A Rare Case of Hepatic Schwannoma in the Setting of Schwannomatosis.

Schwannomas are benign nerve sheath tumors commonly found in the head, neck, vestibular system, and extremities. Primary hepatic schwannomas are exceptionally rare, with 34 cases reported to date according to our review of the literature. This case report describes a 79-year-old man with a medical history of skin and thyroid cancer, who presented with no clinical symptoms and underwent a follow-up MRI due to an initial scan indicating a suspicious hepatic mass resembling an atypical hemangioma. The MRI revealed a 3.6 cm left hepatic mass concerning for an intrahepatic cholangiocarcinoma. Histopathological and immunohistochemical studies of a biopsy of the liver mass confirmed the presence of a benign hepatic schwannoma. Further evaluation revealed multiple spinal schwannomas, leading to the diagnosis of schwannomatosis. The diagnosis of hepatic schwannomas poses challenges through imaging alone. This case underscores the importance of microscopic evaluation in accurately diagnosing hepatic masses. Additionally, the presence of concurrent schwannomas should be considered in patients initially diagnosed with isolated schwannomas.

A Rare Case of Paratesticular Leiomyosarcoma.

Paratesticular leiomyosarcoma is a rare urologic cancer that arises from undifferentiated smooth muscles of the spermatic cord or epididymis. Few accounts of this cancer have been reported but previous reports have identified radiation and anabolic steroids as possible risk factors. We report a case of an 83-year-old man with a previous history of radiation therapy for prostate cancer, who presented with a painless left scrotal mass. Given the nonspecific presentation, a histopathological classification was warranted for a definitive diagnosis. The tumor was resected via simple orchiectomy and was diagnosed as a paratesticular grade III leiomyosarcoma without any further treatment. Patient had a follow-up CT scan of the abdomen and pelvis that was normal without metastasis. The patient's history of previous external beam radiation and now development of a secondary tumor sums to the few cases that have been previously reported with this association.

Esophageal Granular Cell Tumor: An Uncommon Cause of Dysphagia.

Granular cell tumors (GCTs) are rare, typically benign, solitary neoplasms that can arise throughout the body, with reports of cases in the tongue, esophagus, colon, skin, vulva, and skeletal muscle, among others. Although GCTs are usually asymptomatic, esophageal GCTs can grow large enough to cause dysphagia. When developing the differential diagnosis for dysphagia, a broad consideration includes routine etiologies such as esophageal strictures, eosinophilic esophagitis, carcinoma, webs and rings, achalasia, and motility disorders, but GCTs may not readily come to mind. Due to their scarcity, this case report is presented to raise awareness of esophageal GCTs and emphasize key goals for diagnosing and managing this uncommon yet treatable cause of dysphagia. This case report details the clinical course of a patient presenting with a chief complaint of difficulty swallowing that was found to be caused by a subepithelial esophageal tumor discovered with esophagogastroduodenoscopy (EGD) and endoscopic ultrasound (EUS). Histopathological studies paired with immunohistochemical investigations of a tissue biopsy confirmed the etiology of the offending esophageal mass to be a GCT. The patient's dysphagia resolved after endoscopic mucosal resection of the GCT, and follow-up evaluations have remained negative for recurrence. This case highlights the esophageal GCT as an uncommon source of dysphagia and the need for EGD and EUS evaluations of subepithelial esophageal lesions accompanied by histopathological analysis for a definitive diagnosis of GCT.

Polypoid Lymphangiectasia in the Sigmoid Colon: A Case Report of a Rare Entity.

Intestinal polypoid lymphangiectasia is an uncommon disorder involving an improperly formed enteric lymphatic system. It is characterized by lymphatic vessel dilatation with impaired drainage or obstruction of the lymph from the intestine. In this report, we present a case of a 73-year-old male patient with chronic intermittent left lower quadrant abdominal pain for one year who was found to have a sigmoid colon polyp on a colonoscopy. Upon microscopic examination, the polyp revealed dilated lymphatic vessels staining strongly for D2-40 (lymphatic vessel marker), supporting the diagnosis of polypoid lymphangiectasia. Intestinal lymphangiectasia has a broad differential diagnosis, warranting histopathological examination for a definitive diagnosis.--------------.

