The Role of the Obturator Nerve—Acute Nerve Grafting After Resection of a Plexiform Obturator Nerve Schwannoma

JBJS Case Connector · 2026-01-01

CASE: A 45 year-old woman presented with an obturator nerve schwannoma (ONS), which was originally suspected to be a gynecologic malignancy. After thorough workup, the mass and obturator nerve were resected en bloc, and sural nerve grafting was performed. The patient had minimal deficits with return to baseline activities by 7 weeks postoperatively. CONCLUSION: We guide the reader through the challenging diagnosis of ONS, which may mimic many other intrapelvic masses. The treatment decision of whether to acutely reconstruct the obturator nerve is also discussed, along with implications and functional importance of the nerve in gait and hip motion.

Combination topical 5-fluorouracil 5%/calcipotriene 0.005% cream for the treatment of cutaneous in situ squamous cell carcinoma: A pilot study

Journal of the American Academy of Dermatology · 2024-08-24 · 4 citations

Infectious Endocarditis Accompanied by Leukocytoclastic Vasculitis

Cureus · 2024-05-24 · 1 citations

Bacterial endocarditis is a rare infection that can present with variable clinical manifestations. Rarely, it can present as cutaneous vasculitis characterized by a purpuric rash mimicking immune-mediated vasculitis. There have been a few case reports of leukocytoclastic vasculitis (LCV) due to infectious endocarditis. It is important to recognize endocarditis as a potential cause of vasculitis because treatment with immunosuppressive agents can have devastating consequences. We report a case of a 53-year-old male with endocarditis who developed a palpable purpura of the bilateral lower extremities. A skin biopsy was performed, and histopathologic and immunofluorescence studies demonstrated LCV.

Pathologic Features of Primary Pancreatic Malignancies

Cancer treatment and research · 2024-01-01

Herpes simplex virus presenting as an oropharyngeal mass

Laryngoscope Investigative Otolaryngology · 2024-12-01

Abstract Objective(s) Present a clinically challenging case of an immunocompetent 74‐year‐old male who presented with marked dyspnea and hemoptysis. After the airway was secured, direct laryngoscopy revealed a large, fungating, hemorrhagic mass of the left lateral pharyngeal wall and surrounding structures. Methods Chart review of a single patient. This patient provided consent for his case materials and images to be used for educational purposes and publication. Results The clinical appearance of the mass was suspicious for an aggressive neoplasm. Initial biopsy of the mass was nonspecific, revealing necrosis and inflammation, but was negative for malignancy. Due to concern for bacterial supraglottitis, empiric treatment with antibiotics was initiated. Cultures were positive for Fusobacterium necrophorum . Repeat biopsy samples showed signs of underlying human simplex virus (HSV) infection, which was confirmed with polymerase chain reaction (PCR) testing. After addition of acyclovir, the patient began to improve clinically and was eventually decannulated. There was complete resolution of the mass at his 1‐month follow‐up. Conclusion HSV supraglottitis is a rare, rapidly progressive, and highly morbid condition. Lack of overt patient risk factors, frequently inconclusive biopsies, and clinical appearance mimicking other etiologies make diagnosis challenging. Superimposed bacterial infection is even less common and may contribute to increased disease severity and progression.

Paclitaxel-induced dorsal hand-foot syndrome

Dermatology Online Journal · 2023 · 4 citations

• Medicine
• Dermatology
• Surgery

Hand-foot syndrome (HFS), also known as palmoplantar erythrodysesthesia or acral erythema, is a known adverse effect of chemotherapeutic agents that most commonly presents as palmoplantar dysesthesia and erythematous plaques localized to the palms and soles. Paclitaxel is an uncommon cause of HFS and is notable for its unique presentation on the dorsal hands and feet. We present an unusual case of paclitaxel-induced HFS localized to the dorsal hands of a 66-year-old man with metastatic angiosarcoma. Early identification and management of HFS is critical to allow for continuation of chemotherapy while improving patient quality of life.

