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Fibroblastic rheumatism (FR) is an uncommon disease of the skin, characterized by the presence of non-tender cutaneous nodules accompanied often by other rheumatic manifestations. This condition shows male predominance, no age preference and unpredictable course, resulting frequently in permanent joint damage. A 60-year-old man came to our department with a 4-year history of multiple non-tender nodules and morning stiffness affecting mainly the upper extremities. Clinical examination revealed arthritis of the hands, confirmed by imaging tests. Laboratory exams were unremarkable. A skin nodule biopsy showed a dermal collagenous lesion with myxoid areas composed of spindle and stellate cells. Immunohistochemical staining demonstrated positivity for CD68 and negativity for CD34, S100, EMA and desmine. FR was diagnosed and the patient started methylprednisolone 16 mg/day. Hydroxychloroquine 400 mg/day and methotrexate 15 mg/weekly were further added as steroid-sparing agents with clinical benefit. Clinicians should be aware of this underreported entity, which can rapidly lead to irreversible deformities.

Background and Aim: Lumpy skin disease (LSD) is a contagious viral disease that has great economic losses among Egyptian breeding flocks. The present study was designed to compare the results of different diagnostic approaches used for the diagnosis of LSD virus (LSDV). Materials and Methods: A total of 73 skin nodule samples were collected from suspected infected cattle with LSDV from some Egyptian governorates during 2019 and 2020. Trials for virus isolation (VI) and identification on embryonated chicken eggs (ECEs) were conducted. Molecular detection, histopathological, and immunohistochemical examination were also conducted. Results: The virus was isolated into ECEs, and 58 samples of 73 were positive and gave a characteristic pock lesion on the chorioallantoic membrane. Twenty-two representative nodular skin specimens of the 58 positive samples were selected to be used for molecular, histopathological, and immunohistochemistry (IHC) diagnosis. Conventional polymerase chain reaction succeeded in detecting LSDV DNA in all tested 22 skin nodule samples. Histological examination of skins of different cases revealed various alterations depending on the stage of infection. IHC was used as a confirmatory test for detecting LSDV antigen in the tissues of the skin nodules of infected cattle using specific anti-LSDV antibodies. Lumpy skin viral antigen was detected within the cytoplasm of the epidermal basal cells layer and prickle cell and within the cytoplasm of the hair follicles' epithelial outer and inner roots. Conclusion: This study confirmed the prevalence of LSDV infection in different Egyptian governorates during 2019 and 2020. In addition, histopathology and IHC could be potential methods to confirm Lumpy skin disease infection besidesVI and molecular detection.

An unusual benign skin tumor is reported occurring in a 68-year-old woman with no significant medical history. The lesion presented as a small skin nodule in the neck. Histologic examination showed a well-circumscribed superficial dermal nodule composed of a solid proliferation of large, round cells with abundant eosinophilic cytoplasm and small centrally placed nuclei displaying a vaguely chondroid appearance. Immunohistochemical studies showed strong positivity of the tumor cells for S100 protein and vimentin and negative staining for SOX10, melanoma cocktail, HMB45, Melan-A, cytokeratin AE1/AE3, inhibin, desmin, smooth muscle actin, CD68, CD164, and neuron specific enolase. Next-generation sequencing using a panel of 50 actionable genes commonly encountered in human neoplasia did not reveal the presence of any mutations. Owing to the remarkable similarity of the lesion to immature cartilage, we consider this to be a benign tumor, most likely resulting from an embryologic defect. We propose the term immature chondroid choristoma to designate this lesion.

Multiple myeloma is a plasma cell neoplasm associated with features of hypercalcemia, renal dysfunction and acquired immune abnormalities. We are reporting a rare case of an 80-year-old multiple myeloma patient with progressive disease with standard chemotherapy and developed cutaneous nodular lesion and pleural effusion. Biopsy of the skin nodule and pleural fluid cytology was suggestive of myelomatous infiltration. Simultaneous pleural and skin involvement is rarely reported in the literature. Such cases are scarcely reported, poorly understood and thus we intend to add to the scientific committee.

With increasing numbers of pet rabbits living out their natural lifespan, rabbit oncology is stepping more and more into the limelight. On the other hand, rabbit tumors are less covered in recent editions of textbooks of veterinary pathology than before. We present 1238 cases with neoplastic and non-neoplastic masses in rabbit tissue, submitted from 2008 to 2019, supplemented by a review of the literature on neoplasms in rabbits. Cutaneous masses comprised 47% of submissions. Trichoblastoma was by far the most common skin neoplasm, and nodular suppurative panniculitis was the second most frequent skin nodule in this series. Epithelial as well as mesenchymal cutaneous neoplasms can be virally induced in rabbits (eg, Shope papilloma, myxomatosis) but were infrequent in the current cases. Mammary neoplasms comprised 21% of submitted masses and 94% of these had histologic features of malignancy. Tumors of the female reproductive tract were responsible for 9% of biopsies and were predominantly uterine adenocarcinoma. Polypoid proliferation of rectal mucosa was the most common lesion in the alimentary tract. A broad spectrum of other neoplasms was described, including sarcomas at vaccination sites and ocular posttraumatic sarcomas, comparable to lesions described in cats.

