Fadel Bennani

Isolated cutaneous metastasis of uterine leiomyosarcoma: case report and review of literature

AbstractA 54 year old lady presented for routine excision of a scalp lesion thought clinically to represent a sebaceous cyst of the right occiput. 4 years earlier she underwent total abdominal hysterectomy and right salpingo-oophorectomy for 3 large uterine fibroids. Histo-pathological examination of the hysterectomy specimen revealed an incidental low-grade leiomyosarcoma. Staging imaging was negative for metastatic disease. She made an uneventful recovery and was treated further by adjuvant pelvic radiotherapy.She noticed an uncomfortable and unsightly cystic swelling on her occiput four years after hysterectomy and was referred for routine excision of what was believed to be a benign lesion. The lesion was excised and sent for histopathological examination. Microscopic analysis including immuno-histochemistry demonstrated an ER and PR positive metastatic deposit of leiomyosarcoma. The margins of excision were histologically clear of disease.At Multi-Disciplinary Team (MDT) discussion a diagnosis of metastatic scalp deposit from previous uterine leiomyosarcoma was made. Re-staging CT brain, thorax, abdomen and pelvis and MRI brain were negative for local recurrence or distant metastases. She is currently undergoing radiotherapy to the scalp and surrounding tissues and will be followed up closely by the involved teams.To the best of our knowledge, this is the first case described in the worldwide literature of isolated cutaneous metastasis to the scalp of uterine leiomyosarcoma without evidence of disseminated disease at other sites.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1311834987345566

Enteropathy associated T cell lymphoma: common in coeliac disease

A 56-year-old male admitted with haematemesis and epigastric pain and severe weight loss on a background of coeliac disease. Computed tomography (CT) abdomen revealed a thickening of the mucosal folds of a short segment of jejunum. He deteriorated and had an exploratory laparotomy and bowel resection with side-side jejojejunal stapled anastomosis and extended right hemicolectomy and ileocolic anastomosis. Histology demonstrated multifocal high-grade malignant T cell lymphoma. Coeliac disease is a very common lifelong disorder. It is associated with osteoporosis, infertility, autoimmune disorders and increased risk of malignancy including an increased risk of non-Hodgkin’s lymphoma (NHL) especially of the T cell type. Enteropathy-type T cell lymphoma is associated with a very poor prognosis. There is significant evidence that adherence to a gluten-free diet decreases the risk of developing enteropathy-type T cell lymphoma and helps to prevent development of autoimmune diseases, diabetes mellitus and osteoporosis in patients with coeliac disease.

Malignant neuroendocrine tumour of the appendix in childhood with loco-regional lymph node invasion.

Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1006600359152743

What is the cause of this synchronous palpable abdominal mass in a woman recently diagnosed with lung cancer as demonstrated in Figure 1

Colonic metastases from lung cancer are rare [1, 2]. Presentation of an abdominal mass in the setting of a new lung cancer diagnosis should prompt complete evaluation including endoscopic and CT imaging. This case also highlights the need for immunohistochemical analysis of unusual tumor deposits facilitating appropriate treatment.

Retraction Note: Paediatric Ewing-like sarcoma arising from the cranium – a unique diagnostic challenge

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Robertson et al. Diagnostic Pathology (2016) 11:54 DOI 10.1186/s13000-016-0502-6

Splenic metastases from caecal carcinoma: Diagnostic considerations and therapeutic strategy

INTRODUCTION The spleen is a highly vascular organ and is in close proximity to many potential primary sites such as the stomach, breast, pancreas and colon. It is however an unusual site for metastatic disease. The reasons for this are not fully understood at the present time. A number of hypotheses have been postulated. Definitive diagnosis and subsequent treatment of metastatic disease to the spleen presents a number of challenges for the surgeon and the wider multi disciplinary team. PRESENTATION OF CASE A 60 year old male presented with a three week history of lower abdominal pain, distension, nausea and a palpable mass in the right iliac fossa. Imaging revealed a large circumferential caecal mass consistent with malignancy with secondary small bowel obstruction. The patient underwent an emergency right hemicolectomy and was subsequently treated with systemic chemotherapy for lymph node positive caecal adenocarcinoma. Two years following initial presentation, two suspicious lesions were noted within the spleen during routine surveillance imaging with computerised tomography of the thorax, abdomen and pelvis. Of note, one month prior to this the patient had a normal surveillance colonoscopy performed with multiple interval carcinoembryonic antigen (CEA) levels recorded within the normal range. Image guided splenic biopsy and subsequent histology confirmed metastatic caecal adenocarcinoma. DISCUSSION Splenic metastases from any source including the colon are a rare phenomenon. CONCLUSION This case questions the value of routine post operative CEA monitoring, underlines the importance of multimodal pathways of surveillance and highlights recent advances in image guided splenic biopsy techniques.

Concurrent diagnosis of Crohn's disease and colorectal carcinoma in a young man with abdominal pain.

The lead time between diagnosis of Crohns disease and presentation with a Crohns related malignancy is generally twenty years from diagnosis. This case outlines that of a young man who presented to the emergency department with abdominal pain and was subsequently discovered to have a malignant stricture complicating underlying Crohns disease that was previously quiescent and undiagnosed. It demonstrates that a new diagnosis of Crohns disease does not rule out previously quiescent underlying disease and therefore risk of colrectal carcinoma.