Primary cutaneous CD30+ T-cell lymphoproliferative disorder presenting as paraphimosis: a case report and review of the literature.

Primary cutaneous CD30+ T-cell lymphoproliferative disorders (PC-CD30+ LPD) as a group are one of the more common types of T-cell lymphoma. More specifically primary cutaneous anaplastic lymphoma (PC-ALCL), one of these lymphoproliferative disorders, is the second most common cutaneous T-cell lymphoma. We report an unusual presentation of PC-ALCL. A 90-year-old, uncircumcised male presented with a 3-week history of painful penile swelling and discharge. The patient was treated with cephalexin and underwent emergent circumcision for paraphimosis. The diagnosis of ALCL was made on microscopic evaluation of the foreskin along with follow-up staging studies. A literature review revealed 31 previously reported cases of penile lymphoma, one of which reported a primary penile CD30+ T-cell lymphoma similar to ours. Only one case report described a lymphoma presenting as paraphimosis. Our case is the second reported case of PC-ALCL of the penis and the first of its kind to present as paraphimosis. Lymphomas must be included in the differential diagnosis of penile lesions and paraphimosis. When present, clinicians should be able to differentiate primary cutaneous lymphoma from lymphomas with secondary skin involvement. All foreskins should be submitted to pathology for proper evaluation of penile lesions.

Leiomyosarcoma arising in the pancreatic duct: a case report and review of the current literature.

Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct.

Human chorionic gonadotrophin producing epithelioid sarcoma metastatic to the placenta.

Pregnancy complicated by sarcoma is a rare event, and metastasis to the placenta is exceptionally rare. Of reported malignancies involving the products of conception, only 8% are sarcomas. We report the first case of placental metastasis of an epithelioid sarcoma, an uncommon malignancy which most frequently affects young adults. In addition to the typical histological features and immunophenotypic profile expected of epithelioid sarcoma, this tumor also expressed human chorionic gonadotrophin (HCG). Although uncharacteristic, the production of HCG has been previously reported in other nontrophoblastic tumors. It may have contributed to the pathogenesis of the tumor metastatic to the placenta in this case.

Diagnostic aspiration of parathyroid adenomas causes severe fibrosis complicating surgery and final histologic diagnosis.

OBJECTIVE: To determine whether fine-needle aspiration (FNA) of parathyroid adenomas may cause a severe fibrotic reaction of the gland and surrounding structures, making surgery more difficult and histology more confusing. DESIGN: A study was conducted over a 33-month period to compare the operative findings of 30 patients who underwent FNA of a parathyroid adenoma to those of 3000 patients who had not had their parathyroid tumor aspirated. Each patient's normal parathyroid glands also served as internal controls. All aspirations were performed by referring physicians under direct ultrasound guidance within 3 months of surgery, and all adenomas were located in routine positions. Patients who had previous thyroid or parathyroid surgery were not included. Patients with secondary or tertiary hyperparathyroidism were not included. MAIN OUTCOME: The control group (non-FNA) showed a fibrotic reaction in 127 (4.3%) tumors appreciated by the surgeon and recognized on histology. In contrast, tumors undergoing FNA had a dense and often severely fibrotic reaction seen at surgery in 19 of 30 (63%) (p < 0.0001) and on histology in 23 of 30 (77%) (p < 0.0001). The fibrotic reaction appeared to mimic malignancy on histology and increased in occurrence with increased numbers of aspiration passes and larger needle bore (p < 0.05). No normal glands (n > 7500) or hyperplastic glands (n = 488) demonstrated fibrosis in any patient. Tumors that were aspirated required an eightfold increase in time to remove (p < 0.005) and more than doubled the total operative time (p < 0.05). CONCLUSIONS: FNA of parathyroid adenomas can cause a severe fibrotic process that typically involves adjacent tissues. This reaction dramatically increases the difficulty of surgical resection, often requiring microdissection techniques to preserve nerves and assure complete removal. The fibrosis can cause confusing histology mimicking malignancy. FNA of parathyroid adenomas should be avoided unless absolutely necessary.