Paschalis Gavriilidis

Pigmented epithelioid melanocytoma: a new concept encompassing animal-type melanoma and epithelioid blue nevus

Pigmented epithelioid melanocytoma (PEM) is a recently proposed term which encompasses those melanocytic tumours previously designated as ‘animal-type melanoma’ or ‘pigment-synthesising melanoma’ and ‘epithelioid blue nevus’, the latter known to be associated with Carneys complex. We report a case of PEM in a previously well 26-year-old Caucasian woman who presented with a dark pigmented nodule on the anterior chest wall.

Extramammary Paget's disease of the vulva.

Vulvar Pagets disease is an extremely rare neoplasm that accounts for less than 1% of the vulvar malignancies. We present a case of a 75-year-old woman, who had an eczematoid lesion involving the labia majora and minora bilaterally, with infiltration to the clitoris. Enlarged non-fixed lymph nodes were palpable in the inguinal region bilaterally. A biopsy of the vulva showed Pagets disease. She underwent radical vulvectomy with bilateral inguinal lymph node dissection. The patient remained disease free at 6-month follow-up.

Granular cell breast tumour mimicking infiltrating carcinoma

Granular cell tumour (GCT) is a rare, usually benign neoplasm that can mimic carcinoma on breast imaging. GCT can originate anywhere in the body but is most frequently found in the head and neck region, particularly in the tongue. Of the reported cases, 6% have occurred in the breast, most commonly in the upper inner quadrant. We report a case of GCT of the breast presenting as a spiculated mass infiltrating the greater thoracic muscle on breast screening mammogram.

Early solitary small bowel metastasis from stage I cutaneous melanoma.

Patient Male, 63 Final Diagnosis: Melanoma Symptoms: Gastrointesinal haemorrhage Medication: — Clinical Procedure: Enterectomy Specialty: Oncology Objective: Unusual clinical course Background: It is reported that the time interval between the initial diagnosis of malignant melanoma and the diagnosis of the gastrointestinal metastases is 43.8±11.3 months. Case Report: We present the case of a 63-year-old Caucasian man who was operated on for superficial spreading Stage IB melanoma and 8 months later was diagnosed with solitary small bowel metastasis without other systemic metastases. Conclusions: Small bowel melanoma metastasis should be suspected in any patient with previous history of malignant melanoma who develops symptoms of anemia, gastrointestinal hemorrhage, and non-specific abdominal pain.

Colon Adenocarcinoma Associated with Synchronous Extramural Gastrointestinal Stromal Tumor (GIST) of the Ileum

Patient: Female, 68 Final Diagnosis: Gastrointestinal stromal tumour and colon adenocarcinoma Symptoms: Fatigue Medication: — Clinical Procedure: Right Hemicolectomy and enterectomy Specialty: Surgery Objective: Rare disease Background: GISTs are mesenchymal tumors representing approximately 1% of all gastrointestinal neoplasia. Their concurrence with colorectal cancers is rare. Case Report: We present a case of coexistence of colon adenocarcinoma and GIST of the ileum in a 68-year-old white woman. Conclusions: The coexistence of mesenchymal and epithelial neoplasia is very challenging; further research is needed to clarify the role of oncogenic mutations and signalling pathways in carcinogenesis of neoplasia of various histiogenic origins.

Intramuscular myxoma of the soleus muscle: A rare tumor in an unusual location

Patient: Female, 52 Final Diagnosis: Myxoma Symptoms: — Medication: — Clinical Procedure: — Specialty: Oncology Objective: Challenging differential diagnosis Background: Intramuscular myxoma is a benign intramuscular neoplasm. However, sometimes it is difficult to distinguish it from soft-tissue sarcomas that underwent myxomatous degeneration. To the best of our knowledge, only 2 cases of intramuscular myxoma in the soleus muscle have been previously reported. Case Report: We present the case of a 52-year-old Caucasian woman who was referred to our tertiary anticancer hospital for magnetic resonance imaging (MRI) diagnosis for suspicion of mesenchymal tumor. Percutaneous core biopsy revealed an intramuscular myxoma (IM). Despite the benign nature of the lesion, the patient desired that the tumor be removed. She underwent wide local excision. The final histopathologic diagnosis was IM. She is doing well 3 years after the operation. Conclusions: Percutaneous core biopsy is the procedure of choice for providing preoperative tissue diagnosis. The treatment of choice is wide local excision. IM does not usually recur after surgical removal.