S2747 A Rare Case of Infectious Esophagitis

The American Journal of Gastroenterology · 2023-10-01

Introduction: The case presented here highlights an unusual instance of bacterial esophagitis in an immunocompromised patient. Case Description/Methods: A 67-year-old man with a history of severe peripheral arterial disease and BCR-ABL positive chronic myeloid leukemia on Nilotinib presented to the hospital with a hemoglobin of 6.3 g/dL. Of note, he recently underwent a bilateral iliofemoral thrombendarteriectomy with stent placement for critical limb ischemia and was subsequently placed on apixaban. Since this procedure, he reports intermittent melena for a month. An esophagogastroduodenoscopy revealed an esophageal ulcer at 30 cm with a deep, cratered base and heaped-up borders in an irregular shape 15 mm in diameter (Figure 1). Biopsies were obtained of the ulcer margin to rule out malignancy. Histologic analysis revealed ulcerated squamous mucosa with abundant fragments of bacterial cocci within all layers of the esophageal mucosa. Fungal organisms were not identified on periodic acid schiff-d (PAS-D) staining. He was treated with amoxicillin-clavulanate for 14 days with plans for endoscopic surveillance in 8 weeks. Discussion: Infectious esophagitis is a condition caused by various pathogens including bacterial, viral, or fungal agents. The majority of patients are immunocompromised due to an underlying condition like human immunodeficiency virus or medications that cause granulocytopenia or lymphopenia. Candida is the most common pathogen of infectious esophagitis, followed by herpes virus or cytomegalovirus. Bacterial esophagitis is rare, composing 11%-16% of infectious esophagitis. Patients present with symptoms of dysphagia and odynophagia, and rarely with ulceration and bleeding. Prompt diagnosis and appropriate antimicrobial therapy are crucial for preventing potential complications such as ulceration, bleeding, or progression to systemic infection. In conclusion, bacterial esophagitis is a rare but important consideration in immunocompromised patients with infectious esophagitis.Figure 1.: Mid-esophageal ulcer and esophagitis.

S2241 Solitary Penile Lesion: A Peculiar Presentation of Colorectal Cancer Recurrence and Metastasis

The American Journal of Gastroenterology · 2022-10-01

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States and 50% of CRC patients will develop metastases in the course of disease. Presented is a case of a 60-year-old male with a past medical history significant for psoriasis and colorectal cancer (Stage C T4bN1M0) treated by chemoradiation with complete response. A year later, the patient presented with painful red lesion on the penis clinically initially thought to be fungal balanitis, treated with various interventions ranging from antibiotics and antifungals without improvement. Biopsy of the lesion demonstrated metastatic colorectal adenocarcinoma filling the corpora. The patient went under partial penectomy and was advised to follow with chemoradiation. This case showcases an atypical presentation of metastatic colorectal cancer, and stands as a reminder to the possibility of metastasis to highly vascular areas, which are not restricted only the liver, but which also include the skin, particularly the scalp, and in this unusual presentation, the penis. Case Description/Methods: A 60-year-old male with past medical history of psoriasis and rectal cancer successfully responsive to chemoradiation presented to with a painful red lesion on the glans penis. He denied any bleeding, discharge, dysuria or difficulty urinating. He admitted to throbbing pain at the area. He had no new sexual partners. Initially thought to be fungal balanitis. He was treated with various interventions ranging from antibiotics and antifungals without improvement. Given the progression of the penile lesion, he was referred to urology. On clinical exam, lesion showed advancement from initial presentation. A 6cm erythematous, raised mass in prepuce involving glans penis with a 2cm indurated base was found. Biopsy of the lesion demonstrated metastatic colorectal adenocarcinoma filling the corpora. The patient went under partial penectomy and was advised to follow with chemoradiation (Figure). Discussion: Although there is a high propensity of colorectal cancer to metastasize to the liver, it is essential to keep in mind other vascular entities that may also be affected. This may include skin with a higher tendency to the scalp or as in this atypical presentation to the penis. However, given the past medical history of rectal carcinoma in this patient, it is reasonable to conclude that the lesion can be cancerous in nature and it should not deter one from making the diagnosis of metastatic rectal cancer in other highly vascular regions.Figure 1.: Low-power magnification of H&E sections of the penile sample shows the vascular corporal regions of the penis which are expanded by atypical glandular structures. Higher power (Top right inset) shows these glandular regions to be malignant with hyperchromasia, and cribriform growth with typical “dirty necrosis” of colorectal adenocarcinoma.

