Primary mediastinal choriocarcinoma presenting as cutaneous metastasis with resistance to chemotherapy: case report and literature review.

Cutaneous metastases of choriocarcinoma are rare. They may indicate poor prognosis and resistance to chemotherapy. In this report, we present a case of a 25-year-old man who presented with central pleuritic chest pain and right upper arm mass for about a week. The patient also had significant weight loss during the last 5 months along with an episode of generalized seizure. Chest computed tomography scan revealed an 8 cm anterior mediastinal mass. A skin punch biopsy from the right upper arm mass revealed a malignant neoplasm with morphology consistent with metastatic choriocarcinoma. Further work-up revealed multiple lung and brain lesions. Ultrasound of the testes revealed no abnormalities. Several chemotherapy regimens were tried; however, there was no response and the disease showed progression. The patient died 6 months after initial presentation.

Classification of Endometrial Carcinoma: New Perspectives Beyond Morphology.

Endometrial carcinoma has been traditionally divided into type 1 or endometrioid type that is usually moderate to well differentiated and type 2 that is usually poorly differentiated with high histologic grade and aggressive clinical behavior. However, interobserver diagnostic agreement is suboptimal, particularly among the high-grade histotypes. Furthermore, recent data indicate that this histotype assignment does not independently correlate with survival. In recent years, there has been remarkable progress in our understanding of the molecular basis of endometrial carcinoma and extensive molecular studies have been performed under The Cancer Genome Atlas Program (TCGA) leading to molecular classification of endometrial carcinoma that has been shown to be significantly prognostic. This classification system divides the tumors into 4 subgroups namely, polymerase ε exonuclease (POLE) ultramutated, hypermutated microsatellite instability, copy number low, and copy number high (serous-like). Carcinomas with POLE domain hotspot mutations are highly prognostically favorable; those with copy number alterations and TP53 mutations are highly aggressive; and microsatellite unstable and "copy number low" endometrioid are associated with intermediate prognoses. The TCGA applied methods that are too costly and cumbersome for widespread implementation into routine clinical practice. Several other groups have attempted to identify these categories by using immunohistochemical biomarkers rather than molecular studies. Immunohistochemical biomarkers have been used successfully to identify all the subgroups except for POLE ultramutated, which requires sequencing for proper categorization. It is hoped that future studies will identify a suitable biomarker for POLE mutation so that this classification can be routinely used in all medical centers.

Metastatic sigmoid adenocarcinoma to the larynx: A case report and updated literature review.

Metastatic laryngeal cancer is a rare entity, usually indicating an advanced disease once discovered. In this report, we are describing a case of a 60-year-old male patient with stage IV colorectal cancer (CRC), who presented to our clinic with dysphonia; further workups showed metastatic CRC.

Primary groin porocarcinoma in a 43-year-old man successfully managed by local excision: A case report and literature review.

Porocarcinoma is a rare skin malignancy that should be suspected in patients with chronic skin lesions. Although it usually affects the elderly population in sun-exposed areas, it may be seen in younger populations and in nonexposed areas such as the groin.

The Histological Spectrum Reported on Evacuated Endometrial Tissue From Patients With Secondary Postpartum Hemorrhage: A Pilot Study.

Background/aim This study sought to explore the possible yield of pathology requests on tissue obtained in uterine evacuation for secondary postpartum hemorrhage (SPPH) at our institution over five years. Material and methods A content categorization of histological reports on endo-uterine tissue obtained from patients with secondary postpartum hemorrhage was undertaken. The aggregate tissue dimensions were also recorded. Additional information on the time elapsed between delivery and hospital presentation was deduced from medical records. Results From the 53 tissue samples reported, we clustered 114 descriptive mentions of phrases and terms and categorized them based on parent tissue, changes, and background cellularity. Inflammation and/or inflammatory changes were mentioned 18.4% of the time, no tissue was identified in 5.8% of instances, whilst placental tissue was encountered in 9.7% of specimens. Separately or in variable combination, decidua, decidualized tissue, hemorrhagic tissue, fibrinous material, and membranous tissue amounted to 48.5% of mentions. There was no correlation between aggregate tissue measurements and time elapsed since delivery. Conclusion Nearly half of the content of histological reports on tissue evacuated SPPH patients were consistent with expected findings on a postpartum endometrium. Remnants of placental tissue were mentioned in about 10% of instances.