Background Neurocysticercosis is the most common parasitic infection of the central nervous system, brain being the most frequent site. Intramedullary location of cysticercus is a rarely described entity in literature. Widespread dissemination of cysticercus is also considered a rare occurrence, and only a handful of cases are documented, almost exclusively from tropical nations. Here we present a case of disseminated cysticercosis with rare initial presentation as acute dorsal myelopathy resulting from intramedullary cysticercus. Case presentation A 62-year-old male patient from India (Asian) presented with features of dorsal myelopathy as manifested by acute-onset symmetric paraparesis, sensory loss below umbilicus, and double sphincter dysfunction. General physical examination revealed pea-sized nodules in skin and tongue. On spinal cord imaging, it was found that he had intramedullary cysticercus with diffuse perilesional edema. Brain and muscle imaging showed extensive cysticercosis suggestive of dissemination. Histological examination from skin nodule and antibody assay confirmed the diagnosis of cysticercosis. Following steroid administration, our patient showed improvement with observable increase in power of the lower limbs. He was subsequently discharged with antiepileptics, symptomatic therapy, and regular physiotherapy. Antihelminthic agents were initially avoided in view of extensive cysticercosis in brain including crucial areas such as brainstem. Conclusion Rare manifestation of a rare but treatable disorder makes it an important reportable observation in the context of tropical medicine.

Cutaneous metastasis of rectal cancer is rare and typically indicates widespread disease and poor prognosis. We report an exceedingly rare case of BRAF-mutated MSS rectal cancer with metastasis to the skin. A 53-year-old woman presented with stage IV unresectable adenocarcinoma of the rectum and received chemotherapy and molecularly targeted agents. Six months later she developed a focal skin nodule in the left groin. During treatment with four cycles of FOLFIRI plus bevacizumab, the skin nodules gradually increased in size, involving the skin of the left thigh. A portion of the rash was bleeding and painful. The biopsy specimen was consistent with a mucinous adenocarcinoma of rectal origin and expressed reduced CDX-2. Palliative treatment with FOLFIRI plus cetuximab and vemurafenib was initiated. The cutaneous nodules decreased in size but were not stable. The patient had severe electrolyte disturbances and depression and opted for palliative care.

Pancreatic panniculitis is a rare complication of pancreatic diseases. We aimed to evaluate a case of pancreatic panniculitis. A 58-year-old woman was referred to our hospital with complaints of painful cutaneous nodules on her limbs. Various diagnostic tests confirmed pancreatic panniculitis and pancreatic adenosquamous carcinoma. We diagnosed pancreatic panniculitis by a skin nodule biopsy that revealed fine basophilic material within anucleate cells and neutrophil infiltration. Abdominal imaging detected a tumor with necrosis on the pancreas and endoscopic ultrasound-guided fine-needle aspiration revealed it as an adenocarcinoma. The patient underwent pancreatoduodenectomy after neoadjuvant chemotherapy. The tumor was composed of differentiated adenocarcinoma and squamous cell carcinoma and diagnosed as adenosquamous carcinoma. This is the first report of pancreatic panniculitis in a patient with adenosquamous cell carcinoma of the pancreas.

A 35-year-old male, presented with a slow growing painless cutaneous nodule of 1.5 cm size of 6-month duration. On local examination, single well defined, freely mobile, non-tender skin nodule was found over the dorsum of right hand. Fine needle aspiration of the swelling yielded particulate material. The cytosmears were highly cellular and showed three population of cells comprising of cohesive clusters of larger cells, discretely lying larger cells and smaller lymphocyte like cells. (Figure 1) The cohesive cells were larger with round nuclei, pale chromatin and moderate amount of cytoplasm. Focal rosette like arrangement were noted. The larger scattered cells were in the form of naked nuclei with fragile cytoplasm giving a glycogenated appearance to the background. The third population of cells comprised of smaller cells with a coarsely clumped clock face appearing chromatin resembling lymphocytes. There was no mitosis, nuclear atypia or necrosis. (Figure 2).

Introduction: Cutaneous adnexal tumors are the group of uncommon tumour usually misdiagnosed clinically with various soft tissue tumour. Therefore, histopathology is the gold standard to diagnose their histogenesis. The aim of the present study is to find out the occurrence of skin adnexal tumors according to age, sex and site distribution along with histopathological diagnosis. Materials and Methods: This retrospective study was conducted in Department of Pathology of Pacific Institute of Medical sciences, Udaipur from September 2016 to August 2019. The formalin fixed paraffin embedded tissue section was stained with hematoxylin and eosin stain for microscopical analysis. Results: A total number of 41 adnexal tumors out of which 22 males and 19 females were studied out of which 36 cases were diagnosed as benign and 5 cases were reported as malignant. The most common cutaneous adnexal tumors diagnosed as sweat gland origin followed by hair follicle, sebaceous gland and pagets disease of nipple. Majority of the cutaneous adnexal tumors reported in head and neck site in a fourth to sixth decades of life. Conclusion: Architectural features help us to diagnose different types of cutaneous adnexal tumors.

Hidradenoma is a rare benign adnexal sweat gland tumor with eccrine or apocrine differentiation. In the skin, it is usually in the form of a solitary skin nodule. The treatment is complete surgical resection with healthy margins, given the high rate of recurrence and the possibility of malignant transformation. We report a case.

