SEVERE LEUKOCYTOCLASTIC VASCULITIS AFTER COVID-19 VACCINATION - CAUSE OR COINCIDENCE? CASE REPORT AND LITERATURE REVIEW.

Vaccination has been the most powerful tool to fight the COVID-19 pandemic while the specific treatment options in clinical practice have been under review for approval and authorization by regulatory bodies. After registration of different vaccines, it is important to ensure a post-marketing surveillance to identify potential risks not observed in controlled trials. Authors report on the case of an 80-year-old male patient who developed severe leukocytoclastic vasculitis of skin and oral mucous membrane after receiving the second dose of COVID-19 mRNA vaccine. He was treated successfully with prednisolone. We also provide a literature review on other reported cases of COVID-19 vaccine induced vasculitis. This type of an adverse reaction seems to be rare. Fortunately, most cases were temporary and well controlled by corticosteroids. The majority of vaccine-associated vasculitis cases have been observed in association with BONT162b2 mRNA vaccine although other vaccines also may cause the event. The knowledge of this possible adverse event is important for early diagnosis and intervention.

PIGMENTED NODULAR CYSTIC HIDRADENOMA OF THE ANKLE.

Solid-cystic hidradenoma is a benign cutaneous tumor that is most commonly found in the head, neck, trunk, and upper extremity regions of patients in the middle to older aged groups. Presentation on lower extremities and in particular on the foot is uncommon. Nodular hidradenomas represent a dermatological pitfall, being difficult to differentiate from basal cell carcinoma and melanoma. We report on a 53-year-old male patient with a pigmented nodular hidradenoma on his ankle that was surgically removed. We discuss histopathology and differential diagnosis of this eccrine tumor of skin. This is the second reported case in the English literature.

CUTANEOUS POLYPOID MELANOMA OF HEAD AND NECK.

Cutaneous polypoid melanoma is an uncommon subtype of malignant melanoma. The clinical behavior of this subtype has been described as aggressive. Tumors can be sessile or pedunculated. The typical patient is a younger adult. Authors have analyzed the case histories of patients with polypoid melanomas of the head and neck region treated at our clinic from 2001 to 2018. We identified 3 female patients with tumors of the neck and cheek. In contrast to other reports, all patients were older than 80-years of age. None of them had a metastatic spread at the time of diagnosis. Treatment was delayed Mohs surgery. Polypoid melanomas of the head and neck region can occur in elderly patients without an aggressive course. In those patients a number of differential diagnoses have to be considered including Merkel cell carcinoma, metatypical basal cell carcinoma, squamous cell carcinoma and tumor metastases.

BASAL CELL CARCINOMA OF THE FOOT - TWO CASE REPORTS AND LITERATURE REVIEW.

Basal cell carcinoma (BCC) is considered the most common skin cancer in men. BCC of the foot, however, is very rare, and may occur on dorsal surface of the foot, foot sole or nail apparatus. Diagnosis is often delayed due to the location at an unusual site. We report on two patients: a 61-year-old female with an ulcerated BCC of the sole and dorsum of the foot on a leg with Klippel-Trénaunay syndrome and a 61-year-old male with an ulcerated BCC of the foot sole. Histologic tumor types were either metatypic or mixed solid and morphea-like with partial glandular infiltration. Perineural invasion was evident in both patients indicating the aggressive tumor behavior in the particular region. Authors also provide a review of the literature with a focus on the years 2000 through 2017.

CARCINOSARCOMA OF SKIN (SARCOMATOID CARCINOMA) - A RARE NON-MELANOMA SKIN CANCER (CASE REVIEW).

Non-melanoma skin cancer incidence is rising worldwide. The leading neoplasias are basal cell carcinoma and squamous cell carcinoma. We report on an 88-year-old female patient with a rapidly grown, symptomless, exophytic tumor of the supraclavicular area. Examination at the dermatology department has revealed a firm, exophytic, reddish tumor covered by crusts, about 4 cm in diameter and easily movable to the ground. The tumor was removed by delayed Mohs surgery (R0 resection). The resulting defect was closed by tissue expansion. Nodal metastases were ruled out by ultrasound. Histologic investigation revealed a biphasical nodular tumor composed of partly fibrous spindle cellular elements, partly myxoid and chondroid mesenchymal components with cellular atypia, atypical mitoses and focal necrosis. Some multinucleated tumor cells were noted. Trabecular and island-like solid epithelial tumor components demonstrated increased mitotic activity and cellular atypia. There was no vascular invasion. The diagnosis of a basaloid carcinosarcoma was confirmed. Basaloid carcinosarcoma is an extremely rare cutaneous neoplasia with less than 30 patients reported. Complete wide excision or Mohs surgery are the favored treatment options.

