Multiple synchronous primary intra-abdominal neoplasms.

Multiple synchronous primary intra-abdominal neoplasms involving more than one organ system are rare, particularly if the appendix is involved. We report a patient with synchronous primary lesions in the colon, appendix, and the kidney. We also discuss the incidence of this entity with respect to sex and age, the organs most often involved in instances of multiple primary lesions, and review the criteria for differentiation of synchronous versus metachronous lesions.

Surgical management of advanced squamous cell skin cancers.

Squamous cell cancer of the skin usually follows prolonged exposure to known carcinogens including ultraviolet light, ionizing radiation, chronic infection or irritation, chemicals, and immunologic suppression. The majority of squamous cell skin cancers metastasize infrequently and can be cured with aggressive wide local excision. However, on occasion they can be quite aggressive locally, with or without associated distant metastasis, and may require a radical surgical approach. We report a series of four male patients covering the spectrum of this disease with the following distribution: lower pole of the right ear, right posterior thigh below gluteal fold with positive inguinal nodes, lateral aspect of the foot with bone involvement, and as an incidental finding in a pilonidal cyst. We conclude that one should not hesitate to proceed with aggressive surgical resection as it may provide the only chance for cure. Finally, one should always look for lymph node metastasis, particularly with large (> 5 cm) lesions adjacent to a regional lymph node drainage basin.

Primary adenocarcinoma, signet-ring, and transitional cell carcinoma of the bladder with penile metastasis.

This article reports a rare case of primary signet-ring cell carcinoma of the bladder with transitional cell and adenocarcinoma variants and metachronous metastases to the penis and lungs. This combination of lesions has not previously been reported. Together, they portend widespread dissemination and an early demise as is frequently the case with signet-ring cell carcinomas arising in other organs such as the breast and gastrointestinal tract. The optimal therapeutic intervention for this myriad of neoplasms with metastasis to the penis has yet to be ascertained because of the rarity of the lesions. Early diagnosis and an aggressive surgical approach appear to offer the best chance for quality survival and possible cure.

Pseudoepitheliomatous hyperplasia and pyoderma gangrenosum after a brown recluse spider bite.

Brown recluse spider bites may result in extensive soft tissue injury, causing months of disability. We have described a patient who had a series of extensive surgical debridements after envenomation. Despite skin grafting, persistent cutaneous lesions and extensive satellitosis progressed to involve the entire lower extremity. A recent biopsy showed pseudoepitheliomatous hyperplasia and pyoderma gangrenosum complicating the original injury. Although the role of early surgical excision and newer forms of medical treatment including dapsone and antivenom are still in evolution, recent reports suggest that the majority of patients will respond to medical therapy and may not require any surgical intervention.