Hepatosplenic T-cell lymphoma (HSTL) is an uncommon, aggressive peripheral T-cell lymphoma with a dismal prognosis, usually expressing gamma-delta T-cell receptor on immunohistochemical study. We report the second instance in the literature of a solitary skin nodule heralding recurrence of HSTL. The patient was a 40-year-old man in apparent remission from HSTL, 4 years after chemotherapy and autologous bone marrow transplant. Biopsy of a flank lesion showed atypical lymphoid cells involving the dermis with a perivascular and periadnexal pattern, and fat lobules of the subcutaneous tissue. Their phenotype mirrored that of previous biopsies, with expression of CD2, CD3, CD7, CD56, and T-cell receptor-gamma, and lack of T-cell receptor-beta, CD4, CD5, and CD8. Cutaneous involvement by HSTL has rarely been reported either at initial diagnosis or at recurrence, and represents a diagnostic pitfall for primary cutaneous gamma-delta T-cell lymphoma.

Introduction. Non-Langerhans cell histiocytoses (non-LCH) are a group of rare diseases with varied clinical manifestations and overlapping features seen among the subtypes. Here, we present a case of Rosai-Dorfman disease with features of necrobiotic xanthogranuloma. Case. A 45-year-old female presented with a 10-year history of an enlarging neck mass with normal overlying skin accompanied by dysphagia and multiple asymptomatic pink to yellowish-brown papules, nodules, and plaques on the face, trunk and extremities. Biopsies of a skin nodule and plaque revealed granulomatous dermal infiltrates (lymphocytes, foamy histiocytes, and Touton giant cells), emperipolesis and areas of necrosis. CD1A and Fite-Faraco staining showed negative results while CD68 and S100 positively stained the tissues of interest. Histopathology of the neck mass paralleled these findings in addition to being negative for lymphoid markers. Patient had monoclonal gammopathy and thyromegaly with enlarged cervical lymph nodes on further tests and imaging. Intralesional and systemic steroids were given which led to flattening of skin lesions and improvement in dysphagia, respectively. Conclusion. Diagnosis and classification of a particular type of non-LCH may be difficult due to similarities across its subtypes. Hence, it is our belief that these diseases may occur on a spectrum. Treatment involves a multidisciplinary approach for the best possible care.

A 9-year-old cat was referred with multiple, raised, ulcerative and non-ulcerative nodules in the periocular area, sclera and ear-base region, and on the ventral aspect of the tongue. In addition, a progressive ulcerative skin nodule on the tail was observed. Fine-needle aspirations of multiple nodules from the eyelid and sclera revealed the presence of histiocytes with numerous acid-fast intracellular bacilli. The replication of slowly growing mycobacteria in liquid media was detected from biopsied nodules after three months of incubation. The molecular characterization of the isolate identified Mycobacterium (M.) lepraemurium as the cause of the infection. The cat was treated with a combination of surgical excision and a four-week course of antimicrobial therapy including rifampicin combined with clarithromycin. This is an unusual manifestation of feline leprosy and the first molecularly confirmed M. lepraemurium infection in a cat with ocular involvement in Europe. The successful combination of a surgical and antimycobacterial treatment regimen is reported.

Extramedullary blast crisis of chronic myeloid leukemia (CML) is defined as extramedullary disease composed of blasts regardless of the proliferation of blasts in the bone marrow. The commonly affected sites are the lymph node, central nervous system, bone, skin, and soft tissue. However, skin infiltration of CML patients as the initial presentation while their bone marrow is still in the chronic phase is extremely rare. In this article, we present a case of a 51-year-old woman who was admitted to our hospital complaining about a skin nodule in her right calf and easy fatigability for 1 week. The peripheral blood and bone marrow analysis both supported the diagnosis of CML in the chronic phase, whereas the excisional biopsy specimen obtained from her right calf showed immature cells infiltration, and fluorescence in situ hybridization test was positive for p210 BCR/ABL1 gene rearrangement. Based on the presence of extramedullary myeloid sarcoma, the patient was diagnosed with extramedullary myeloid blast crisis of CML despite the chronic phase in the bone marrow.

Background Sarcoidosis is a systemic granulomatous disease of unknown origin characterized by non-caseous necrotizing epithelial cell granuloma that affects the lung and lymphatic system. Sarcoidosis mainly occurs in young and middle-aged people, usually manifested as bilateral hilar lymph node enlargement, lung infiltration, and eye and skin lesions. Sarcoidosis has a high natural remission rate, but patients with progressive imaging or pulmonary function accompanied by significant clinical symptoms or extrapulmonary lesions need to be treated. Methods The sarcoidosis patient had received a 3-month methylprednisolone treatment which significantly improved clinical manifestations including cough and sputum, and extrapulmonary presentation, such as skin nodules and enlargement of parotid glands. Results A 52-year-old female reporting repeated cough and sputum, with scattered skin rashes and nodules on the extremities, accompanied by nasal congestion, enlargement of abdominal and retroperitoneal lymph nodes and parotid glands was studied. Computed tomography (CT) showed miliary nodules diffusely distributed in both lungs, multiple enlarged lymph nodes in mediastinum, bilateral enlarged hilar lymph nodes, and right pleural effusion. Bronchoscopy with lung biopsy showed granuloma formation, special staining including acid resistance was negative, but signet ring cell carcinoma and tuberculosis cannot be excluded. Biopsy of a skin nodule also showed granulomatosis. PET-CT reported all considered as inflammatory lesions, with a high possibility of tuberculosis. Based on all the information, we confirmed the diagnosis of sarcoidosis stage II. She was then successfully treated with a steroid monotherapy, which resulted in a satisfactory clinical outcome without serious complications. Conclusions Clinical manifestations of this patient are unspecific. Based on the pathological finding, clinical and radiological manifestation, and evidence of no alternative diseases, sarcoidosis stage II is diagnosed. Treatment with a steroid was of benefit in this sarcoidosis patient.

