Ectopic fingerlike structure in the thoracic region. Case report

Unilateral hyperplasia of the left posterior arch and associated vertebral schisis at C6 level

We report on a 5-year-old girl with unilateral hyperplasia of the left posterior arch of C6 associated with spina bifida occulta at the same level. Anteroposterior and lateral radiographs of the cervical spine showed hypertrophy of the left lamina as well as overgrowth and elongation of the left spinous process of the sixth cervical vertebra. Computed tomography (CT) examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch at the same level. Magnetic resonance (MR) imaging examination ruled out other spinal anomalies. The neck pain, the young age of the patient and the local aesthetic abnormality contributed to the surgical indication. To the best of our knowledge, this is the first case in the English literature of unilateral hyperplasia of a posterior cervical arch. Only one previous study has reported a similar congenital anomaly, but it was limited to the left side of the spinous process.

Teratoma in human tail lipoma

We report a case of a rare congenital teratoma that developed in a lipoma attached to a remnant human tail. A male newborn baby presented with a large, 3-cm mass with an open margin, which pedunculated from a tail attached to the midline skin of the coccygeal area. Magnetic resonance images demonstrated multiple sacral spinal bifida without cord tethering, and also showed neural roots and a lipoma and teratoma with peripheral homogeneous high density and internal low density on T(2)-weighted images. Intraoperatively, we found and dissected two nerve roots from the filum terminale which extended into the mass. Pathologic examination of the mass revealed abnormal differentiation of respiratory epithelium and squamous cell metaplasia along the open margin of the mass, and mainly lipoma in the rest of the mass. We suggest that this case could support the hypothesis of transient teratomatous cells in the pathogenesis of the spina bifida with lumbosacral lipoma.

A morphological study of ectopic plantar nail

Ectopic nails are rare. Four adult patients presented to us, affected by true ectopic nails of the foot, sole, and toes, occurring bilaterally in one case. Full documentation of these anomalies was collected. The aim of this study was to better describe the morphologic features of ectopic plantar nails by using, besides histologic evaluation, transmission and scanning electron microscopy. New morphologic criteria were identified to determine if ectopic plantar nail differed from normal and ectopic hand nails. Morphologically, ectopic plantar nails are smaller than normal ones, but still form cuticles, nail grooves and nail folds, and periungual wrinkles. Furthermore, they form with a flat angle between the nail matrix and proximal nail fold, and have a nail plate interrupted by several transverse nails grooves.

Ectopic plantar nail: a report of two cases

Ectopic nail is an extremely rare condition related to acquired or congenital anomalies. Almost 40 cases are reported in the literature, mostly in Japanese patients. In the majority of these patients, ectopic nails developed in the dorsal aspect of the fingers; they are associated in some cases with acquired or congenital growth anomalies or to polydactyly. Recently, we observed two male adult patients with true ectopic nails of the foot (sole and heel). Both patients were not affected by ectodermic dysplasia or foot malformations. The lesion relapsed after surgical excision in one case. Histology showed features of a well-developed and normal nail plate and matrix. A transmission electron microscope study was done in one case, showing typical aspects of onychocytes. The other nail was reproduced by a silicone replica technique and its superficial texture, shape and relationship with surrounding tissue were analysed by scanning electron microscopy.