Cases reported "Soft Tissue Neoplasms"

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1/17. Metastatic soft tissue squamous cell carcinoma.

    Metastatic squamous cell carcinoma of the soft tissue is extremely rare. We report two patients with soft tissue metastasis from squamous cell carcinoma of the cervix in one and scalp in another. Case 1: A 63-year-old black woman with a history of cervical cancer presented with a painful mass over the right scapula. An incisional biopsy revealed squamous cell carcinoma. She underwent radiation treatment followed by wide local excision with en bloc resection and a myocutaneous flap closure. Case 2: A 46-year-old white man with a history of squamous cell carcinoma of the scalp and two kidney transplantations requiring long-term immunosuppression presented with a 2-month history of a left proximal arm mass. magnetic resonance imaging revealed that the mass was within the triceps muscle and fixed to the humerus. biopsy revealed squamous cell carcinoma. He underwent a shoulder disarticulation for tumor invasion into the adjacent humerus and neurovascular bundles. The patients remain disease-free at 12 and 8 months, respectively. To our knowledge there are no reports of soft tissue squamous cell carcinoma metastatic from the cervix and only rare cases from the lung, head, and neck. The optimal mode of treatment and prognosis is undefined in these patients because of its rare incidence. Surgery and radiation with curative intent were used.
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2/17. Clear cell sarcoma with melanin pigment.

    A patient with a clear cell sarcoma of tendons and aponeuroses arising in the left sacral area is reported. The tumor grossly contained two black foci that had pigment with the staining characteristics of melanin on light microscopy. Electron microscopy of these areas showed the pigment to be within melanosomes. This is the second report of a neoplasm diagnosed as clear cell sarcoma in which melanin was demonstrated; the possibility that the tumor represents a soft tissue variant of malignant melanoma is discussed. It is suggested that clear cell sarcoma is a heterogeneous entity, and that a number of different soft tissue neoplasms may present with a clear cell pattern, making diagnosis and classification difficult.
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3/17. A non-healing ulcerated fingertip following injury.

    A man went to his primary care physician 3 months after slamming his right thumb in a car door. The nail had turned black and sloughed off several weeks later, leaving a red, draining wound on the tip of his thumb. The wound drained continuously for the next 2 months and showed little progress in healing. His physician started him on antibiotics, but the wound still showed no progress in healing over the next 6 weeks. Cultures were obtained that grew out staphylococcus and streptococcus spp. Another course of antibiotics was given, but the patient's condition failed to improve. At this point the patient was referred to a surgeon. He missed several appointments before finally presenting to the surgery clinic nearly 6 months after his original office visit. He was diagnosed clinically as having a giant pyogenic granuloma and was given antibiotics as well as silver nitrate sticks to cauterize the wound daily. After missing several more follow-up appointments, the patient returned with a spongy, weeping soft-tissue wound over the dorsum of his right thumb [that] doubled in size over the past 3 months. Radiographs obtained at that time were normal, but a bone scan revealed late uptake, cause for concern that this was osteomyelitis. What is the differential diagnosis, and what tests are necessary?
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4/17. Recurrent tumoral calcinosis.

    Tumoral calcinosis is a rare, benign disease that commonly affects the African blacks. We report on a 20-year-old Nigerian presenting with recurrent multiple subcutaneous masses around the scapular, elbow, hip and gluteal regions. The x-rays, fine needle aspiration cytology and tissue biopsy confirmed the diagnosis and the patient had a successful excision with good healing.
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5/17. granular cell tumor of the biliary tree. A report of two cases and a review of the literature.

    Granular cell tumors are relatively uncommon soft tissue tumors usually presenting in the skin and subcutaneous tissues or tongue, although many sites have been described. Two cases arising in the extrahepatic biliary tree are described, and the previously reported cases of this rare presentation are reviewed. These tumors may mimic sclerosing cholangitis and cholangiocarcinoma clinically, and occasionally histologically, in this relatively young group of patients. The histogenesis appears to be related to schwann cells as in granular cell tumors of other sites, evidenced by histologic, immunohistochemical, and electron microscopic findings. Granular cell tumors, albeit rare, should be considered in the differential diagnosis of biliary tract disease in young patients, particularly black women, and are curable by surgical excision.
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6/17. Well-differentiated extraskeletal osteosarcoma. A soft-tissue homologue of parosteal osteosarcoma.

    We describe a unique case of a low-grade extraskeletal osteosarcoma revealing both histologic and radiologic features reminiscent of parosteal osteosarcoma. The tumor, which had been present for 10 years, occurred in the left axilla of a 74-year-old black woman. To date, all the published cases of extraskeletal osteosarcoma have been high-grade neoplasms; to our knowledge, this is the first reported case of a low-grade extraskeletal osteosarcoma.
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7/17. Clear cell sarcoma of tendons and aponeuroses (malignant melanoma of soft parts): report of 2 cases.

    Clear cell sarcoma of tendons and aponeuroses (CCSTA, malignant melanoma of soft parts), first described by Enzinger in 1965, is a rare and slow-growing soft tissue tumor mainly affecting the extremities of young adults. The tumor is believed to be a tumor of melanocyte, although its histogenesis is not definitely established. Here we report 2 cases of CCSTA with typical clinical and pathological features. A tumor grew from the right ankle of a 32-year-old man (case 1) and from the left foot of an 18-year-old woman (case 2). The tumors were deep seated and intimately bound to tendons or aponeuroses without involvement of the overlying skin. Grossly, they were greyish white, variegated with brown or black patches. Histologically, the tumor cells were arranged in nests or fascicles and composed of fusiform or polygonal cells with clear cytoplasm. Ultrastructurally, they consisted of closely apposed cells with intracytoplasmic melanosomes. Case 1 was found to have distant metastases within 6 months and died 1 year later. Case 2 received postoperative radiotherapy and was free of recurrence or metastasis 14 months after operation. The treatment of CCSTA should include radical excision, radiotherapy, and chemotherapy. The prognosis is poor.
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8/17. Tumoral calcinosis. Case presentation and review.

    Tumoral calcinosis is a disease of unknown etiology with a greater prevalence among blacks, in which subcutaneous calcifications are found around the extensor surface of the hip, shoulder, hand and occasionally the knee. They must be differentiated from other more common causes of calcification.
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9/17. farber lipogranulomatosis: an unusual presentation in a black child.

    Farber disease, a rare, inherited condition of lipid metabolism usually appears within the first two months of life. The patients may die in the first few years of life or may live into the second decade. We believe this patient to be the first black American reported with Farber disease. Additionally, the characteristics of the disease in this patient were at variance with previously reported cases.
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10/17. A case report of malignant mesenchymoma with discussion of musculoskeletal tumor staging: the Enneking system.

    A 54-year-old black man presented with a soft-tissue sarcoma of the left anterior thigh. Surgical staging studies and initial biopsy results identified the lesion as a grade IIB pleomorphic liposarcoma. After radical hip disarticulation, follow up pathologic studies of the disarticulated limb showed the tumor to be confined to the anterior compartment of the left thigh without extracompartmental extension. The post-excisional surgical pathology report identified at least four different malignant mesenchymal elements: liposarcoma, myosarcoma, chondrosarcoma, and extraosseous osteogenic sarcoma. The sarcoma was therefore reclassified as a malignant mesenchymoma. The fact that the tumor was found to be intracompartmental at the time of surgery changed the staging of the tumor to stage IIA. A radical surgical margin, as recommended by Enneking, remained the treatment of choice. Three months postoperatively, the patient had chest pain and dyspnea. Chest films revealed multiple pulmonary nodules and the patient died of pneumonia 3 months later.
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