Mastocytic Enterocolitis: An Overlooked Diagnosis for Unexplained Chronic Diarrhea in a Patient With Colon Polyps and a Family History of Colon Cancer.

Chronic intractable diarrhea is a common presenting complaint that is often clinically worked up for a wide variety of diseases including inflammatory bowel disease, celiac disease, and hyperthyroidism. When lab results come back normal, patients are often diagnosed with irritable bowel disease-diarrheal subtype, overlooking the potential diagnosis of mastocytic enterocolitis. Mastocytic enterocolitis is an uncommon diagnosis where patients can benefit from mast cell stabilizers that directly target the underlying pathology. Given the broad differential diagnosis of nonspecific diarrhea presentation, a histopathological examination is warranted for definitive diagnosis. We hope to raise awareness of this potentially treatable disease that can be effectively managed with antihistamines. We describe the case of a 63-year-old male patient with a family history significant for colon cancer who presented with intractable diarrhea and was ultimately diagnosed with mastocytic enterocolitis by histopathology. His symptoms were relieved by antihistamine treatment.

A Spoonful of Eponyms Helps the Pathology Go Down: Using Food Eponyms and Visual Mnemonics in Preclinical Pathology Education.

Food eponymophilia in medicine describes a phenomenon by which diseases or pathologies are named for food items, such as "oat cell carcinoma" or "coffee bean nucleus." Some argue that these metaphors enrich medical education by providing familiar analogies to communicate pathology that is otherwise difficult to describe. Others argue that these metaphors are esoteric, burdensome, culturally irrelevant, and outdated. Few studies have ever focused on the use of metaphors in medical education, and even fewer have focused particularly on pathology or food eponyms. We aim to investigate the use of food eponyms in undergraduate medical education, particularly in pathology education, at the University of Central Florida College of Medicine. We used an interactive learning module to objectively assess whether or not students learn and retain pathology knowledge better using food eponyms, and a post-module survey to assess student perception of the use of these visual mnemonics within pathology educational activities. Results suggest that students not only learn and retain pathology knowledge through this type of activity, but that they also find these eponyms and mnemonics useful as they prepare for their USMLE step 1 exam, clinical clerkship, and future practice. This study is the first of its kind to investigate the usefulness of food eponymophilia in medical education and suggests that students empirically benefit from the use of these memory aids and find this form of learning enjoyable. Preclinical pathology education should make use of these tools in an effort to make pathology as palatable as possible. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01474-w.

Invasive Micropapillary Carcinoma: A Rare Case of Male Breast Cancer.

Invasive micropapillary carcinoma (IMPC) is a rare form of breast cancer, accounting for 3.8-5.9% of all breast cancer types. Less than 1% of all breast cancer occurs in men and there have been only nine other cases of IMPC specifically in male patients reported in the literature. This case presents a 77-year-old Caucasian man who was found to have IMPC of the left breast after presenting for a painless mass in the left lower subareolar region. After a left modified radical mastectomy, the patient was found to have only one metastatic lymph node with his variant of IMPC being less aggressive requiring no further treatment other than annual surveillance with mammography.

A Rare Case of Angioleiomyoma of the Hand.

Angioleiomyoma is a benign tumor of the vascular system that is often not considered in the differential diagnosis of a painless subcutaneous nodule of the body. In this report, we present a rare case of angioleiomyoma of the phalanx in the left hand in a middle aged man. He underwent surgical excision of the mass with no complications. Given the nonspecific and indolent presentation, our case had a broad differential diagnosis including ganglion cyst and histopathological examination was warranted for definite diagnosis. At 9-month follow-up, the patient was asymptomatic with no signs of recurrence.

Malignant Hidradenocarcinoma of the Axilla.

