Distal Duodenal Stricture Secondary to Mesenteric Fibromatosis (Intra-Abdominal Desmoid Tumor) of the Jejunum.

Introduction: Mesenteric fibromatosis (intra-abdominal desmoid tumor) is rare, with only a few cases reported in the literature. Clinical symptoms range from asymptomatic, nausea, early satiety, abdominal pain, and gastrointestinal bleeding. Although histologically benign, such a tumor may become locally invasive, and aggressive forms contribute to significant morbidity and mortality. Case Presentation: We report the case of a 52-year-old West African male with a 1-year history of intermittent hematochezia and intermittent bloating. Colonoscopy revealed a 4-mm rectal polyp and internal hemorrhoids. Esophagogastroduodenoscopy revealed a severe duodenal stricture 4-5 cm distal to the ampulla. Further work-up with contrast-enhanced computed tomography of the abdomen and pelvis revealed a 5.0 × 3.7 × 4.3-cm mass within the mesentery, encasing the distal portion of the duodenum. Exploratory laparotomy was performed, and the mass was excised from the jejunum. Histopathology findings and immunohistochemical analysis revealed the diagnosis to be mesenteric fibromatosis (desmoid tumor), positive for nuclear ß-catenin and SMA, and negative expression of STAT6, desmin, caldesmon, pan-cytokeratin, or c-KIT. The Ki67 index is <1%. Conclusion: This case report highlights the diagnostic challenges of mesenteric fibromatosis due to its nonspecific clinical presentation. Recognizing uncommon presentations of mesenteric fibromatosis and risk factors aids in early diagnosis, management, and treatment. Importantly, this also aids in the prevention of complications such as intestinal obstruction, bowel ischemia, and fistula formation.

An unusual case of B-cell lymphoma of the scalp.

B-cell lymphoma is a lymphoproliferative non-Hodgkin lymphoma arising from B cells, a type of immune lymphocytes that produces antibodies in the follicles of lymph nodes. Primary cutaneous B-cell lymphoma (PCBCL), a subtype of B cell lymphoma, originates within cutaneous tissue without evidence of extracutaneous involvement. There are very few reports of PCBCLs originating in the scalp. The most common tumors of the scalp are usually benign with only 1%-2% being malignant, most being basal cell carcinoma, squamous cell carcinoma, or melanoma. Primary cutaneous follicular cell lymphoma (PCFCL) is regarded as the most common lymphoma of the skin with an indolent course and favorable prognosis due to the response rate to treatment methods such as surgical removal with local radiotherapy, topical drugs, and intralesional therapies. This report highlights a rare case of PCFCL originating in the scalp, to raise awareness of a topic that requires continued established management.

The phenomenon of spontaneous tumor regression in breast cancer.

Spontaneous tumor regression is an increasingly prevalent phenomenon of partial or complete disappearance of primary tumor tissue or associated metastases in the absence of therapeutic intervention. Cases of spontaneous regression have been established in malignant tumors, such as testicular germ cell tumor, renal cell cancer, melanoma, basal cell carcinoma, neuroblastoma, colon cancer, breast cancer, as well as metastases. Breast cancer has increasingly been reported to have a higher rate of spontaneous regression than previously thought. Immunologic response is cited as the forefront of spontaneous regression phenomenon, with the focus on immunologic cell death. This report brings awareness to a case of spontaneous regression observed in invasive ductal carcinoma of the breast and how disruption of the tumor microenvironment can take a variable course even in malignant disease.

Glomus tumor mimicking digital adenocarcinoma.

Glomus tumors are uncommon, benign lesions commonly located on the digits of the hands and are diagnostically challenging. This is because hemangiomas or ganglion cysts are more commonly identified in those locations. Our case report underlines the diagnostic challenge of a glomus tumor and the importance of immunohistochemical staining.

CK-7 negative primary lung adenocarcinoma.

Cytokeratin (CK) 7 is normally expressed in the vast majority of lung adenocarcinoma (ADC). However, on rare occasions, as reported in this paper, CK7 negativity can challenge the diagnosis of pulmonary ADC. Hence, the need to use a combination of 'immunomarkers' such as thyroid transcription factor 1, Napsin A, p40, p63 and CK20.

Intraductal papilloma arising in ectopic breast tissue within the axillary region.

Intraductal papilloma arising within breast tissue is relatively a common pathology. However, it is rare to find a papilloma within ectopic breast tissue. To our understanding there have been only a few reports of this. Here, we present a rare case of extranodal Intraductal papilloma within axillary ectopic breast tissue.

Management of epididymal leiomyosarcoma: literature narrative, case report and discussion on the use of simple epididymectomy or high radical orchiectomy.

Epididymal leiomyosarcomas are rare malignant tumors of smooth muscle origin. We present a case of a low-grade tumor with negative margins managed with a high-radical inguinal orchiectomy. Our review of the literature suggests that low-grade and localized tumors with negative margins can be managed with simple epididymectomy and imaging surveillance.

Supraclavicular metastasis from prostate cancer: unusual case and literature review.