The appearance of cutaneous metastases from breast carcinoma is variable and can present as nodules or inflammation of the skin, mimicking benign skin conditions. In addition, the skin lesions may be the initial presentation of unsuspected visceral malignancy or the site of either persistence or recurrence of metastatic disease in an oncology patient with a history of a solid tumor. The features of a woman with metastatic breast cancer that presented as a nodule that was masked by her concurrent, new-onset, hidradenitis suppurativa are reported. The diagnosis was suspected when the skin nodule persisted after her hidradenitis suppurativa improved; the diagnosis of cutaneous metastasis was confirmed with a skin biopsy. Occult breast cancer (primary or recurrent disease) may be masked by an inflammatory condition, such as hidradenitis suppurativa. Therefore, if a primary dermatologic condition does not appropriately respond to therapy, pathologic evaluation may be warranted to exclude the possibility of another disease, such as cutaneous metastases from underlying visceral cancer.

Objectives: Cutaneous metastasis (CM) though rare, indicates a terminal event in any malignancy and has a grave outcome. The present study reiterates the role of fine needle aspiration cytology (FNAC) in the diagnosis of metastatic cutaneous nodules. Materials and Methods: From 2015 to 2017, the department received 22,000 cases for FNAC. Among these cases, aspirations from the skin and subcutaneous region were performed on 6,083 cases. After excluding primary tumors of skin/subcutis, 25 cases on cytology were suggestive of metastasis. Clinicoradiological and histopathological profiles in these cases were reviewed. Results: Among these 25 patients, the male to female ratio was 1:1.09 (F, 12; M, 13) in the age group of 18–72 years. Most common primary malignancy in females was of breast and in males was gall bladder. The most common manifestation was a palpable skin nodule, with the abdominal wall being the predominant site. The most common diagnosis, on cytology, was metastatic adenocarcinoma. Conclusion: FNAC is a minimally invasive method, which aides in prompt detection and appropriate management of cases presenting with skin nodules and clinically unsuspected of malignancy. Whereas in known primary tumor, it indicates dismal prognosis by diagnosing CM; in cases with unknown primaries, cytomorphology in conjunction with clinicoradiological findings often gives a clue to the possible primary site.

Primary breast carcinoma is the most common cause of cutaneous metastases in adult females, comprising about one fourth of patients with the disease. Although CM usually manifests as a late event in the course of a known neoplasm, they are rarely the presenting sign of an undiagnosed malignancy. Invasive Lobular carcinoma is known to be more likely to spread to unusual sites.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma (NHL) with subtypes that can be distinguished on the basis of clinical, immunophenotypic, morphologic, and molecular characteristics. The genital tract as a primary site for NHL is very rare (1).

We describe a case of sebaceous carcinoma (SC) in a 75-year-old man who presented with a rapidly growing nodule on the left cheek for four weeks. A 75-year-old man presented with a crusted non-tender nodule on the left cheek that had been present for six months. The nodule showed rapid growth in the four weeks before the visit. Shave biopsy of the lesion was reported as SC. SC is a rare but aggressive type of skin cancer that can develop from any sebaceous gland in the body. However, it mostly occurs in the eyelids. In this case, SC developed on the left cheek of the patient, which is an atypical presentation. Extraocular variant of SC has a greater potential to metastasize and has a lower survival rate compared to ocular variant. Early and accurate diagnosis followed by a wide excision surgery or Mohs micrographic surgery carries a favorable prognosis. Early detection of extraocular variant of SC may be difficult. It is imperative for primary care providers to order a histopathology examination to investigate a rapidly growing mass in the head and neck region where there are numerous sebaceous glands.

Made available in DSpace on 2021-06-25T10:36:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Background: Malignant peripheral nerve sheath tumors are neurogenic neoplasms that originate from cells that surround the axons of peripheral nerves. Surgery is the treatment of choice for peripheral nerve sheath tumors. They have a better prognosis when the lesion is in the extremity of a limb and the surgeon leaves wide peripheral margins after resection. However, this procedure makes local treatment a challenge due to difficult wound healing in this region. This report describes a successful case involving the use of a meshed skin graft immediately after resection of a neurofibrosarcoma in the distal region of the radius bone of a dog. Case: A 6-year-old Boxer bitch weighing 40 kg was admitted with a history of a round, firm, non-ulcerated skin nodule attached to the lateral side of the distal region of the right radius bone, which had been present for about 40 days. Fine needle aspiration cytology of the lesion showed the presence of mesenchymal cells, suggesting a sarcoma. Thus, the decision was made for an incisional biopsy to confirm the diagnosis and for the preparation of a subdermal pattern tubular flap for subsequent rotation and transposition to close the wound that would be formed after the complete removal of the lesion. After the 7th postoperative day, the diagnosis of low-grade neurofibrosarcoma was confirmed and due to the presence of necrotic onset in the middle portion of the tubular flap, further surgical intervention was scheduled for the resection of the tube flap, en bloc removal of the neoplastic lesion with peripheral margins of 2 cm, and wound closure with a free skin graft. A mesh skin graft was made with a portion of the right flank skin. The mesh graft was carefully implanted on the recipient bed using simple interrupted sutures with a 3-0 non-absorbable monofilament suture material. A dressing made with water-based sterile lubricating solution and gauze and a modified Robert Jones bandage were applied. The patient was treated with analgesic medication, antimicrobial therapy, and gastric protectors. The first bandage and dressing were changed after 48 h, and only warm physiological solution was used. Histopathological analysis confirmed the diagnosis of low-grade neurofibrosarcoma with free surgical margins. The dressing was changed every 72 h for up to 12 postoperative days, when the immobilization was removed, and wound cleaning could be completed at home using physiological solution and a dressing with nitrofurazone ointment. Granulation tissue was first seen at day 12, and at day 30 the wound was completely closed. Discussion: The primary closure of skin defects after the resection of tumors located in the distal portion of limbs is often not possible due to a lack of adjacent skin. Thus, grafts are commonly used to repair the skin in these areas using the technique presented in this report. In order to survive, skin grafts need a vascular bed capable of allowing new blood vessel connections with the implanted skin portion. There is no consensus in the literature on the best bed for graft implantations. In the case described in this study, a free mesh graft was implanted on a fresh wound without granulation tissue, which resulted in excellent clinical evolution and total survival of the graft. Excellent clinical results were achieved with the graft, since its survival and adherence to the recipient bed occurred without complications. The clinical result of this case suggests that the application of full-thickness mesh grafts to fresh wounds in distal limbs immediately after tumor resection is a good alternative when the surgical wound is too large (which prevents primary closure). Good preoperative planning associated with good surgical techniques and adequate postoperative management are essential for the success of the technique under these conditions. M.V. Autônomo Programa de Pós-Graduação em Cirurgia Veterinária Faculdade de Ciências Agrária e Veterinárias (FCAV) Universidade Estadual Paulista (UNESP) Departamento de Clínica e Cirurgia da FCAV-UNESP Programa de Pós-Graduação em Cirurgia Veterinária Faculdade de Ciências Agrária e Veterinárias (FCAV) Universidade Estadual Paulista (UNESP) Departamento de Clínica e Cirurgia da FCAV-UNESP

