malignas com citoplasma basófilo, núcleos hipercromáticos e nucléolos proeminentes. O diagnóstico citológico foi confirmado pela histologia.Conclusões: É crucial obter um diagnóstico pré-operatório preciso de modo a desencadear um plano cirúrgico curativo. A CAAF possibilita uma abordagem pouco invasiva, segura e efectiva, de modo a esclarecer um diagnóstico diferencial exigente.

Primary renal angiosarcoma: radiologic-pathologic correlation and literature review.

We present a case of primary renal angiosarcoma. We focus on the characteristic striated pattern of the tumor on T2-w MR sequence as well as on other radiological features and correlate them with the pathologic findings. A review of the imaging characteristics of cases published in the literature was subsequently performed.

Rare presentation of occult medullary carcinoma of the thyroid as a mediastinal mass.

OBJECTIVE: To describe a rare case of occult (<1 cm in diameter) medullary thyroid carcinoma (MTC) in a 45-year-old woman, presenting as an asymptomatic mediastinal mass. DESIGN: The diagnostic methodology included laboratory measurements of relevant biochemical and hormonal parameters including calcitonin (CT), carcinoembryonic antigen (CEA) and chromogranin A, and imaging techniques including ultrasound (U/S), computed tomography (C/T), magnetic resonance imaging (MRI) and radio labeled somatostatin analog ((111)In-DTPA-octreotide). RESULTS: Chest CT revealed a mediastinal mass measuring 5 cm in diameter abutting the right thyroid lobe. CEA was elevated and an association with thyroid malignancies was considered. CT was found to be markedly elevated, pointing to the diagnosis of MTC metastatic to the mediastinum. The patient underwent total thyroidectomy, lymph node dissection and removal of the mediastinal mass. Histological examination revealed MTC of the right thyroid lobe measuring 0.5 cm, metastatic to regional and superior mediastinal lymph nodes. CONCLUSIONS: Occult MTC can infrequently present as an asymptomatic mediastinal mass. Elevated serum CT and CEA along with imaging techniques leads to the correct diagnosis and surgical management of the disease.

Imported human tungiasis in Greece.

BACKGROUND: Tungiasis is a parasitic skin disease caused by the sand flea Tunga penetrans. It is widespread in poor urban and rural communities in sub-Saharan Africa, the Caribbean and South America. Imported cases of tungiasis are increasingly being reported due to the increased numbers of travelers visiting the affected areas. CASE REPORT: A 28-year-old woman presented with a lesion on the subungual area of the right fourth toe, covered with a central dark crust. The lesion appeared two weeks after returning from Tanzania. The flea Tunga penetrans was identified by histopathological examination of a biopsy material. This is the first case of tungiasis in Greece. CONCLUSIONS: Tungiasis should be considered in the differential diagnosis of parasitic infections in travelers returning from endemic geographical areas.