Acral melanoma of the hallux.

OBJECTIVE: A case of misdiagnosed acral melanoma of the hallux and its diagnostic challenge are herein presented. Acral melanoma is insidious and subtle. A methodic approach to any suspicious lesions is mandatory. A case of misdiagnosed acral melanoma of the hallux is herein reported in a 66-year-old healthy man. Suggestions concerning similar non-healing lesions are herein presented. MATERIALS AND METHODS: It was firstly clinically diagnosed and treated as a micosis at another centre. The absence of any amelioration after three years pushed us to perform a biopsy. RESULTS: An acral melanoma was revealed, treated by amputation. CONCLUSIONS: In case of a non-healing ulcer of the lower extremities, melanoma should be taken into consideration. Even in absence of any suggestive risk factors or clear signs of melanoma, the lack of any improvement after treatment should raise doubts about diagnosis. In particular, biopsy is advisable as a first attempt to guide the management.

Multiple lipomatosis after stem cell trasplant and chemotherapy: a case report.

BACKGROUND: Lipomas are the most common type of soft tissue benign tumor. They can be either isolated entities or involved in a multiple lipomatosis, which may have a familial basis or be an acquired condition. AIM: Chemotherapy and/or blood stem cell transplantation may be plausible causes of multiple lipomatosis. MATERIALS AND METHODS: A 28 year-old patient was diagnosed with non-seminomatous germ cell left testicular cancer. The patient was addressed to chemotherapy and peripheral blood stem cell chemomobilization. After stem cells collection, the patient underwent autologous peripheral blood stem cell transplant. RESULTS: A subsequent de novo multiple lipomatosis onset developed. CONCLUSIONS: Although this is a preliminary study and further elaborations are needed, dermatologists and surgeons facing with multiple lipomatosis should consider previous chemotherapy and peripheral blood stem cell mobilization/transplant as possible causes of its onset.

Insulin sensitivity in Familial Multiple Lipomatosis.

BACKGROUND: Familial Multiple Lipomatosis (FML) is a mainly autosomal dominant rare benign condition. Excessive fat storage (obesity), as well as the inability to store fat (lipodystrophy), is associated with insulin resistance. AIM: Our study aimed to document if also patients affected by regional excess of subcutaneous adipose tissue as in FML show this feature. PATIENTS AND METHODS: Metabolic studies were performed in four brothers. A standard 75 g oral glucose tolerance test (OGTT) was submitted to each patient, with blood sampling at 0, 30, 60, 90, 120 and 180 min. Insulin sensitivity was calculated from the OGTT as the oral glucose insulin sensitivity index (OGIS), using the 2-h OGIS equation. Eight obese, non-diabetic subjects matched for BMI, age and sex, were used as controls. RESULTS: All the patients revealed a normal glucose tolerance and a normal HBA1c. CONCLUSIONS: Isolated subcutaneous fat accumulation is not necessarily associated with insulin resistance, on the contrary it may even allow a relatively high degree of insulin sensitivity.

Duplication of the glans penis manifested at puberty.

We report the case of a complete duplication of the glans, with prepuce and a blind end urethra just proximal to the dorsal aspect of the balanopreputial fold. The malformation was not evident at birth and during childhood, and became manifest only at puberty, with the growth of the external genitalia. It was not associated with other urinary malformations. Surgical excision was easy and uneventful.

Endoscopic excision for postrhinoplasty mucous cyst of the nose.

Mucous cysts formation following a rhinoplasty is a rare complication. Only 16 cases have been reported. The cysts seem to arise from mucosal remnants left in the subcutaneous layer and must be distinguished from other complications causing postoperative swelling of the nose, such as foreign body, paraffinoma and bony or cartilagineous fragments. We describe two cases of dorsal mucous cysts following rhinoplasty, provide a review of the concerning literature and discuss the removal of the lesions by nasal endoscopy. Nasal endoscopy allows excellent exposure of the operative field, without the need of open rhinoplasty technique, allowing fast healing, minor swelling and no external scar.

Double lateral osteotomy in aesthetic rhinoplasty.

Lateral osteotomy is a very important step in a cosmetic rhinoplasty; it allows the surgeon to narrow the nose, to close the open roof created after hump removal, and to achieve symmetry of an asymmetrical nasal bony framework. In most patients a single lateral osteotomy reaches the expected result, with excellent cosmetic outcome, good stability, and rapid healing. We find that double lateral osteotomy is useful in managing severe asymmetry of nasal walls in patients with too prominent and thick maxillary processes that join asymmetrically together with nasal bones. It is also valuable in correcting very large and wide noses. We review our experience of about 1660 rhinoplasties with more than one year follow-up. Two hundred and ten cases (12.65%) had been treated with monolateral, or bilateral double osteotomy. We evaluate postoperative aesthetic and functional results.

Bilateral upper and lower lid fatty herniation: an unusual presentation of non-Hodgkin's lymphoma.

We report the case of a patient presenting with eyelid hernias who required bilateral upper and lower blepharoplasty; histological examination of the excised fat revealed B-cell non-Hodgkin's lymphoma. At diagnosis, the disease was already systemically advanced, but the patient was asymptomatic. No sign of disease had been detected in the preoperative tests. The bilateral orbital presentation of a systemic lymphoma is very rare, and is usually accompanied and revealed by exophthalmos, increased tear secretion, diplopia and decreased visual acuity. To our knowledge, this is the first case in which lid hernias were the first and only clinical sign of such a systemic disease.

Soft tissue sarcomas: research of prognostic factors and therapeutics scheme.