Pilomatricoma is a benign tumor arising from hair follicle matrix cells, presenting as an asymptomatic, firm, slow growing, mobile, superficial skin nodule typically in children. This lesion with an atypical clinical presentation is frequently misdiagnosed as other skin lesions and even as malignant entities regardless of detailed cytological, imaging examinations; the site of occurrence is one of the keys to accurate diagnosis. Here, we present a case of pilomatrixoma involving the ear, the cymba conchae of the auricle, which is an extremely rare site for the lesion in a 52-year-old woman. The present case suggests that this benign tumor needs to be included in the differential diagnosis in patients who present with an atypical auricular lesion.

In this chapter fine needle aspiration cytology (FNAC) of a skin nodule in a young female is discussed.

A female presented in the sixth decade of life with a history of undifferentiated small cell carcinoma of the right breast in clinical remission, status-post chemotherapy and resection 6 years previously, presented with a chronic anterior knee skin nodule that grew in size over the prior 5–6 weeks. She had no history of opportunistic infections or recent immunosuppression. As it grew, the nodule became tender to touch. Examination revealed a 4–6 mm superficial purple-red nodule. Also, a similar lesion was present on the dorsum of her left foot for the past year, which also recently grew and became tender. The patient did report frequently kneeling on soil when gardening in Florida. She reported no other symptoms. Due to a concern for cutaneous metastasis of the patient’s previously diagnosed small cell carcinoma of the breast, the anterior knee lesion was biopsied. Histology revealed histocyte-rich inflammation with foci of acute inflammation as well as pigmented fungal forms. Subsequent fungal culture of excised tissue grew Cladophialophora bantiana, identified by ribosomal gene DNA sequencing.

Differentiated thyroid cancer arising from thyroid follicular epithelial cells is the most frequent endocrine malignancy, and skin metastases are very rare. We describe a case of a 70-year-old women with a history of an indeterminate thyroid nodule on cytology. A painless, erythematous skin nodule of about 7 mm diameter was removed from the scalp and diagnosed as a metastasis from thyroid cancer. After total thyroidectomy, a histological diagnosis of follicular thyroid cancer was made. Two cycles of radioactive iodine were performed. Both the follicular thyroid carcinoma (FTC) and the metastasis were investigated for the presence of BRAF/RAS and TERT promoter mutations. The results showed that the cutaneous metastasis was BRAF wild-type and TERT promoter-mutated (position g.1,295,228 C>T); in contrast, the primary thyroid lesion was negative for both molecular markers.

Cutaneous metastases of urological malignancies are a rare phenomenon. We present a case of a renal transplant recipient who presented with skin nodule 12 years posttransplant. Pathohistologic evaluation revealed metastasis from the renal adenocarcinoma. The patient was treated with temsirolimus and later with sorafenib ; however, he died 13 months after the initial presentation with a functional renal allograft.

Highlights • Undifferentiated pleomorphic sarcoma is extremely rare in the neck region. • Despite the availability of imaging modalities that suggest otherwise, clinical examination remains crucial in identifying malignancy in the neck. • A multidisciplinary approach is needed to obtain clear surgical margins due to the proximity of neurovascular structures., Undifferentiated pleomorphic sarcoma very rarely affect the neck. We report a case of a 62 year old man who presented with a right sided skin lump which he noticed after sustaining a neck contusion in a road traffic accident about one year ago. The initial CT and ultrasound scans of the lump were suggestive of a thrombosed varix. Clinical examination showed a hard skin nodule with signs of tethering. He underwent a wide excision of the skin nodule and the histology showed undifferentiated pleomorphic sarcoma with margins involved. He subsequently underwent another re-excision of margins and pectoralis major flap reconstruction. Following surgery, he was also prescribed adjuvant radiotherapy and he remains well about 12 months after follow up. The surgical management of undifferentiated pleomorphic sarcoma in the neck is challenging due to the proximity of critical neck structures and the need to obtain clear margins. Thus, adjuvant radiotherapy is often used to improve disease control.