CELLULAR FIBROUS DERMATOFIBROMA OF THE SOLE.

Cellular fibrous dermatofibroma is a rare variant of dermatofibroma/histiocytoma. We present a 61 years old female with a slow-growing, firm tumor on the sole of her right foot. The tumor was removed by slow Mohs surgery within 2 cm negative margin. Histopathologic investigation revealed a nodular encapsulated tumor composed of spindle and some epithelioid cells in a storiform growth pattern. Minimal mitotic activity was reported, however without evidence of atypical mitoses. Tumor cells expressed CD10, focally smooth muscle antigen and desmin, but remained negative for S100 protein and CD34. The diagnosis of cellular fibrous dermatofibroma was confirmed. The defect was closed by full thickness skin graft.

[Disseminated necrobiotic xanthogranuloma]. / Disseminiertes nekrobiotisches Xanthogranulom.

Necrobiotic xanthogranuloma is a rare non-Langerhans-cell histiocytosis. A 62-year-old woman presented with yellowish erythematous plaques, nodules, and papules in the periorbital region and the extremities. She had a nodular tumor grown on the left upper lid that clinically resembled a keratoacanthoma. Histologically it was a xanthogranulomatous lesion. She suffered from monoclonal gammopathy of unknown significance of κ­type. Treatment was realized with a combination of systemic dapsone/prednisolone and topical corticosteroids.

SCLEROSING MICROCYSTIC ADNEXAL CARCINOMA OF THE SCALP (CASE REPORT).

Microcystic adnexal carcinoma is a rare malignant sweat gland tumor. We present the case report of a 63 year old male patient who developed this malignancy on the scalp, which is an uncommon site. The tumor has been removed by delayed MOHS technique with no relapse. The differential diagnoses and treatment options are discussed.

Generalized eruptive histiocytoma in adult patient.

Generalized eruptive histiocytoma is a rare benign skin disorder with less than 50 cases reported world-wide. It belongs to type IIb of histiocytoses. The histiocytic cells are CD68 positive but lack other markers like CD1a or S100. We report on a 60-year-old male patient with generalized eruptive histiocytoma treated successfully by PUVA combined with topical corticosteroids.

Nodular epitheloid sarcoma of the upper limb. A case report and review of the literature.

Epitheloid sarcoma is a rare malignant soft tissue sarcoma. We present a 36-year-old male patient with a primary tumour on his wrist and subcutaneous spread in a sporotrichoid pattern along the upper extremity. Early surgical treatment with micrographic control of all margins provides best long term outcome as long as a solitary lesion is present. In case of cutaneous and internal spread of the disease treatment options are only palliative. Early diagnosis, therefore, is most crucial.

Foot ulcers in klippel-trenaunay syndrome: two case reports and one metatypical Basal cell carcinoma.

Klippel-Trenaunay syndrome (KTS) is a congenital malformation with vascular anomalies of capillaries, veins and lymphatics and hypertrophy of bones and soft tissues, associated with microdeletion of 2q37.3 and upregulation of angiogenic factor AGGF1. Although KTS predisposes to venous thromboembolic diseases and may be associate with potentially life-threatening vascular complications including bleeding, pulmonary embolism, and deep vein thrombosis, the development of leg or foot ulcers is uncommon. We present two adult patients with KTS and foot ulcers and advise doctors to keep in mind that chronic foot ulcers in KTS may have an underlying neoplasia.

Failure of vismodegib in advanced Basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common malignant tumor of mankind. For locally advanced and metastatic BCC treatment options are limited. Recently, the first hedgehog signal pathway inhibitor, vismodegib, has been approved for such tumors. Although high response rates have been reported for spontaneous BCC and Gorlin-Goltz syndrome, some tumors do not respond primarily or secondarily. We report about a 38-year-old female patient with a large multicentric BCC of temple with primary chemoresistance of the tumor. We discuss possible mechanism and other limitations of vismodegib in BCC.