The Soft Tissue Sarcomas shows consisting mortality that grazes 50%. Commonly the histologic type, the largeness of the tumor and the degree of malignity, are considered prognostic factors influencing the survival of patients affected from such tumor. The aim of our study is to characterize the new prognostic factors influencing the local recidives and metastatic dissemination. We have analysed 17 possible clinical and histologic prognostic factors in 80 patients affected of soft tissue sarcomas. The results have dimonstrated that: the compartimentality and the cellular differentiation seem to be more influent to the insurgence of local recidives and metastasis; while the low malignity degree, the wide surgical margins and the histopatological characters of benignity can influense positively the survival.

Diffuse hyperplastic oncocytosis of the parotid gland.

Oncocytic tumours rarely affect the major salivary glands, accounting for less than 1% of all salivary-gland tumours. The World Health Organisation classification groups these tumours into three principal types: diffuse oncocytosis, focal adenomatous oncocytic hyperplasia and oncocytoma. Diffuse hyperplastic oncocytosis is the rarest lesion: only six cases have been previously reported in the literature. This condition of putative hyperplastic pathogenesis follows a benign course, whereas oncocytomas may recur after excision. No metastatic dissemination or recurrence of diffuse hyperplastic oncocytosis has been reported. We present and discuss a new case of diffuse hyperplastic oncocytosis of the parotid gland.

Analysis of infiltrating epitheliomas of the nose examined from 1986 to 1995.

OBJECTIVE: Epitheliomas of the nose are frequently highly aggressive lesions with wide cutaneous-subcutaneous growth or an infiltrative growth pattern, especially when located at the columellar base, the alar base, and toward the inner chantal region. The aim of this study was to review this lesion with respect to location, recurrence, and treatment. METHOD: The authors present a retrospective study of 193 infiltrating epitheliomas of the nose examined between 1986 and 1995, including primary and recurrent cases. The authors term "clinically infiltrating epithelioma" any epithelioma whose growth implies the infiltration of the osteocartilaginous framework. RESULTS: The analysis of this case series, based on the histotype and the site of the epitheliomas, confirms that most of the primary histologically infiltrating basal cell carcinomas (BCCs) and of the recurrent BCCs are located at the alar base. The analysis of recurrences shows an aggressive local behaviour (multiple recurrences in the same site, change of the histologic pattern toward a more malignant one, etc.) suggesting that many of them were submitted to an insufficient physical or surgical treatment in the past. CONCLUSIONS: A radical surgical approach at the first signs of the primary lesion is mandatory in cases of nasal epithelioma.

Malignant tumors of the orbital region. Analysis of cases examined from 1986 to 1995.

OBJECTIVE: To present a retrospective study of 154 orbital tumors examined from 1986 to 1995. METHODS: We analyzed the clinical behavior and the degree of local malignity also in relationship with the particular anatomical characteristics of this site. RESULTS: In this are, it is not rare finding tumors with a scarce cutaneous extension but a deep involvement including the bone, or of recurrences after a previous insufficient treatment with an aggressive clinical course. CONCLUSION: The principles for the surgical approach are: exeresis as radical as possible, one-stage operation for tumoral resection and reconstruction, bringing of trophic tissue able to sustain any complementary treatment, easy and fast execution, and short clinical course.

Frontal exostose resection during an endoscopic subperiosteal lifting: case report.

Ever slowly, plastic surgery has adopted minimally invasive procedures in order to avoid extensive incisions, large scars, and to obtain better results. Endoscopy was introduced into cosmetic surgery of the face in 1992 and it is getting more and more widespread as are its indications, often replacing open surgical approach. Sometimes, a patient seeking a solution to the stigma attached to the aging face may present other problems that are surgically treatable. The authors describe a case of surgical endoscopic resection of a frontal osteoma during endoscopically assisted brow-lift rhytidoplasty.

Congenital epulis: an ultrastructural and immunohistochemical study.

In the light of recent findings concerning the presence of S-100 antigen in granular cell myoblastoma (GCM), we investigated by immunoperoxidase the presence of this antigen in a case of congenital epulis (CE). The absence of S-100 in CE granular cells is suggestive for antigenic differences with GCM. Upon ultrastructural investigation, bundles of collagen fibers were observed in the cytoplasm of CE granular cells and cells displaying features of initial cytoplasmic vacuolar transformation were also detected. Interstitial cells containing angulated bodies, a common finding in GCM, were not found.

Variation in acute phlogistic reactions in the skin of rabbit fetuses.

There is little in the literature on cutaneous inflammatory reactions in mammal fetuses. The subject now has practical import since advances in medical science allow surgical intervention in premature infants. A study was performed on 45 rabbit fetuses. They were inoculated in the derma of the dorsum with 0.01 ml of a 1% solution of carrageenan, a strong inflammatory drug. Treatment was performed on the nineteenth, twenty-third, and twenty-seventh days of pregnancy. Two rabbits were treated twenty-four hours after birth, and 6 adult rabbits were treated. Histological examination and a count of inflammatory cells were performed on each fetus. The results showed that, during fetal life, the cellular inflammatory reaction is low in the earliest stages but increases gradually during gestation. It is only after birth that there is a great increase, and even then the level remains lower than in adults.

Steroid hormone receptors in female breast angiosarcomas.

Breast angiosarcoma is an extremely rare neoplasm usually affecting premenopausal women. Previous reports suggest that it is hormone-dependent. A case of primary breast angiosarcoma in a 16-year-old patient is presented in which the presence of estradiol, progesterone, and testosterone receptors was investigated. The histological findings initially revealed a simple angioma, but four months later the histological picture had completely changed, showing an angiosarcoma. Our data indicate a lack of receptors for steroid hormones in this tumor, which argues against the hypothesis presented in the literature.