Prostate cancer is the most common cancer among men, with the most common metastatic sites in bone, regional lymph nodes, liver and thorax. It is most commonly diagnosed in the early stages with clinical findings of enlarged prostate on digital rectal exam and positive prostate specific antigen. Distant metastases associated with prostate cancer commonly occur to bone. It is imperative to be cautious in assuming primary breast, lung or head and neck malignancy in patients presenting with lymphadenopathy in the upper aerodigestive pathways. Cervical lymphadenopathy due to prostate cancer is becoming more prevalent since previously reported. Here we present a case of prostate cancer recurrence found through metastasis to supraclavicular lymph nodes and we also highlight homeobox protein CDX2 as a potential clinico-pathological marker in metastatic prostate cancer.

Sarcomatoid mesothelioma: unusual findings and literature review.

Sarcomatoid mesothelioma is an aggressive disease secondary to its propensity to undergo rapid growth, show inconsistent expression of tumor markers and invade surrounding tissues. Therefore, there are numerous obstacles that clinical researchers face as they look for new methods to diagnose and treat the malignancy. We present a case of sarcomatoid mesothelioma, originally thought to be metastasis from renal cell carcinoma.

Incidental discovery of desmoid-type fibromatosis encapsulating granular cell tumor in a neck mass.

Multiple primary cancers are defined as primary malignant tumors of different histological origins in one person. Desmoid-type fibromatosis (DF) is an extremely rare, locally aggressive, connective tissue malignancy that can be rooted anywhere in the body with the most common sites being thoracic wall and extremities. In contrast, granular cell tumors are rare neoplasms derived from Schwann cells commonly found in the oral cavity, skin and gastrointestinal tract. Moreover, diagnosing a patient with two primary cell tumors has become more common and the challenge of treatment becomes the focus in clinical situations. However, findings of a mass containing DF encapsulated by a granular cell tumor. Currently, there are no established guidelines for this rare condition. This case report serves to raise awareness of these two uncommon primary tumors emerging in an idiosyncratic nature.

Multifocal synchronous renal cell carcinoma of three different histologic subtypes: unusual findings and literature review.

We present a case of three multifocal synchronous ipsilateral clear cell, papillary type 1 and papillary type 2 renal cell carcinoma (RCC), with papillary type 2 RCC appearing bilaterally. With review of the literature, it was determined that multifocal synchronous RCC subtypes and bilateral renal tumors are both rare in occurrence.

Synchronous granulosa cell tumor of the ovary and endometrial adenocarcinoma.

Granulosa cell tumors of the ovary are sex cord stromal tumors. Sex cord stromal tumors make up 8% of ovarian tumors. Ninety percent of sex cord stromal tumors of the ovary are granulosa cell tumors. There are two types of granulosa cell tumors: juvenile and an adult type (Jamieson and Fuller. Molecular pathogenesis of granulosa cell tumors of the ovary. Endocr Rev 2012;33:109-44). This article provides a literature review outlining histopathology, immunocytochemistry and cytogenic characteristics of adult granulosa cell tumor of the ovary and a case report of synchronous adult granulosa cell tumor of the ovary and endometrial adenocarcinoma.

Letter to the Editor: The Efficacy of Cell-Assisted Lipotransfer Versus Conventional Lipotransfer in Breast Augmentation: A Systematic Review and Meta-Analysis.

This is a letter to the editor about a meta-analysis titled "The efficacy of cell-assisted lipotransfer versus conventional lipotransfer in breast augmentation: a systematic review and meta-analysis" by Li and Chen published in the year 2021. The most frequently performed aesthetic procedure is breast augmentation surgery. In breast augmentation, cell-assisted lipotransfer (CAL) has received high recognition due to its positive outcomes. There are controversies in the medical literature on the use of CAL for breast augmentation. This meta-analysis by Li and Chen has concluded that CAL using ASC was superior to other methods as it improved fat survival rate in breast augmentation. We have written this letter to the editor of the Aesthetic Plastic Surgery journal about this meta-analysis because of its impactful information provided by this study to the medical literature for breast augmentation surgery using cell-assisted lipotransfer. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for the prevention and control of peritoneal metastasis in patients with gastrointestinal malignancies: a systematic review of randomized controlled trials.

Peritoneal metastasis is associated with poor prognosis, with studies in the literature reporting the survival of peritoneal metastasis without treatment to be three to six months. Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown positive outcomes by improving the prognosis in patients with gastrointestinal malignancies. This systematic review of randomized controlled trials was done to determine the prophylactic role of hyperthermic intraperitoneal chemotherapy in preventing and controlling peritoneal metastasis gastrointestinal origin. Randomized controlled trials published between January 2019 to June 2021 were included. The databases used were MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane library. Cochrane handbook for systematic review of intervention was used to assess the risk of bias in included trials. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of five trials met the inclusion criteria. Two studies were on patients with gastric cancer, and the other three studies were on patients with colorectal cancer. HIPEC was given to a total of 116 gastric cancer patients and 308 colorectal cancer patients. In all the included studies on patients with gastric cancer, the peritoneal recurrence-free survival was significantly higher in the group that received HIPEC. There was no significant improvement in peritoneal-free survival in patients with colorectal cancer who received HIPEC. HIPEC appears to be effective in preventing peritoneal metastasis in patients with locally advanced gastric cancer without minimal postoperative complications. However, in patients with advanced colorectal malignancy, HIPEC does not seem to play a crucial role in preventing and controlling peritoneal metastasis.