Basal cell carcinoma or not Basal cell carcinoma? That is the question!

Basal cell carcinoma is the most frequent malignant tumor in mankind. Although diagnosis often is based on clinical signs confirmed by histopathology, there are simulators of this tumor and there are basal cell carcinomas with misleading clinical appearance. Here we present 4 samples that illustrate the challenge in diagnostics. We also discuss differential diagnosis and treatment.

Non-healing facial lesions: cutaneous old world leishmaniasis in dresden.

Cutaneous leishmaniasis is a common vector-borne disease world-wide but not in Central Europe. The typical clinical manifestation is an enlarging papule on the site of infection. Vectors are sandflies and reservoirs may be wild animals like rodents, dogs or even humans. Patients with any kind of immunodeficiency are at risk. We report on two otherwise healthy patients, 16 and 18 years-of-age, who presented non-healing facial lesions. The diagnosis of cutaneous leishmaniasis was confirmed through intracellular amastigotes in Giemsa stains of skin biopsies. One infection was of Syrian origin and the other was contracted in Tuscany. Since both lesions were classified as complex cutaneous lesions, drug therapy was initiated with itraconazole orally or intralesional meglumine antimonite. A complete response was obtained in both patients. No other adverse effects rather than injection pain with meglumine antimonite were observed. We should be aware of cutaneous leishmaniasis in travelers returning from endemic regions or from migrants and refugees from endemic regions.

Benign chondroid syringoma (mixed tumor of skin) on the flank with satellites: case report and literature review.

BACKGROUND: Mixed tumor of skin (chondroid syringoma) is a rare skin tumor. METHODS: We report on the rare occasion of an atypical mixed tumor of skin (chondroid syringoma) in a 71-year old Caucasian male patient. RESULTS: The tumor presented as a firm subcutaneous nodule on his flank. Histopathologic investigations revealed a focally increased proliferative activity and satellites in the adipose tissue. This is in accordance with the diagnosis of an atypical chondroid syringoma. The differential diagnosis to malignant chondroid syringoma is discussed. The tumor was removed by delayed Mohs surgery. CONCLUSIONS: Atypical chondroid syringoma is a very rare subtype of mixed tumor of skin. It is an important differential diagnosis to malignant chondroid syringoma of skin.

Cutaneous angiosarcoma is a rare aggressive malignant vascular tumour of the skin.

BACKGROUND: Cutaneous angiosarcoma (AS) is a rare aggressive malignant vascular tumour of the skin. METHODS: We analysed the cases of cutaneous AS in two large dermatological departments of Saxony during the last 10 years. RESULTS: A total of eight AS cases were identified, mostly with head and neck involvement. Because of age and late diagnosis, only a minor part was completely resectable. As a palliative therapy pegylated liposomal doxorubicin was used. The drug was well tolerated. Our cases and those published in the literature suggest a high rate of responses and a possible sensitisation to subsequent radiation therapy. CONCLUSIONS: Although complete surgical resection followed by wide-field radiation therapy has been established as a therapeutic standard for AS, delay in diagnosis and older age with comorbidities warrant for a safe and effective adjuvant treatment. Pegylated liposomal doxorubicin combined with radiotherapy seems to be a useful and safe alternative.

Cervical manifestation of a borderline type ovarian cancer with pseudomyxoma peritonei - a case report.

Borderline tumours of the ovary (BOTs) are rare tumour entities that do not show any destructive or invasive growth in the majority of cases, even though they can display characteristics of malignant tumours The mucinous subtype can also originate from the appendix, and ovarian metastases can mimic primary ovarian BOTs, often accompanied by peritoneal manifestation in terms of pseudomyxoma peritonei. In cases where a concomitant appendiceal tumour is present, it may prove difficult to determine the primary tumour. This report describes a special case of BOT with a specific example of the complexity of the differential diagnosis of pseudomyxoma peritonei. Especially the case was simultaneously linked to appendiceal and ovarian cancer. Moreover, this case was exceptional for its unusual manifestation of BOT in the cervix.

The effects of cannabis on heart rate variability and well-being in young men.

