Esophageal verruciform xanthoma following radiotherapy.

Verruciform xanthoma (VX) is an uncommon benign lesion of unclear etiology which has only been reported twice before in the esophagus. We describe a 70-year-old male who presented an exophytic esophageal lesion incidentally found upon endoscopy 2.7 years following radiation therapy for unresectable squamous cell carcinoma of the tracheal carina. Histologically, the lesion showed a papillary surface change with numerous foamy histiocytes within the lamina propia papillae. Xanthoma cells were strongly positive for vimentin and CD68 (KP1). Polymerase chain reaction did not demonstrate human papillomavirus (HPV) infection. Our results indicate that esophageal VX is not an HPV-induced lesion and suggest a causal relationship between VX and radiotherapy, as previously noted. Histological differential diagnosis is discussed and emphasis is placed on obtaining adequate biopsy material for accurate diagnosis.

[Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report.] / Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura.

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases.

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar.

Placental anomalies in children with infantile hemangioma.

Evaluation of the placenta provides some important insights into pathophysiologic changes that take place during the prenatal and intrapartum process. We investigated the pathogenic significance of placental features and their relationship to the development of infantile hemangioma in order to obtain a better understanding of its cause. Placental specimens were reviewed from 26 singleton pregnancies of women whose offspring weighed less than 1500 g. A group of 13 neonates who developed infantile hemangioma in the immediate neonate period were compared with 13 healthy preterm infants of comparable postconception age who had no infantile hemangioma. Pathologic placental changes were analyzed in both groups. Gross lesions with disturbance of the utero-placental circulation were found in all placentas from children who developed infantile hemangioma, including massive retroplacental hematoma in two infants, extensive ischemic infarction in seven, and large dilatated vascular communications, severe vasculitis, chorioamnionitis and funiculitis in four. Placental features included percentages greater than 25% of avascular villi, platelet and fibrin aggregates, and multifocal disease involving more than one histologic section. Examination of 13 placentas of low-birth-weight infants without infantile hemangioma only showed abnormal placentation in one and isolated villous dismaturity in two. The higher ratio of placental pathologic findings in patients with infantile hemangioma suggests that reduced placental oxygen diffusive conductance contributes to fetal hypoxic stress and that hypoxic/ischemic changes in the placenta could be related to infantile hemangioma development via vascular endothelial growth factor and placental growth factor expression, among others, within the villious vessels and throphoblasts.

Puerperal ileal perforation secondary to endometriosis: Case report and literature review.

OBJECTIVE: Bowel endometriosis is an uncommon disease that can cause serious complications and may require immediate medical attention. We wish to remind about bowel perforation caused by endometriosis, its diagnostic difficulty, and the need or urgent management in late pregnancy and puerperium. CASE REPORT: We present a 38-year-old woman, which presented with bowel perforation requiring urgent surgery. A pathological exam disclosed deep ileal infiltrative endometriosis. CONCLUSION: Even though bowel endometriosis is a rare complication, it should be considered in the differential diagnosis of severe abdominal pain in late pregnancy or puerperium. A multidisciplinary management of these patients is needed.

Solitary hemorrhagic cerebellar metastasis from occult papillary thyroid microcarcinoma.

BACKGROUND: Cerebellar metastasis (CM) from papillary thyroid carcinoma (PTC) is exceptional with only 12 reported cases and usually carries a very poor prognosis. In the two previously reported patients in whom CM was detected before PTC, other distant or local metastases were already present by the time of PTC diagnosis. We report a patient found to have papillary thyroid microcarcinoma after surgical resection and histopathological study of a large solitary hemorrhagic CM, who showed no evidence of other metastatic sites and survived 7 years after initial diagnosis. SUMMARY: A 65-year-old female patient with a history of surgical resection of a 7-cm cerebellar mass diagnosed with PTC metastasis, and adjuvant treatment with cranial external radiotherapy, was referred to us. The neck ultrasonography showed a solitary 4-mm right thyroid nodule. Histopathology after total thyroidectomy revealed a 2-mm papillary thyroid microcarcinoma, sclerosing variant, with capsule infiltration but no regional lymph node invasion. Although she received a total dose of 500 mCi of 131-I after surgery and the last two whole-body scans were normal, serum thyroglobulin levels progressively increased. The patient refused any further test or treatment other than basal blood sampling and suppressive therapy with levothyroxine and remained stable for 4 years until she started to complain about deviation of her walk. A computed tomography scan showed a regrowth of the metastasis. She suffered a sudden worsening of her neurological status because of a big intratumoral hemorrhage that required decompressive craniectomy and hematoma evacuation surviving 3 years more after this episode. CONCLUSIONS: To our knowledge, this is the first reported case of a solitary CM from an occult PTC, and also the first that developed an acute cerebellar hemorrhage years after cranial surgery, however, exhibiting the longest reported survival. This case highlights the importance of not only an appropriate initial treatment of the CM and primary PTC in these patients, but also a close follow-up, to avoid further complications and improve their prognosis.

Quiste renal complicado por fistulización de apendicitis aguda sobre un mucocele apendicular. Primera descripción en la literatura / Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report

Se describe el primer caso clínico en la literatura revisada de un paciente con un quiste renal complicado por sobreinfección tras fistulización de una neoplasia apendicular con apendicitis aguda, así como el manejo realizado y las opciones terapéuticas en un caso similar

We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases

Xantoma verruciforme de esófago tras radioterapia / Esophageal verruciform xanthoma following radiotherapy

Resumen El xantoma verruciforme (XV) es una lesión benigna poco frecuente y de etiología desconocida que se ha documentado solo dos veces en el esófago. Se describe a un varón de 70 años de edad que presentaba una lesión exofítica de esófago, descubierta de forma incidental durante una endoscopia 2,7 años después de recibir radioterapia por un carcinoma escamoso en la carina traqueal sin posibilidad de resección. Histológicamente, la lesión mostraba una superficie papilar, con numerosos histiocitos espumosos dentro de las papilas de la lámina propia. Las células xantomatosas resultaron positivas para vimentina y CD68 (KP1). La reacción en cadena de la polimerasa no detectó la presencia del virus del papiloma humano (VPH). Nuestros resultados indican que el XV esofágico no es una lesión inducida por el VPH, y sugieren una relación causal entre el XV y la radioterapia, como ya se ha señalado con anterioridad. Se realiza el diagnóstico diferencial histológico y se hace hincapié en la obtención de material de biopsia adecuado para llevar a cabo un diagnóstico preciso (AU)

Abstract Verruciform xanthoma (VX) is an uncommon benign lesion of unclear etiology which has only been reported twice before in the esophagus. We describe a 70-year-old male who presented an exophytic esophageal lesion incidentally found upon endoscopy 2.7 years following radiation therapy for unresectable squamous cell carcinoma of the tracheal carina. Histologically, the lesion showed a papillary surface change with numerous foamy histiocytes within the lamina propia papillae. Xanthoma cells were strongly positive for vimentin and CD68 (KP1). Polymerase chain reaction did not demonstrate human papillomavirus (HPV) infection. Our results indicate that esophageal VX is not an HPV-induced lesion and suggest a causal relationship between VX and radiotherapy, as previously noted. Histological differential diagnosis is discussed and emphasis is placed on obtaining adequate biopsy material for accurate diagnosis (AU)