Angiodysplasia of the appendix: a diagnostic challenge and the importance of colonoscopy

The case report discusses the challenges in diagnosing gastrointestinal bleeding of unknown origin, with angiodysplasia (AD) of the appendix being a rare cause. The report presents a case of a man in his late 60s who presented with vomiting, diarrhoea and rectal bleeding. As a result of the bleeding, the patient developed a type II myocardial infarction (MI), which had to be simultaneously managed further complicating the diagnostic process. Despite a normal CT angiogram, ongoing bleeding led to suspicion of AD, which was diagnosed using colonoscopy with limited bowel preparation. The patient underwent an open appendicectomy and was found to have AD of the tip of the appendix as the cause of the bleeding. The case highlights the limitations of CT angiography in haemodynamically unstable patients and subsequent importance of colonoscopy with bowel preparation in diagnosing rare causes of bleeding, even with limited bowel preparation, and the potential life-threatening consequences of untreated AD.

Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics

Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.

Metastatic Basal Cell Carcinoma: A Rare Manifestation of a Common Disease

Introduction

Basal cell carcinoma (BCC) is considered the most common malignancy in Caucasians. It constituted about 80% of all nonmelanoma skin tumors and, despite its high prevalence, is an extremely rare occurrence of metastases, with incidence rates varying from 0.0028% to 0.55%.

Case Report

A 58-year-old male patient with BCC on the left nasolabial sulcus for 17 years, reporting 3 previous excisions, evolved with local recurrence. A new procedure was performed, and anatomopathological study confirmed sclerosing BCC. Seven months later, he presented with a mass in the left submandibular region. Combined positron-emission tomography and computed tomography (PET-CT) showed cervical hypercaptation in the left cervical level I and vertebral body of L5. Excision of the cervical lesion was performed with diagnosis of sclerosing BCC compromising the submandibular gland. Biopsy of the lumbar lesion was found to be compatible with bone metastasis.

Conclusion

BCC represents a very common entity, and the presence of metastasis, although infrequent, must be proposed because of the greater morbidity and mortality of this complication. This case shows the importance of early diagnosis and intervention in BCC as a way to avoid unfavorable outcomes.