Rare presentation of intra-spinal extradural grade 1 chondrosarcoma: A case report.

INTRODUCTION: Lumbar Spine Chondrosarcomas are rare entities that accounts for less than 10% of all spinal Chondrosarcomas, patients can present with symptoms of nerve root irritation secondary to direct compression caused by the tumor mass effect. Radiologically these tumors are destructive in nature with soft tissues classifications, and the treatment of choice for it is complete surgical excision, however in some scenarios they are difficult to access and complete resection becomes not feasible. PRESENTATION OF CASE: A 37 years old male, presented to our spine clinic with chief complaint of chronic low back pain with radicular symptoms, normal power in both lower limbs, while his radiological evaluation showed intra-spinal extra-dural Chondrosarcoma arising from the posterior cortex of the 5th vertebral body, for which he underwent surgical decompression of the lumbar canal with resection of the lesion and unilateral stabilization of the spinal segment. CONCLUSIONS: Unlike Chondrosarcomas of the appendicular skeleton, lesions arising in the spinal element may be difficult to detect on plain radiographs and further imaging is crucial for better evaluation, as this will help in surgical planning for excision of the tumor. In difficult cases with inaccessible locations, marginal excision of spinal Chondrosarcomas can be achieved utilizing a minimally invasive technique with preservation of some spine motion with acceptable clinical outcomes.

Recurrent chest pain as a rare presentation of extra-pelvic endometriosis.

Periodic chest pain, with bloody pleural effusion should raise the suspicion of pleural endometriosis as a well-known, but a rare condition in clinical practice.

First Schistosomal Cholecystitis Complicated by Cholangitis and Liver Abscess: Case Report and Review of Literature.

Schistosomiasis is one of the most prevalent parasitic infections in the developing world. When it affects the gastrointestinal system specifically the liver, it causes periportal fibrosis followed by cirrhosis. Cholecystitis however is a rare presentation, and associated liver abscess has certainly never been reported to date. We report a case of acute cholecystitis complicated by cholangitis and liver abscess in a 46-year-old man. After complex course of treatment, he had laparoscopic cholecystectomy, and the histology report confirmed schistosomiasis. Gallbladder schistosomiasis is an uncommon disease that is associated with dense fibrotic changes that strongly mimics xanthogranulomatous cholecystitis. Liver abscess may occur during the disease evolution especially in patient originating from endemic backgrounds. We present the case and a comprehensive literature review.

Recurrent nasopharyngeal rhinosporidiosis: Case report from Qatar and review of the literature.

Rhinosporidiosis is a chronic granulomatous infectious disease that predominantly affects the mucosal membranes of the nose and nasopharynx. The disease is caused by Rhinosporidium seeberi, an eukaryotic pathogen with distinct geographical distribution particularly in tropical and subtropical areas acquired mainly through aquatic exposure. We report a case of a young Nepalese male who presented with recurrent right nasopharyngeal mass where surgical excision and histopathological examination confirmed the diagnosis following distinct pathognomonic findings. There is no optimal effective management of the disease and surgical excision coupled with cauterization to prevent recurrence is the recommended best option since medical treatment alone is ineffective. The clinical presentation, assessment and management options are reviewed.

Histological diagnosis of cardiac lipoma in an adult with tuberous sclerosis.

Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem disorder caused by mutations in either of the two genes, TSC1 or TSC2, which code for the proteins hamartin and tuberin, respectively. These proteins act as tumour-growth suppressors with mutations in their genes leading to multiple hamartomatous growths throughout the central nervous system, lungs, heart, kidneys, eyes and skin. There have been reports of patients with TSC having an increased incidence of cardiac neoplasms, especially rhabdomyomas. A much smaller proportion of TSC patients have also been reported to have either, angiomyolipomas or lipomas, the diagnosis in these cases being made via CT. We present the first case of an adult with TSC, where a histological diagnosis of cardiac lipoma was made and discuss its implications.