Extraocular sebaceous carcinoma mimicking benign sebaceous cyst.

Extraocular sebaceous carcinoma (SC) is an exceptionally rare neoplasm and has been confused in the past with basal cell carcinoma showing sebaceous differentiation. However, in contrast to the latter tumour, SC can be an aggressive cancer. We describe the case of a 55-year-old man with a 3-year history of a 5×2 cm lesion on the posterior thoracic wall. It had increased in size during this period but was otherwise asymptomatic. There was no significant past medical history or lymphadenopathy. Nor was there a family history of malignancy. The lesion was totally excised. The histopathological report revealed SC. As this neoplasm may be associated with Muir-Torre syndrome, the patient was screened for underlying internal neoplasia. All haematological, biochemical and tumour markers, imaging and endoscopic examinations were normal. Since SC may appear before the development of internal malignancy, our patient was scheduled for follow-up visits every 3 months.

Sacrococcygeal chordoma, a rare cause of coccygodynia

Patient: Male, 73 Final Diagnosis: Sacrococcygeal chordoma • Symptoms: Coccycodynia • sacral pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Sacrococcygeal chordomas are rare and difficult to diagnose tumors. Case Report: A 73-year-old man in the last 6 months felt a pain in and around the coccyx when sitting and especially when rising from the sitting position. He consulted his family physician and was referred by him to a general surgeon with the diagnosis of pilonidal disease. During the operation, the surgeon found an unusual mass and performed a wedge biopsy of the tumor. When chordoma was returned as the diagnosis, the patient was referred to our tertiary hospital for further treatment. The sacrococcygeal chordoma was excised en bloc with the coccyx and the fifth sacral vertebra by posterior approach. Conclusions: Because of minimal response to chemo- and radio-therapy, resections with wide margins at initial surgery is the most important factor influencing local recurrence.

Solitary metachronous splenic metastasis from cutaneous melanoma

Melanoma has been found to metastasise to the spleen, usually in cases of disseminated disease. Solitary splenic metastasis from cutaneous melanoma is very rare. Herein we report the case of a 43-year-old man who developed solitary splenic metastasis from cutaneous melanoma. The patient was operated for T4b N1a Mo superficial spreading melanoma of the anterior thoracic wall. He subsequently underwent left axillary lymph node dissection due to a positive sentinel lymph node. The 33 retrieved lymph nodes were negative for metastasis. The patient received adjuvant therapy with high-dose interferon α-2b. After 27 months and during the follow-up visit an increasing lactate dehydrogenase serum level was observed. Furthermore, CT of the whole body revealed a solitary hypodense tumour of the spleen 9 cm×6 cm. Curative splenectomy was performed and the histopathological report confirmed metastatic melanoma to the spleen.

Hibernoma of the thigh: a lipoma-like variant rare tumour mimicking soft tissue sarcoma.

A 43-year-old Caucasian woman appeared with painless progressively enlarging tumour of the anterior part of the left thigh of approximately 6 months’ duration. A differential imaging diagnosis of liposarcoma or large lipoma was made. An excisional biopsy was performed with complete removal of a large lobulated and encapsulated grossly ovoid mass. Frozen section diagnosis was unidentified lipomatous tumour with no evidence of malignancy. The final pathological diagnosis was lipoma-like hibernoma. The patients postoperative course was uneventful and discharged on the seventh postoperative day with full function of the involved leg. Hibernoma is benign tumour and it is not known to recur after complete local excision which is the treatment of choice.