Apocrine Papillary Hidrocystoma With Mucinous Metaplasia (Goblet Cell Type): A Case Report and Review of the Literature.

ABSTRACT: Mucinous metaplasia (goblet cell type) is exceptionally rare in the skin. This is the second case of apocrine papillary hidrocystoma with mucinous metaplasia (goblet cell type) and a review of the literature exploring the significance and frequency of mucinous metaplasia with goblet cells in nongenital skin. The patient is an elderly man who presented with a blue-pigmented nodule on the scalp that was clinically suggestive of an atypical nevus. Histologically, the lesion was composed of a simple cyst of cuboidal cells with decapitation secretion and mucinous metaplasia with goblet cells. Papillary formation was identified in the cysts. Most cases of cutaneous mucinous metaplasia have been reported on genital skin, usually after chronic inflammation of the area. This type of mucinous metaplasia is categorized as benign mucinous metaplasia of the genitalia (BMM) and is believed to be unrelated to apocrine glands owing to the different histologic features and absence of apocrine differentiation by immunohistochemistry. Mucinous metaplasia (goblet cell type) has been previously reported in benign adnexal tumors (eccrine acrospiroma/hidroadenoma, mixed tumor, and syringocystadenoma papilliferum) and in malignant tumors (apocrine hidradenocarcinoma and squamous cell carcinoma). To date, mucinous metaplasia has not been identified in the histologically normal apocrine glands.

Should Preoperative Fascia Iliaca Block Be Used for Hip Arthroscopic Labral Repair and Femoroacetabular Impingement Treatment? A Prospective Single Blinded Randomized Study.

PURPOSE: To evaluate the analgesic effect of preoperative fascia iliaca block on postoperative morphine equivalent dose, pain level, and patient satisfaction for patients electing to undergo primary hip arthroscopic labral repair with osteochondroplasty. METHODS: This prospective study included 60 patients (fascia iliaca block group: n = 27; control group: n = 33) undergoing elective arthroscopic hip surgery by a single board-certified orthopedic surgeon, fellowship trained in hip arthroscopy. Participants for the study included patients older than 10 years of age and younger than 85 years of age, American Society of Anesthesiologists classifications I to III, diagnosed with symptomatic femoroacetabular impingement, and/or hip labral tear, and/or cartilage damage, and electing to undergo arthroscopic hip surgery. Patients were randomized by surgical date to receive preoperative fascia iliaca block or control (no fascia iliaca block). Preoperative fascia iliaca block was administered by 1 of 4 board certified anesthesiologists using identical anesthetic (35-40 mL ropivacaine 0.35%). Postoperative morphine equivalent dose, self-reported pain level (visual analog scale) and patient satisfaction were measure postoperatively. RESULTS: There were no significant differences between the control group and the fascia iliaca block group in sex, age, height, weight, or body mass index. There was a significant difference between the 2 groups in distribution of American Society of Anesthesiologists classification (p = .031). There were no significant differences in postoperative morphine equivalent dose for patients receiving fascia iliaca block compared with the control group. There were no significant differences in self-reported visual analog scale pain and patient satisfaction between the 2 groups at any of the measured time points following surgery. CONCLUSIONS: Based on the results of this study, routine preoperative fascia iliaca block for elective hip arthroscopic labral repair and treatment of femoroacetabular impingement is not recommended. LEVEL OF EVIDENCE: Level II, prospective single blinded randomized study.

A Case of Trichogerminoma With Pilomatrical Differentiation and a Unique Immunohistochemical Profile.

Trichogerminomas are rare adnexal neoplasms first described by Sau et al in 1992. Including the initial report, 20 cases have been reported, all with similar histological features, namely tumor nodules composed of basaloid cells that form densely packed, round nests or "cell balls" and which demonstrate variable degrees of pilosebaceous differentiation. In this study, the authors report a case of a trichogerminoma with pilomatrical differentiation and a unique immunohistochemical profile. The patient is a 71-year-old man with a well-delineated nodule on the top of the scalp. Histologically, the lesion measured 16 mm in greatest dimension and was composed of nodules of basaloid cells with central, compact, slightly eosinophilic cells nests. Immunohistochemically, the tumor nodules diffusely expressed cytokeratins 34ßE12, AE1/3, and CK5/6. Diffuse expression of ß-catenin and nuclear expression of p63 were also evident. The peripheral basaloid cells, but not the cell balls, expressed CD10, Ber-EP4, BCL-2, and CK7, the latter a previously unreported finding. The histological findings and immunohistochemical profile are compatible with a diagnosis of a trichogerminoma.

Rare testicular tumor discovered by assault: an unusual presentation of a primary testicular neuroendocrine tumor grade 2.

Testicular neuroendocrine tumors (NET) or carcinoid tumors are rare neoplasms which represent 1% of all testicular tumors and can be divided into 3 subgroups: pure primary testicular NET, primary testicular NET associated with a teratoma, and NET metastases to the testis. We report an unusual presentation of a primary testicular neuroendocrine tumor in a 39-year-old male who presented after a physical altercation during a soccer game. Histology showed a diffuse infiltrating tumor with extensive involvement of the tunica albuginea and tunica vaginalis. Immunohistochemical expression of CD56, synaptophysin, and chromogranin A was strongly positive in the tumor cells. Foci of tumor cell necrosis and occasional mitotic figures as well as extensive lymph-vascular invasion were also identified. A review of the literature reveals differing opinions on the prognostic significance of primary tumor size, mitotic index, tumor necrosis, and nuclear atypia. In our patient, the increased mitotic rate (3-5 mitotic figures per 10 hpf and a Ki-67 index of 5%), foci of necrosis, and mild to moderate nuclear atypia warranted a diagnosis of neuroendocrine tumor grade 2, formerly atypical carcinoid. Long term surveillance in these patients is essential as metastasis occurs in up to 15% of cases. At the 6-month followup, the patient remains symptom free.