INTRODUCTION: The effects of cannabis use on the autonomic regulation of the heart had been identified in tests with volunteers. We studied these effects of cannabis use on young adults in everyday life. METHODS: We measured heart rate variability (HRV) and well-being (WHO-5 score) in young men during a routine medical examination. Seventy-two men were identified with a positive drug screening test solely for tetrahydrocannabinol. The comparison group consisted of 72 men, matched according to age and body mass index, who used no illicit drugs or pharmaceuticals. RESULTS: In the cannabis group, HRV was significantly increased compared to the control group. The median value of root mean square of successive differences (RMSSD) at rest was 56.2 ms in the drug users and 48.6 ms in the controls (p<0.05). The ratio of low-to-high frequency was higher in the controls (median 1.87 vs. 1.62; p<0.05). Psychological well-being, measured by WHO-5 score was significantly lower in cannabis users. DISCUSSION: Our data support the hypothesis that the use of cannabis leads to a change in cardiovascular sympathovagal balance.

Atypical fibroxanthoma: a series of 25 cases.

OBJECTIVE: Atypical fibroxanthoma is a rare mesenchymal tumour of skin that develops on skin of elderly patients. We analysed our patients with atypical fibroxanthoma over the last 8 years. PATIENTS AND METHODS: We analysed the pathology files of our hospital for the period 2001-2009. In all cases, histology and immunohistology were performed. Data on co-morbidities, treatment and outcome were obtained. RESULTS: We identified 25 patients (except two female patients, the rest were men) aged 52-95 years (mean: 79.5 years; standard deviation +/- 9.06 years). All tumours were localized in the head and neck region, except a single tumour on the shoulder. Fourteen patients had a cancer history, six had actinic keratoses or Bowen's disease (n = 1). Five patients had cardiac surgery or pacemaker, one each had a renal transplant, systemic sarcoidosis or non-Hodgkin's lymphoma. Medical history was positive for radiotherapy or chemotherapy in four patients. Histology showed a spindle-shaped dermal and subcutaneous tumour growth intermingled with multinucleated giant cells. The phenotype of tumour cells was vimentin-positive, but S100- and keratin-negative. Some tumours showed a focal expression of CD68. Complete microhistographic controlled surgery ('Mohs like') was possible in all cases followed by mesh-graft transplantation in three patients. Eighteen patients showed a complete remission. Four patients had a relapse within 2 years of follow-up treated by surgery. One patient is still under radiotherapy. All patients with a safety margin of 2 cm had no recurrence or relapse during follow-up. CONCLUSIONS: Micrographic controlled surgery with wide 2 cm safety margins is the treatment of choice. A regular follow-up for the next 5 years is recommended.

Late recurrence (10 years or more) of malignant melanoma in south-east Germany (Saxony). A single-centre analysis of 1881 patients with a follow-up of 10 years or more.

BACKGROUND: Late recurrent melanoma (MM) is rare. OBJECTIVE: In the present study, we analysed the frequency of late recurrent MM in south-eastern Germany. PATIENTS AND METHODS: In our centre, 2314 MM patients were documented (1972-2001). A total of 1881 patients in stage I or II (AJCC) with a follow-up of > or = 10 years were selected and screened for late recurrence (> or = 10 years after diagnosis). RESULTS: Twenty patients were identified (1.1%), 13 women and 7 men, median age 44 years (age range 30-74 years). Nineteen suffered from cutaneous MM and one had a uveal MM (excluded from further analysis). The primary cutaneous MM occurred on the trunk (6), on the upper limb/shoulder (4), or on the lower limb (9). MM type was superficial spreading (13), nodular (2), acrolentiginous (1), lentigo maligna-type (1) or unclassified (2). Tumour thickness varied from 0.33 mm to 9.5 mm (median 2.0 mm). Ulceration was seen in four, and spontaneous regression in two MM patients. Invasiveness into blood or lymphatic vessels occurred in seven MM patients. The largest period from primary diagnosis to recurrence was 25.1 years with a median of 13.9 years. Metastatic spread was loco-regional (12 patients) or distant (7). Four patients were survivors and three of these had in-transit metastases only. Overall survival was 14.7 +/- 6.6 years. Statistical analysis could not identify factors significantly associated with late recurrence. CONCLUSIONS: Late recurrence is a clinical sign of melanoma dormancy. We conclude that late recurrences argue for a lifelong follow-up of melanoma patients.