Scalp metastases mimicking alopecia areata. First case report of placental site trophoblastic tumor presenting as cutaneous metastasis.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare neoplasm of intermediate trophoblastic cells of the placenta. There is a wide range of biologic behavior, with metastases occurring in about 15% of cases. Cases with metastases have all presented with abnormal vaginal bleeding or gynecological symptoms. METHODS: We describe a 31-year-old G3P3003 woman who presented with several alopecic patches resembling alopecia areata, which on biopsy proved to be metastatic, previously unsuspected, PSTT. CONCLUSIONS: This represents the first case in which PSTT presented initially with metastases, and specifically, with cutaneous metastases. A new primary tumor source of alopecia neoplastica is presented. The role of mitotic counts in predicting prognosis in PSTT is supported. Alopecia areata was mimicked very closely. Dermatologists should be alert to any features atypical of alopecia areata, including erythema, induration, or palpability, and maintain a low threshold for biopsy in atypical cases.

Invasive Chrysosporium infection of the nose and paranasal sinuses in an immunocompromised host.

Aggressive fungal rhinosinusitis with Chrysosporium sp. occurred in a patient with acute lymphocytic leukemia. The infecting organism is an exceedingly rare human pathogen. Usually, human chrysosporial infections are mild and unmarked by symptoms. Most case reports appear in the pathology literature and describe the incidental finding of adiaspores in the pulmonary parenchyma at autopsy. Clinical disease from active growth of chrysosporial mycelia in human tissues has been noted on a porcine aortic valve prosthesis and in a tibial abscess. Hyphal elements were not recovered from any other body parts of these patients. Histopathologic and microbiologic studies permitted the identification of this rarely encountered organism. Our patient experienced systemic spread of Chrysosporium organisms. Treatment of this pathogen is the same as for other opportunistic fungal infections.

Survival statistics for multiple primaries in head and neck cancer.

The recognition of a second primary carcinoma in a patient with known head and neck cancer is considered a poor prognostic sign. However, its true implication for patient survival is not known. A retrospective 10-year study showed that second primary malignancies developed in 207 of 875 patients. Second primary malignancies were most commonly associated with glottic index tumors, followed by floor of mouth tumors. The second primary was most likely to occur at a time interval of 1.5 years from diagnosis of the index tumor. Second primary neoplasms were more likely to develop in patients whose original head and neck tumor was stage I or II, or whose histopathology showed well or moderately well differentiation. Patients with head and neck cancer in whom a second upper aerodigestive tract tumor develops have a 75% chance of 1-year survival, but only a 25% chance of 5-year survival. The average time from diagnosis of second primary to the time of death was 2.3 years. If we are to increase the survival time of our patients with head and neck cancer, we must consider that a second primary will develop in one of four patients. We must therefore consider the high risk of second primary malignancy when formulating the original treatment plan for a patient manifesting his or her first head and neck cancer.

Immunohistochemical localization of fibronectin in the chinchilla cochlea.

The purpose of this study was to better understand the molecular composition of the cochlea. Fibronectin (FN), a well characterized adhesive glycoprotein, was localized by immunofluorescence microscopy in fresh and fixed cochlear tissues, and in fixed kidney tissue, using a polyclonal, affinity-purified, rabbit, anti-fibronectin antibody and a secondary antibody coupled to FITC. The FN antibody was free from cross-reactivity with other known basement membrane and cell matrix molecules. FN reactivity in the cochlea was most intense in the basilar membrane, latero-basal borders of Boettcher's cells, otic capsule, endothelial basement membranes (particularly those of the stria vascularis), and as a diffuse, fan-shaped network radiating into the spiral ligament. Little FN labelling was present in the epithelial basement membranes. Negative control tissue showed no immunoreactivity; whereas, positive kidney control tissue showed appropriate FN immunoreactivity in the mesangium of the glomerulus. The most significant finding of this study was that FN is a major component of the basilar membrane and its distribution appears to correspond to the amorphous ground substance. FN was not localized in the organ of Corti or at the tips of the hair-cell stereocilia.