Painful, bleeding fingertip papule

JAAD Case Reports · 2022-01-21

A 66-year-old man presented with a 3-month history of a painful and bleeding fingertip papule that had temporarily improved after silver nitrate application. Pertinent history included stage IV clear cell renal cell carcinoma (ccRCC) treated with radical nephrectomy and adjuvant ipilimumab/nivolumab. Recent imaging confirmed continued regression of metastases, and the patient was clinically doing well. Examination demonstrated a violaceous and hyperkeratotic papule (Fig 1). Biopsy revealed a dermally based, lobulated, eosinophilic epithelioid cell population with extravasated red blood cells (Fig 2). Immunohistochemistry was negative for CD31, CK7, and CK20 and positive for AE1/AE3, AMACR, PAX8, and CD10 within the epithelioid cell population.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT) Question 1: What is the most likely diagnosis?A.PoromaB.Squamous cell carcinomaC.WartD.Pyogenic granulomaE.ccRCC metastasis Answers:A.Poroma – Incorrect. Poromas can have a strikingly similar presentation clinically. However, histologically, they are different in appearance, being composed of sheets and nodules of cuboidal epithelial cells with scattered small clear spaces representing duct formation. In addition, vascular proliferation is not often observed.B.Squamous cell carcinoma – Incorrect. Squamous cell carcinomas can and do occur on the digits and can have a similar clinical appearance. However, histopathologically, they are composed of atypical keratinocytes, which invade into the dermis, often with desmoplastic tumor response.C.Wart – Incorrect. Clinically, warts appear as hyperkeratotic papules with small, thrombosed capillaries and could resemble this patient’s lesion. However, histologically, warts are characterized by acanthosis, hypergranulosis, and hyperkeratosis of the epidermis, and koilocytosis of keratinocytes can be observed in the upper granular layer.D.Pyogenic granuloma – Incorrect. Pyogenic granulomas are typically located on the head/neck and oral mucosa, with a predilection for children and pregnant patients. Although they can also occur on the hands, they are histologically very different in appearance on high-power evaluation. Histologically, lobules of capillaries would be seen in a pyogenic granuloma; cytologically, atypical epithelioid cells would not be present. In addition, pyogenic granulomas have a vastly different immunoprofile from that of metastatic renal cell carcinoma (RCC).E.ccRCC metastasis – Correct. This question requires the interpretation of both the clinical history and histologic description. The suspicion for cutaneous RCC is often low, and biopsy is usually performed to rule out another vascular entity, including the following benign lesions: pyogenic granuloma, poroma, and glomus tumors. Typically, ccRCC will contain diffuse cells with clear cytoplasm arranged in a trabecular pattern with prominent vasculature compared with the eosinophilic and papillary arranged cells of papillary renal cell carcinoma (pRCC). However, it is not uncommon for metastatic lesions of ccRCC to show a variety of histologic features, including cells with eosinophilic cytoplasm.1Lee C. Park J.W. Suh J.H. Nam K.H. Moon K.C. Histologic variations and immunohistochemical features of metastatic clear cell renal cell carcinoma.Korean J Pathol. 2013; 47: 426-432https://doi.org/10.4132/KoreanJPathol.2013.47.5.426Crossref PubMed Scopus (16) Google Scholar Question 2: Which of the following would be the expected immunohistochemical staining of ccRCC?A.AE1/AE3+, AMACR+, CK7+, PAX8+B.CD10+, AMACR−, CK7−, PAX8+C.AMACR−, CK7+, CD10−, PAX8+D.AE1/AE3−, AMACR−, CK7+, PAX8−E.Vimentin-negative, AE1/AE3+, CK7+, PAX8− Answers:A.AE1/AE3+, AMACR+, CK7+, PAX8+ – Incorrect. This immunohistochemical profile is typical of pRCC. Although both pRCC and ccRCC are positive for AE1/AE3 and PAX8, the presence of CK7 and AMACR supports papillary type over clear cell type.2Alshenawy H.A. Immunohistochemical panel for differentiating renal cell carcinoma with clear and papillary features.J Microsc Ultrastruct. 2015; 3: 68-74https://doi.org/10.1016/j.jmau.2015.01.003Crossref PubMed Google ScholarB.CD10+, AMACR−, CK7−, PAX8+ – Correct. The absence of AMACR and CK7 support clear cell origin.2Alshenawy H.A. Immunohistochemical panel for differentiating renal cell carcinoma with clear and papillary features.J Microsc Ultrastruct. 2015; 3: 68-74https://doi.org/10.1016/j.jmau.2015.01.003Crossref PubMed Google Scholar,3Choate E.A. Nobori A. Worswick S. Cutaneous metastasis of internal tumors.Dermatol Clin. 2019; 37: 545-554https://doi.org/10.1016/j.det.2019.05.012Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The presence of CD10 is indicative of pRCC or ccRCC origin.2Alshenawy H.A. Immunohistochemical panel for differentiating renal cell carcinoma with clear and papillary features.J Microsc Ultrastruct. 