ABSTRACT
ABSTRACT: A diagnosis of synchronous tumors is always questionable when they show similar histology. We present a case of synchronous tumors, i.e. melanoma (MM) arising from the scalp and angiosarcoma (AS) from the cheek in a patient of Xeroderma pigmentosum (XP). The presence of melanin in AS of the cheek led to a differential diagnosis and a possibility of transdifferentiation of malignant melanoma in the first instance. Immunohistochemistry (IHC) was negative for melanoma markers (Melan A, SOX-10 & S 100) and positive for vascular markers (ERG, CD31 & CD34) ruling out transdifferentiation and concluding the cheek swelling as angiosarcoma. The presence of non-cutaneous malignancies is rare in XP and the presence of MM in a nearby site and the melanin pigment in the cutaneous malignancy mislead the diagnosis. The morphology of the tumor was the key which led to the further workup of the case.
ABSTRACT
Renal angiomyolipoma (AML) is a benign mesenchymal tumor composed of fat, smooth muscle, and blood vessels. It represents 1-3% of solid renal tumors. Despite the benign nature of this tumor, it can be aggressive with locoregional extension. We describe a case of a 60-year-old female who presented with left flank pain and unstable blood pressure. A CT scan showed a renal mass with hemorrhagic densities. Peroperatively, bleeding from the renal mass was revealed, and the patient underwent radical nephrectomy. A myriad of symptoms such as acute flank pain, flank mass, and bleeding led to the diagnosis of Wunderlich syndrome, which is usually seen secondary to AML and renal cell carcinoma. Histopathologic examination helped in arriving at the diagnosis of renal AML with secondary changes, ruling out malignancy. Early diagnosis and immediate intervention saved her life and reduced morbidity. This case report helps in sensitizing clinicians and thus facilitates the detection of similar cases at the earliest.