Malignant hidradenocarcinoma is a very rare and highly aggressive primary skin neoplasm that arises in the eccrine sweat glands. Diagnosis is typically made with histopathological evaluation after excisional biopsy. Reports of this tumor are scarce in the literature, thus making its characterization and management particularly challenging. A 71-year-old male presented in the clinic with swelling of the left lateral axilla on routine dermatological examination. Clinically, the lesion was suspected to be a capillary hemangioma. Upon surgical excision, the specimen was diagnosed as malignant hidradenocarcinoma based on histological characterization with immunohistochemical staining. Subsequent wide excision with sentinel lymph node biopsy was performed, which came back negative for residual tumor and metastasis. Due to the low incidence of this cancer and the markedly poor prognosis, accurate diagnosis of these tumors is highly important. Wide excisional biopsy and sentinel lymph node biopsy appear to be the most common initial treatment plans based on the available literature. With high rates of recurrence and metastasis, there remains the need to characterize effective adjuvant therapy for the post-operative management of hidradenocarcinoma.

Benign Granular Cell Tumor of the Cecum.

Granular cell tumors (GCT) are usually benign, soft tissue tumors that are mostly found in the oral cavity, skin, and subcutaneous tissue. GCTs in the gastrointestinal (GI) tract are mainly located in the esophagus. A 63-year-old male was referred to the gastroenterology clinic for a major complaint of six months of painless rectal bleeding. Laboratory results showed mild macrocytic anemia. He denied any prior colonoscopies and hence, a lower endoscopic procedure was done. The colonoscopy showed multiple polyps, one of them located at the cecum. The cecal polyp showed polygonal cells with abundant eosinophilic infiltration and S100 stain positive. This confirmed a diagnosis of GCT. GCTs are thought to be derived from the neural tissue (Schwann cells). This entity is usually asymptomatic; however, tumors located at the lower GI tract can present with hematochezia. Only 2% of GCTs follow a malignant course, with associated poor prognosis.  This case is being presented because of its asymptomatic nature. It is important to monitor these lesions in order to recognize early signs/symptoms concerning for malignancy.

Team-Based Learning Is Effective in Teaching Appropriate Utilization of Hemostasis Laboratory Tests Using Storyline Case-Authoring Software.

Introduction: Team-based learning (TBL) is an effective way to teach medical students a challenging topic: coagulation. This TBL requires students to discuss a differential diagnosis, order and analyze laboratory tests, and decide upon appropriate treatment. Methods: The coagulation TBL was utilized in a hematology/oncology system-based medical course. The TBL began with Individual and Group Readiness Assurance Tests (IRAT and GRAT, respectively) consisting of the same 10 multiple-choice questions. Next came a team application activity with the goal of evaluating a bleeding patient. Each team was given the clinical case and a whiteboard. Each team recorded a differential diagnosis and chose relevant laboratory tests from 20 hematology/coagulation assays placed in case-authoring software. Next, teams recorded the laboratory results, final diagnosis, and treatment on the whiteboards. Teams then voted for the best whiteboard. After discussing the highly voted whiteboard, instructors provided case discussion and elaboration about all 20 laboratory tests and their interpretation. Results: The IRAT average score was 77.0% compared to the GRAT group average of 99.5% for the year 2016-2017. Instructors noted great enthusiasm and teamwork. Institutional module evaluation feedback results showed that students were pleased and felt competent analyzing laboratory tests in a bleeding patient. Discussion: TBL provides a powerful way of teaching students the clinical reasoning approach to a bleeding patient and the appropriate use of laboratory test ordering and analysis. It is enjoyable and interactive and teaches students how to narrow their differential diagnosis by effective laboratory utilization.

A Rare Location of a Neuroendocrine Tumor.

Neuroendocrine tumors (NETs) arising in the duodenum are rare neoplasms that are often classified as indolent and have a low potential to metastasize. Although rare, multiple reports cite an increasing incidence of duodenal NETs. Symptoms are usually nonspecific and the diagnosis is made via endoscopy. Endoscopic resection is the mainstay of therapy. The prognosis is usually favorable. We describe a case of a duodenal NET that presented with vague symptoms in order to increase the awareness of this rare but increasing in frequency entity.