Malignant granular cell tumor manifesting as exophytic skin lesion: report of a case

Granular cell tumor [GCT] also known as Abrikossoff tumor is an uncommon tumor of putative Schwannian derivation that is rarely malignant. We report a case of malignant granular cell tumor [MGCT], which manifested as an ulcerated exophytic skin lesion. The patient was a 41-year-old male who presented with a progressively enlarging, ulcerated skin lesion of six month duration, in the left inguinal region. On examination a well-circumscribed elevated and ulcerated lesion was identified. The lesion was firm in consistency and was fixed to the skin. A clinical diagnosis of squamous cell carcinoma was considered. The lesion was excised with wide surgical margins. Microscopic examination revealed solid sheets of polygonal to spindle cells with moderate pleomorphism. Most cells revealed prominent nucleoli and mitosis was frequent. The cells were strongly immunoreactive to S100, vimentin and neuronspecific enolase. The tumor cells expressed p53 and Ki-67 in about 60% and 40% of the cell population respectively. A diagnosis of MGCT was made. We report this case because of its unusual clinical presentation and briefly discuss its prognosis and differential diagnosis

Double appendix: report of a case

A 30-year-old female presented to the surgery outpatient department with complaint of pain in right iliac fossa of one day duration. The pain was associated with nausea and vomiting. On examination, there was localized tenderness and rigidity in the right iliac fossa with positive rebound tenderness. Multiple pigmentation of skin in the abdomen, accessory nipple and scoliosis were also noted. Laboratory investigation revealed neutrophilic leukocytosis. Ultrasound abdomen showed an appendix measuring 4 cm in length and a fibroid uterus. Diagnostic laparoscopy revealed an inflamed appendix with a small blind structure in continuity with the cecum. Operative diagnosis of double appendix was made. Microscopic examination confirmed double appendix with features of appendicitis and periappendicitis in the bigger appendix. We report this case because of it rarity. The surgical resident should be aware of this rare congenital anomaly to avoid missing the other appendix in appendectomy procedures and avoid its medico-legal consequences

Mixed ademocarcinoma-carcinoid [collision tumor] of the appendix

To report a case of mixed adenocarcinoma and carcinoid in the gastrointestinal tract. A 52-year-old man presented with a mass at the base of the appendix. On microscopic examination of the tumor, mixed adenocarcinoma and carcinoid was identified. The carcinoid component was insular/trabecular in morphology, and the epithelial component revealed mucinous adenocarcinoma. Morphologically and immunohisto-chemically the 2 components showed a clear-cut distinction, without any intervening intermediate cell population. The adenocarcinomatous component displayed omental depost and metastasis to the regional lymph nodes. One year later, the patient developed multiple metastatic deposits of adenocarcinoma in the liver, rectus muscle, ileum and sigmoid colon. This tumor had an aggressive clinical course and behaved more like adenocarcinomal than carcinoid

Lymphoepithelioma-like carcinoma of the urinary bladder: report of a rare case

Lymphoepithelioma-like carcinoma [LELC] is a rare malignant neoplasm in the urinary bladder, which can histologically mimic lymphoma, poorly differentiated invasive transitional cell carcinoma or poorly differentiated squamous cell carcinoma with a lymphoplasmacytic background. A urinary bladder tumor was identified in a 65-year-old man suffering from hematuria for several weeks. Transurethral biopsy revealed an undifferentiated tumor with prominent lymphocytes and plasma cell infiltration. Immunohistochemical evaluation showed positive staining for cytokeratin and epithelial membrane antigen. Subsequent radical cystectomy showed pure LELC. We present the case to highlight the significance of recognizing this unusual bladder tumor and discuss the important differential diagnosis, treatment options and prognosis

unusual case of extensive xanthogranulomatous orchitis in a diabetic patient

We report an unusual case of extensive xanthogranulomatous orchitis [XGO] in association with poorly controlled diabetes mellitus. A 65-year-old Kuwaiti man with poorly controlled diabetes mellitus presented with a painful left testicular swelling of 1 year duration. Testicular tumor markers were normal. Scrotal ultrasonography showed a mass lesion of mixed echotexture, which almost replaced the testicular parenchyma. Left-sided orchiectomy was performed with the clinical diagnosis of testicular neoplasia. Subsequent examination revealed the diagnosis of XGO, and the patient is well 2 years after the operation. Extensive tumorous XGO associated with diabetes mellitus has not been previously reported. We offer this case to highlight the implied role of poorly controlled diabetes mellitus in the pathogenesis of XGO