Complications 18 years after polyacrylamide hydrogel augmentation mammoplasty: a case report and histopathological analysis.

Polyacrylamide hydrogel (PAAG) is a synthetic substance previously used as an injectable material for augmentation mammoplasty. Current literature has demonstrated that the average time from PAAG injection to the onset of complication ranges from 6 to 39 months. We present a unique case report describing the onset of complications 18 years after PAAG augmentation mammoplasty. To the best of our knowledge, the presentation of a healthy female who experienced unprovoked expansion of breast tissue >15 years after polyacrylamide injection has not been previously reported in surgical literature. This suggests that serious complications of PAAG injection may occur later than the literature has previously described. Importantly, this case is the first demonstration of the successful surgical removal of polyacrylamide 18 years after injection. Additionally, this case also provides a histopathological analysis of breast capsules which showed evidence of an extensive chronic inflammatory reaction to polyacrylamide, consistent with previous reports.

Adenoid cystic carcinoma of the breast with distant metastasis to the liver and spleen: a case report.

Adenoid cystic carcinoma (ACC) of the breast is a rare malignancy, accounting for 0.1-1% of breast cancers. Histologically breast ACC is similar to ACC's found in salivary tissue and is a triple-negative breast cancer with an uncharacteristically favorable prognosis and low incidence of metastasis. Most cases present as a painful, palpable mass; however, asymptomatic cases found on screening mammograms have also been noted. Core needle biopsy or excisional biopsy is necessary for definitive diagnosis of breast ACC. Immunohistochemistry of these cancers can differentiate breast ACC from masses with similar histology, such as invasive cribriform carcinoma and collagenous spherulosis. There is no well-established treatment guideline for ACC; however, it has been noted that reoccurrence and metastasis are noted more in cases of local resection than mastectomy.

Incidental discovery of mucinous adenocarcinoma from a suspected inflammatory perianal mass.

Mucinous adenocarcinoma is a rare tumor that may be associated with longstanding perianal fistulas. It represents 6.9% of all anal cancers. The diagnosis of this malignancy can be delayed because the symptoms experienced by people with the disease are usually attributed to the fistula and not to malignant transformation. As a result, the diagnosis of perianal mucinous adenocarcinoma in the setting of chronic perianal fistulas requires a high index of clinical suspicion and specific histological features.

Squamous cell carcinoma mimics small cell carcinoma of the lung: a case report.

Squamous cell carcinomas (SCC) accounts for roughly 20% of lung cancers in the USA. The 2015 World Health Organization classification of lung tumors further categorizes SCC as three subtypes: keratinizing, non-keratinizing and basaloid variant. The non-keratinizing subtype is a poorly differentiated tumor that can present histologically in different ways, and one of which is a rare variant that strongly resembles small cell carcinoma. As a result, histological diagnosis alone is not sufficient to properly diagnose lung carcinomas. Immunohistochemistry has been increasingly used over the past few years to differentiate between lung tumors. The combination of morphological and immunohistochemical staining should be the mainstay for diagnosis of all lung carcinomas as more targeted therapies become more available.

Gerald Klatskin (1910-1986): A pioneer in hepato-biliary disorders and biopsy techniques.

The widespread use of liver biopsies underscores its utility and significance within the field of medicine. Dr. Gerald Klatskin's pioneering work on liver biopsy techniques, as well as his study of liver histopathology, paved the way for its diagnostic and therapeutic applications around the world. His attention to detail as well as meticulous account of hilar cholangiocarcinoma has had a lasting impact on the medical community. Eponymously, the tumor was named after him-Klatskin's tumor. Klatskin was also well known and respected for his commitment and devotion to his fellows who themselves went on to hold prestigious academic positions and make significant contributions of their own. The life and work of Klatskin documents a pioneering hepatologist and devoted teacher.

Anterior knee schwannoma.

Peripheral nerve tumors are relatively uncommon with schwannomas being the most common type. Schwannomas are usually benign encapsulated tumors composed of neoplastic Schwann cells that generally do not transform to malignancy. Many are discovered incidentally as solitary tumors. The cause is unknown. Most occur spontaneously, while some develop in association with genetic disorders such as neurofibromatosis type 2 or schwannomatosis. Schwannomas can occur anywhere in the body. They affect all ages, with peaking incidence between ages 20 and 50 years, without predilection to sex or race. Many are asymptomatic; however, presenting signs and symptoms, such as paresthesia and pain, are due to mass effect and direct nerve invasion. Diagnosing includes combinations of thorough physical examination, imaging modalities such as magnetic resonance imaging and surgical biopsy. Treatment depends on factors such as location of the tumor and severity of symptoms. Asymptomatic patients are treated conservatively while symptomatic patients undergo surgical resection with favorable prognosis.