An extensive pyoderma gangrenosum mimicking necrotizing fasciitis: An unusual case report.

INTRODUCTION: Pyoderma Gangrenosum (PG) is a rare, benign and inflammatory disease characterized by ulcerative skin lesions. We report the successful management of an unusual case of PG following a caesarean section, with extensive cutaneous skin involvement and mimicking necrotizing fasciitis. PRESENTATION OF CASE: A 36-year-old woman was admitted with extensive surgical site inflammation after a caesarean section. Despite antibiotic treatment and wound care, the clinical course deteriorated rapidly. Wound debridement following negative pressure closure was performed due to an immediate increase in skin necrosis. A diagnosis of PG was reached based on the absence of a positive wound culture, resistance to wound debridement and the histopathological results. A course of high-dose corticosteroids was started, and a successful clinical course was finally achieved. The patient is now in the 14th month of remission, with no recurrence. DISCUSSION: PG is often reported after bowel surgery, especially after complicated stoma or diverticulitis, breast surgery and occasionally after C-sections. The diagnosis of pyoderma gangrenosum may be challenging because of a wide variety of macroscopic features and its pronounced similarity to necrotizing fasciitis. Treatment with systemic corticosteroids is the most common management option, while surgical treatment is extremely controversial. CONCLUSION: An extensive PG following surgery can mimic necrotizing fasciitis. An interdisciplinary treatment approach provides early diagnosis and effective treatment resulting in less morbidity.

An immunohistochemical profile of giant cell carcinoma of the larynx.

OBJECTIVE: This report describes a case of a 62-year-old male with giant cell carcinoma of the larynx that presented as a neck mass and hoarseness. METHODS: Case report, review of the world literature, and an immunohistochemical examination. RESULTS: Extended total laryngectomy and bilateral functional neck dissection were performed. Microscopical examination showed that the tumor was composed of solid masses of anaplastic small cells with hyperchromatic nuclei. There were multinucleated giant cells with huge nuclei, prominent nucleoli, and clear or eosinophylic cytoplasm. The diagnosis of giant cell carcinoma of the larynx was made. An immunohistochemical staining was applied to the case and tumor showed immunoreactivity with cytokeratin 8/18, cytokeratin 18, cytokeratin 19, vimentin, epithelial membrane antigen, S-100, cytokeratin 7 and did not show immunoreactivity with cytokeratin 10, cytokeratin 20, and carcinoembryogenic antigen. CONCLUSION: Giant cell carcinoma of the larynx is an extremely rare tumor the origin of which is not clearly understood. It is believed to be the counterpart of giant cell carcinoma of the lung in larynx. It is the sixth case reported in English literature and also the first case that is examined immunohistochemically. In conclusion, giant cell carcinoma of the larynx is confirmed to be a specific entity of simple epithelial origin and it is the counterpart of giant cell carcinoma of the lung.

Cytokeratin expression patterns of gastric carcinomas according to Lauren and Goseki classification.

The Goseki system is a new gastric carcinoma classification system that classifies gastric carcinomas as grade I (intestinal type), grade II (mucinous type), grade III (mucin-poor, diffuse infiltrating type), and grade IV (signet ring cell type). The main advantage of the Goseki classification may be to separate these distinct entities into different groups. CK7 is not observed in normal gastric mucosa but can be detected in chronically inflamed gastric mucosa and coexists with incomplete intestinal metaplasia. CK20 can be observed in the superficial foveolar epithelium and mature goblet cells. The aim of this study was to examine the cytokeratin expression profiles in gastric carcinomas that are classified according to both the Goseki and Lauren systems. CK7, CK8, CK19, and CK20 were applied to the paraffin sections of 66 gastric carcinoma cases. The cytokeratin expression patterns were grouped as CK20+/CK7+, CK20+/CK7-, CK20-/CK7+, or CK20-/CK7-. The results were examined statistically. CK20 immunoreactivity was observed in 18%, 24%, and 31% of grade I, III, and IV cases, respectively. The CK20+/CK7- pattern was observed in 20% of the grade IV and 66.7% of the grade II carcinomas and was not observed in grade I or grade III tumors (P<0.0001). Goseki grade III and IV carcinomas originate from superficial gastric mucosa, but grade III carcinomas are poorly differentiated. Goseki grade II carcinomas have a specific immunophenotype other than intestinal-type gastric tumors. The Goseki classification seems to be superior in identifying poorly and well-differentiated forms of diffuse infiltrating carcinomas and mucinous carcinomas.