Epidermal naevus is a congenital cutaneous hamartoma with a benign course. We highlight a rare case of epidermal naevus with concurrent basal cell carcinoma. A 79-year-old male had a skin biopsy at our centre for an enlarging skin nodule within a linear papular lesion measuring 2 x 4 cm at the left side of his neck, which was later diagnosed as basal cell carcinoma arising from an epidermal naevus. PIK3CA mutation is attributed to basal cell carcinoma which suggests the basal cell carcinoma component is independent of the epidermal naevus component. Clinicians and pathologists must be aware of possible malignant changes that might arise in an epidermal naevus.

CASE REPORT A 5-year-old Domestic Shorthair-cross was presented with a raised, alopecic skin nodule affecting the external surface of the right upper lip with an adjacent second smaller satellite lesion. Fine needle aspiration cytology revealed numerous intracellular and extracellular negatively stained bacilli. Histopathology confirmed granulomatous inflammation with multinucleate giant cell formation and abundant intracellular acid-fast bacilli, consistent with a mycobacterial aetiology. PCR testing of the fresh tissue from the satellite lesion and subsequent sequence analysis identified Mycobacterium sp. strain Tarwin. The skin lesion was surgically excised and clarithromycin 62.5 mg twice daily was administered to the cat for 25 days. CONCLUSION There was no recurrence of the lesion at the time of writing, 16 months after the surgery. This is the second autochthonous case of feline leprosy caused by M. sp. strain Tarwin originating in New South Wales, Australia.

Patient: Male, 24 Final Diagnosis: Subcutaneous panniculitis-like T-cell lymphoma Symptoms: Fever • skin nodules Medication: — Clinical Procedure: Skin biopsy • PET-CT Specialty: Hematology Objective: Rare disease Background: Subcutaneous panniculitis-like T cell lymphoma is a very uncommon subtype of cutaneous T cell lymphoma. The manifestations of this rare disease are atypical at onset, and may mimic some rheumatic or dermatologic diseases, which causes the delay of diagnosis and treatment. Case Report: We report a 24-year-old man suffering from intermittent fever and skin nodules on the left anterior chest wall, who was initially misdiagnosed with nodular panniculitis and finally diagnosed with subcutaneous panniculitis-like T cell lymphoma through repeat examination of biopsy of the skin nodule. Positron emission tomography revealed extracutaneous adipose tissue involvement. Subsequently, hemophagocytic syndrome occurred while under a conventional dose of glucocorticoid, but remission was induced by treatment with cyclosporine A and high doses of dexamethasone. Conclusions: In order to avoid the delay diagnosis and inappropriate treatment of subcutaneous panniculitis-like T cell lymphoma, in addition to a thorough physical examination, PET-CT and disease-specific pathologic, immunophenotypic, and T cell receptor tests of the skin biopsy should be performed. Extracutaneous involvement, especially hemophagocytic syndrome, indicated worse prognosis. Even so, cyclosporine A plus high-dose corticosteroid could be an option of treatment.

An 88-year-old Inuit man from Northern Canada presented with an extensive skin rash associated with numerous violaceous skin nodules on his palms and lower extremities. Biopsy of a skin nodule revealed Kaposi’s sarcoma (KS), a human herpesvirus 8 (HHV8)-associated malignancy, whereas biopsy of the erythematous skin showed an atypical infiltrate of CD4-positive T-cells that, together with TCR gene rearrangement and presence of clonal T-cells in peripheral blood by flow cytometry, was consistent with a T-cell lymphoma, mycosis fungoides (MF) subtype. Serology was negative for HIV and HTLV-I/II and no immunodeficiency syndrome was identified. The patient was successfully treated with an oral retinoid for KS, and with topical hydrocortisone and ultraviolet B (UVB) phototherapy for MF. This case highlights the existence of HHV8-related lesions in native persons of Northern Canada, and also that MF-induced immunosuppression combined with immunosenescence may play a role in the development of non-HIV-related KS.

Background and Aim: Lumpy skin disease (LSD), is a highly infectious viral disease of cattle, caused by LSD virus (LSDV) which belongs to the genus Capripoxvirus of family Poxviridae. In the summer of 2017, skin lesions suggestive of LSD were observed in cattle at several governorates in Egypt. This study aimed to detect LSDV in cattle specimens using rapid serological and molecular diagnostic assays. Materials and Methods: A total of 46 skin biopsies and uncoagulated blood samples were collected from cattle with LSD suggestive clinical signs, as well as 290 coagulated whole blood samples from cattle without skin lesion in different governorates in Egypt during the summer of 2017. Skin biopsies were used for virus isolation from the chorioallantoic membrane of 11-day-old specific pathogen-free embryonated chicken eggs (SPF-ECEs). LSDV was identified using conventional polymerase chain reaction (PCR), real-time PCR (RT-PCR), and fluorescent antibody technique (FAT) with specific hyperimmune serum against LSDV. Cattle sera were examined using indirect FAT (IFAT) and indirect enzyme-linked immunosorbent assay (ELISA). Results: Skin nodules and sitfast lesions were significant clinical signs observed in all LSD suspect cattle. SPF-ECEs, from which positive isolations were made and it showed characteristic inflammatory and focal white pock lesions. The isolated viruses were identified as LSDV by FAT, conventional gel-based PCR, and RT-PCR. Among the skin biopsies and corresponding blood samples, LSDV-positive samples percentage were 39.13 and 36.95 by RT-PCR, followed 34.78 and 28.26 by conventional PCR and then 32.6 and 26.8 by FAT, respectively. The total positive percentage of LSDV antibody detected in cattle serum samples were 17.93 and 14.48 by indirect ELISA and IFAT. Conclusion: LSDV was detected and identified in skin biopsies and corresponding blood samples of naturally infected cattle, more LSDV-positive samples were detected by RT-PCR, followed by conventional PCR and then FAT. The indirect ELISA detected more antibody-positive samples than the IFAT from cattle serum samples. The RT-PCR assay is simple, sensitive, rapid, and reliable for the detection of LSDV in blood and skin nodule biopsies of suspected cattle.