2015; 3: 68-74https://doi.org/10.1016/j.jmau.2015.01.003Crossref PubMed Google ScholarC.AMACR−, CK7+, CD10−, PAX8+ – Incorrect. This immunohistochemical profile is most consistent with clear cell papillary RCC, given the absence of CD10 and AMACR and presence of CK7.2Alshenawy H.A. Immunohistochemical panel for differentiating renal cell carcinoma with clear and papillary features.J Microsc Ultrastruct. 2015; 3: 68-74https://doi.org/10.1016/j.jmau.2015.01.003Crossref PubMed Google ScholarD.AE1/AE3−, AMACR−, CK7+, PAX8− – Incorrect. The presence of CK7 is not consistent with ccRCC.E.Vimentin-negative, AE1/AE3+, CK7+, PAX8− – Incorrect. Both pRCC and ccRCC are of epithelial lineage and thus are classically positive for AE1/AE3.2Alshenawy H.A. Immunohistochemical panel for differentiating renal cell carcinoma with clear and papillary features.J Microsc Ultrastruct. 2015; 3: 68-74https://doi.org/10.1016/j.jmau.2015.01.003Crossref PubMed Google Scholar Although not performed in this case, it should be noted that staining with vimentin (a stain commonly believed as mesenchymal and historically used for sarcoma) is positive in ccRCC. Renal tumors that are associated with BAP1 mutation will also show constituent loss of BAP1 staining by immunohistochemistry. Question 3: Which is the most commonly reported site of cutaneous ccRCC metastasis?A.BackB.ChestC.ExtremityD.FaceE.Scalp Answers:A.Back – Incorrect. The back is a less common site for cutaneous metastasis of RCC.3Choate E.A. Nobori A. Worswick S. Cutaneous metastasis of internal tumors.Dermatol Clin. 2019; 37: 545-554https://doi.org/10.1016/j.det.2019.05.012Abstract Full Text Full Text PDF PubMed Scopus (15) Google ScholarB.Chest – Incorrect. The head and chest are the 2 most frequent sites of RCC metastasis, with the former being more common than the latter.3Choate E.A. Nobori A. Worswick S. Cutaneous metastasis of internal tumors.Dermatol Clin. 2019; 37: 545-554https://doi.org/10.1016/j.det.2019.05.012Abstract Full Text Full Text PDF PubMed Scopus (15) Google ScholarC.Extremity – Incorrect. Metastasis affecting the hand is reported to occur in 0.1% of RCC cases.4Kamala L.H. Ranjith S. Benson R. Cutaneous acral metastasis from renal cell carcinoma—a case report.Indian J Surg Oncol. 2019; : 1-3https://doi.org/10.1007/s13193-019-00961-2Crossref Scopus (1) Google Scholar The majority of acrometastases from RCC involve the bone.4Kamala L.H. Ranjith S. Benson R. Cutaneous acral metastasis from renal cell carcinoma—a case report.Indian J Surg Oncol. 2019; : 1-3https://doi.org/10.1007/s13193-019-00961-2Crossref Scopus (1) Google Scholar Cutaneous metastasis to the finger with no bone involvement (as seen in our case) is extremely rare. We found only 2 case reports describing cutaneous RCC metastasis to the finger without bone involvement.4Kamala L.H. Ranjith S. Benson R. Cutaneous acral metastasis from renal cell carcinoma—a case report.Indian J Surg Oncol. 2019; : 1-3https://doi.org/10.1007/s13193-019-00961-2Crossref Scopus (1) Google Scholar,5Bibi C. Benmeir P. Maor E. Sagi A. Hand metastasis from renal cell carcinoma with no bone involvement.Ann Plast Surg. 1993; 31: 377-378https://doi.org/10.1097/00000637-199310000-00017Crossref PubMed Scopus (18) Google ScholarD.Face – Incorrect. The head, in general, is the most common site of cutaneous metastasis of RCC; however, the scalp specifically is a more common site than the face.3Choate E.A. Nobori A. Worswick S. Cutaneous metastasis of internal tumors.Dermatol Clin. 2019; 37: 545-554https://doi.org/10.1016/j.det.2019.05.012Abstract Full Text Full Text PDF PubMed Scopus (15) Google ScholarE.Scalp – Correct.3Choate E.A. Nobori A. Worswick S. Cutaneous metastasis of internal tumors.Dermatol Clin. 2019; 37: 545-554https://doi.org/10.1016/j.det.2019.05.012Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The classic presentation of cutaneous RCC metastasis is a single nodule with blue, purple, or black-brown pigmentation affecting the scalp; however, the presentation can be variable, with even multiple nodules or plaques being observed.3Choate E.A. Nobori A. Worswick S. Cutaneous metastasis of internal tumors.Dermatol Clin. 2019; 37: 545-554https://doi.org/10.1016/j.det.2019.05.012Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar It is estimated that only 1.3% to 3% of RCCs will have a cutaneous metastasis.4Kamala L.H. Ranjith S. Benson R. Cutaneous acral metastasis from renal cell carcinoma—a case report.Indian J Surg Oncol. 2019; : 1-3https://doi.org/10.1007/s13193-019-00961-2Crossref Scopus (1) Google Scholar RCCs develop unpredictable metastases due to their propensity to be angioinvasive, and this vascular prominence underlies the theory that the majority of ccRCCs present on the scalp. None disclosed.

Erythema, Blisters, and Scars on the Elbows, Knees, and Legs

Cutis · 2021-01-01

A 69-year-old man presented with an asymptomatic rash on the extensor surfaces of 2 years' duration. He reported recurrent blisters that would then scar over. The lesions did not occur in relation to any known trauma.