White piedra of the hair is a rare superficial fungal infection caused by several Trichosporon spp. It typically manifests as white to light brown hard nodules, firmly attached to frontal, occipital and parietal scalp hair. The incidence of white piedra varies from country to country, and men and women of all ages are affected. In Latin America, children and women appear to be the most affected with white piedra of the hair. Given the variability of causative agents and the paucity of literature, very little is known about the geographical distribution of white piedra of the hair in American continent countries to help understand its epidemiology and aid in its diagnosis and treatment. In this report, we describe a case of white piedra of the hair in a Peruvian woman...

Buruli ulcer is caused by Mycobacterium ulcerans . This neglected disease occurs in scattered foci around the world, with a higher concentration of cases in West Africa. The mycobacteria produce mycolactones that cause tissue necrosis. The disease presents as a painless skin nodule that ulcerates as necrosis expands. Finding acid-fast bacilli in smears or histopathology, culturing the mycobacteria, and performing M. ulcerans PCR in presumptive cases confirm the diagnosis. Medical treatment with oral rifampin and intramuscular streptomycin or oral treatment with rifampin plus clarithromycin for 8 weeks is supported by the World Health Organization. This review summarizes the epidemiology, pathogenesis, clinical presentation, diagnostic tests, and advances in treatment.

Fibroblastic connective tissue nevus (FCTN) is a benign cutaneous mesenchymal lesion characterized by proliferation of CD34-positive fibroblastic/myofibroblastic spindle-shaped cells. We report a case of agminated FCTN on the right lower abdomen of a 1-year-old boy.

Painless Skin Nodule on the Finger of an 18 Year Old Andrea Olofson;Shaofeng Yan;Konstantinos Linos; The American Journal of Dermatopathology

A 15-year-old female adolescent presented with progressive neck swelling of 1 year duration and received 6 months of antituberculosis therapy in a local hospital with no benefit. After excision biopsy, she came to our institution. Examination showed 3 fungating, ulcerating neck masses and a chest wall skin nodule. Pathology confirmed Hodgkin lymphoma, stage IV BXE. FDG PET/CT showed a large neck tumor, a satellite skin nodule with local skin infiltration of tumor. She received 6 cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy and radiation therapy 2100 cGy. After chemotherapy, FDG PET/CT was negative. She is 2 years disease free.

A 6-month-old male baby presented with a solitary skin nodule (2.5×2.5×2.5 cm) on his left cheek (figure 1). The nodule was medium-hard and sharply demarcated. The skin on the surface of the nodule was smooth. Two months earlier, the lesion was discovered coincidentally as a soybean-sized papule with no redness, swelling, heat, pain, pruritus or desquamation. The lesion then gradually increased in size and became erythematous. The infant had no systemic findings of fever, chills, night sweats or weight loss. Lymphadenopathy and hepatosplenomegaly were absent. Figure 1 A solitary skin nodule on the left cheek of the infant. The key clinical feature of the case is an enlarging solitary skin nodule on his left cheek, with no other discomfort or systemic involvement. The differential diagnosis includes skin malignancy, juvenile xanthogranuloma, mastocytosis, angioma, dermatofibroma and Langerhans cell histiocytosis. Surgical resection of the entire nodule was performed for pathological diagnosis and management strategy. Microscopically, H&E staining revealed a dense non-epitheliotropic infiltrate of small-to-medium-sized atypical T-cells. The infiltrate showed a nodular pattern in the dermis and subcutis. Immunohistochemistry showed neoplastic cells were CD3+/CD4+/CD2+/CD5+ and CD8 (−)/CD30 (−)/CD56 (−)/TIA-1 (−)/CD20 (−)/CD7 (−). The proliferative marker, Ki-67, showed a low nuclear reaction involving 10% neoplastic cells (figure 2). In situ hybridisation for Epstein-Barr virus (EBV) was negative. Clonal TCR gene rearrangements were detected (figure 3). The diagnosis of primary cutaneous …

The Siamese fighting fish (Betta splendens) is one of the popular aquarium ornamental fish in the global trade. Large numbers of ornamental fish farmed in central Thailand suffered from two common syndromes; preliminarily named skin nodule syndrome (SNS) and big belly syndrome (BBS): they showed noticeable clinical signs of abnormal appearances resulting in depressed saleability. Since very few specifics are known about causative agents of these syndromes, this study aimed at investigating histopathological features and culturable bacteria associated with these fish infected in the process of farming. Histopathologically, SNS fish consistently exhibited necrosis and severe melanization in the muscles and multiple internal organs. Whereas BBS fish exhibited either typical granulomas or tissue damage associated with acid-fast stained bacteria and Gram negative bacteria, respectively. Six different Gram negative bacterial species were recovered from BBS fish while 23 bacterial species belonging to 14 genera were recovered from fish suffering from SNS. Most of the culturable bacteria are new to betta fish and some of them are known to be marine bacteria, suggesting possible entry route via a contaminated live feed, commercial Artemia shrimp. The true causative agents of these syndromes remain unclear. However, histopathological changes and existence of a wide range of bacteria associated with the naturally diseased fish suggest involvement of multiple bacterial infections.

Basosquamous cell carcinoma is an uncommon skin cancer with an incidence rate between 1.5% and 2.7%. Surgical excision is the therapy of choice for most skin neoplasm. Depending on the tumor presentation size, location, and patient general condition, there are complementary approaches available: radiation therapy, for curative intent or used as an alternative to maximize local control and symptomatic relief. The case is a 54-year-old male with a seventeen year history of six times recurrent Basosquamous cell cancer that started as a skin nodule on the left nasolabial fold and ended with a mass penetrating into the left ethmoid sinus and orbital cavity. The patient was then treated using intensity modulated radiotherapy as the only effective second alternative modality after debulking surgery. Radiation intent was curative, aiming for eradication of the tumor, maximizing the local control and relief of symptoms. The follow-up demonstrated an eighty percent tumor shrinkage as measured on imaging studies in addition to an excellent cosmetic outcome. Intensity modulated radiotherapy proved to be an efficient treatment modality, with acceptable toxicity and excellent local control, when the patient did not prefer the surgical option for the cosmetic compromise.

Classical Kaposi’s sarcoma (KS) typically affects elderly men of Mediterranean and Jewish origin. We present an unusual case of classical KS in a human immunodeficiency virus (HIV) negative elderly farmer from rural Nigeria. He had multiple brownish nodules and plaques on both lower extremities associated with lymphoedema. Histopathological examination of a biopsy of the skin nodule confirmed the diagnosis of KS. The lesions only showed marginal improvement on chemotherapy which necessitated a referral for radiotherapy. There is a need to look beyond the traditional geographical distinction of KS variants as we continue to experience a dynamic role for environmental co-factors in the development of KS.

Leukemia cutis is defined as the infiltration of neoplastic leukocytes or their precursors into the epidermis, the dermis, or the subcutis which results in clinically identifiable cutaneous lesions. Here we describe a case of Chronic myeloid leukemia who presented with a subcutaneous skin nodule over the abdomen for which Fine needle aspiration cytology was done and was reported as leukemia cutis.

Traditionally considered to be a loco-regional disease, head neck cancers metastasize infrequently to distant sites. Among these, skin metastases have been rarely reported and almost always they have been encountered during or after treatment of primary. We present here a case of squamous cell carcinoma of base of tongue with multiple dermal metastases at initial presentation. This report signifies that rarity of such cases must not delay the confirmation of diagnosis since these patients already carry a dismal prognosis. only a month back. Other than a history of heavy smoking for the last 30 years, there were no other forms of addiction. He was neither diabetic, nor hypertensive and had a ECOG performance of '2'. Clinical examination and contrast enhanced CT scan of neck revealed irregular hard mass in base of tongue eroding into left retromolar trigone and hard bilateral neck nodes with the largest one measuring 5.4X 6.2cm.A specimen from the tongue mass showed grade 2(moderately differentiated) squamous cell carcinoma with peri-neural invasion but no lympho-vascular tumor emboli was detected. Punch Biopsy from a skin nodule revealed metastatic squamous cell carcinoma deposits. Metastatic work-up revealed no other sites of metastasis. Routine investigations were essentially normal. The disease was staged to be cT4aN3M1. Salvage chemotherapy with Docetaxel (80mg/m2 on day 1), cisplatin (75mg/m2 on day 1) and 5-Flurouracil (1000mg/m2 day1-4) was initiated within a week and he has tolerated well two such cycles so far. A partial response of the primary and neck nodes has been documented and the skin nodules have completely disappeared (figure 2).

Mantel cell lymphoma is one of the small B-cell non-Hodgkin's lymphomas and usually involves lymph nodes, bone marrow, spleen, liver, gastrointestinal tract, and Waldeyer's ring, but rarely skin and orbit. A 53-year-old man presented skin nodules and plaques on the head, trunk, and lower extremities for half a month, and the left periorbital region swelled 4 days ago. Serum calcium and lactate dehydrogenase were increased to 3.12mmol/L (normal 2.03–2.65mmol/L) and 853U/L (normal 71–231U/L), respectively. Histopathologic examination of the skin nodule revealed tumor cells infiltrated nodular distribution in the dermis and subcutaneous tissue. Immunophenotyping of the abnormal lymphocytes indicated positive reactions for L26, CD79a, Bcl-2, Cyclin D1, and Ki-67 (>80%), but negative for CD5, CD21, CD23, CD38, CD3, CD10, UCHL-1, TdT, MPO, CD30, ALK, CD117, and CD34. Fluorescence in situ hybridization analysis with the CCND1/IGH probe revealed a fusion signal on the abnormal lymphocytes. The final diagnosis was a rare case of blastoid mantle cell lymphoma involving skin and orbit with hypercalcemia. Following the R-Hyper-CVAD treatment plan, the patient achieved a quick and excellent recovery on the 6th day. Unfortunately, the patient eventually died of pneumonia one month later.